Asthma diagnosis and treatment
An audiovisual reminder function improves adherence with inhaled corticosteroid therapy in asthma

https://doi.org/10.1016/j.jaci.2006.11.700Get rights and content

Background

Adherence to medication regimens is poor in the management of chronic diseases, including asthma.

Objective

To determine whether an audiovisual reminder device improves adherence with inhaled corticosteroid (ICS) therapy in adult asthma.

Methods

A randomized open-label parallel group study of 110 adult or adolescent subjects with asthma was undertaken. Subjects were randomized to receive 24 weeks of fluticasone propionate 250 μg, 1 actuation twice daily via a metered dose inhaler (MDI) with or without an audiovisual reminder function (AVRF). All MDIs had electronic covert adherence monitors. The primary outcome variable was adherence, defined as the proportion of medication taken as prescribed over the final 12 weeks of the study. Adherence was also assessed as the proportion of subjects who took >50%, >80%, or >90% of prescribed medication.

Results

The proportion of medication taken in the last 12 weeks was greater in the AVRF group (93%) compared with the control group (74%), with a difference of 18% (95% confidence interval [CI] 10-26%; P < .0001). The proportion of subjects taking >50%, >80%, or >90% of their medication was greater in the AVRF group, with a ratio of proportions adherent of 1.33 (95% CI, 1.10-1.61; P = .003), 2.27 (95% CI, 1.56-3.3; P < .0001), and 3.25 (95% CI, 1.74-6.1%; P < .0001), respectively.

Conclusion

An audiovisual reminder function can significantly improve adherence with ICS therapy in adult asthma.

Clinical implications

An audiovisual reminder function has potential to improve adherence with medication regimens across a wide spectrum of diseases, in both research and clinical practice.

Section snippets

Subjects

Adolescent and adult subjects aged 12 to 65 years with a diagnosis of asthma were enrolled in this study (Fig 1). Subjects were recruited from research volunteer databases, newspaper advertisements, and informal contacts. Inclusion criteria were the requirement to take regular ICS at a fixed dose, no exacerbation in the previous month or run-in period, not pregnant or lactating, and if of child-bearing potential, using contraception. Exclusion criteria were a diagnosis of chronic obstructive

Results

There were 110 subjects with asthma (50 men) randomized in the study. These subjects were aged between 13 and 65 years and on entry were taking a median (range) daily dose of BDP or equivalent of 500 μg (100-4000 μg per day). There were no differences in baseline characteristics between the 2 groups (Table I). By the completion of the study, 11 and 9 subjects in the AVRF and control groups, respectively, did not provide data in the final 12-week period of the study (Fig 1).

Discussion

This study has demonstrated that an AVRF can significantly improve adherence with ICS therapy in adult asthma. The absolute difference in adherence was large, at around 18%, and the proportion of subjects who achieved more than 80% and 90% adherence was between 2- and 3-fold higher in the subjects who had the AVRF.

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    Supported by a research grant from GlaxoSmithKline, UK.

    Disclosure of potential conflict of interest: R. Beasley has served as a medical advisor for Nexus6 Ltd. The rest of the authors have declared that they have no conflict of interest.

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