Improving adherence and asthma outcomes in school aged children with asthma

Abstract

.Asthma is one of the most common chronic conditions in children. Effective treatments are available, the most important of which are inhaled corticosteroids, which reduce morbidity and mortality. Despite the availability of effective preventive therapies, asthma control continues to be poor, primarily due to poor adherence. Interventions have been developed to improve adherence; however, changes have been modest, or not sustained. Where there have been significant increases in adherence, these have not translated to improvements in outcomes. A novel approach to adherence support is needed. Electronic monitoring devices (EMDs) have risen to prominence over the last decade, assuming an important role in adherence measurement and intervention. The ability of EMDs to provide objective, real-time data and user feedback places EMDs at the forefront of contemporary adherence interventions. This thesis discusses adherence in chronic disease, specifically asthma, and the role of EMDs in adherence promotion. Studies using EMDs to improve adherence in asthma have shown improvements in adherence, but the link to outcomes has been inconclusive. This thesis presents the main findings from a randomised controlled trial (RCT) investigating the use of an EMD in children with asthma. The results from this trial provide the first unequivocal evidence of the beneficial effects of EMDs on clinical outcomes. It provides a direction for future adherence research, focusing on the effect of EMDs on clinical outcomes, beyond adherence promotion. This thesis also presents the first performance and patient acceptability data for EMDs in children. The positive findings highlight the potential for EMDs to be used outside of the research setting, though key issues of quality control, usability and cost-effectiveness need to be addressed before EMDs can be integrated into practice. Other factors influencing adherence are also discussed. This study found associations between higher adherence and female sex, Asian ethnicity, smaller household size and a younger age at diagnosis. These findings can help identify those at risk of nonadherence to help target adherence interventions. This thesis highlights areas of knowledge growth and areas where questions remain unanswered. It provides a platform for future research, presenting new possibilities for improving medication adherence and clinical outcomes.