Background

Asthma is a common chronic condition amongst children. Poor adherence to asthma medications can increase asthma exacerbations, absence from school, healthcare utilisation and costs and decrease quality of life. Emerging evidence suggests the use of electronic adherence monitoring devices in improving children's adherence to medications.

Objectives

This study aimed to evaluate the effectiveness of electronic adherence monitoring devices in improving inhaler adherence amongst children with asthma.

Design

This study is a systematic review and meta-analysis.

Data sources

A systematic search using Cochrane Library, PubMed, Embase, CINAHL, Web of Science, Scopus and ProQuest Dissertations and Theses from inception up to April 6, 2021, was conducted.

Review methods

Randomised controlled trials evaluating the use of electronic adherence monitoring devices amongst children and published in English were included. The outcomes were inhaler adherence, asthma exacerbation, lung function, asthma control and accessibility. The overall effect was measured using Hedges’ g and determined using Z-statistics at a significance level of p < 0.05. Heterogeneity was assessed using χ² and I² statistics. The individual and overall quality of evidence was assessed. Sensitivity and subgroup analyses were conducted. Narrative synthesis of outcomes was performed when meta-analysis could not be conducted on the data.

Results

A total of 13,429 records were identified, and 10 randomised controlled trials in 11 articles amongst 1,123 participants were included in the meta-analysis. Meta-analysis revealed that the electronic adherence monitoring device group was 1.50 times more likely to adhere to inhalers compared with the control group with medium-to-large effect size (g = 0.64). A series of subgroup analyses showed that no significant subgroup differences for inhaler adherence were found amongst different populations, comparator, setting, duration of the monitoring period, reminder, and feedback functions of the electronic adherence monitoring devices. Children found the devices as user friendly with high accessibility scores. However, no significant differences were observed between the intervention and control groups for asthma exacerbations, lung function and asthma control.

Conclusions

The findings from this study suggested that electronic adherence monitoring devices could improve inhaler adherence. Future devices should contain actuation and inhalation functions that can help to confirm actual inhalation amongst children with asthma. The overall evidence of outcomes ranged from very low to high. Furthermore, future large-scale trials were recommended before clinical implementations.

中文翻译：

---

哮喘儿童的电子依从性监测设备：随机对照试验的系统评价和荟萃分析

背景

哮喘是儿童常见的慢性病。哮喘药物依从性差会增加哮喘发作、缺勤、医疗保健利用率和成本，并降低生活质量。新出现的证据表明使用电子依从性监测设备来提高儿童对药物的依从性。

目标

本研究旨在评估电子依从性监测设备在改善哮喘儿童吸入器依从性方面的有效性。

设计

本研究是一项系统评价和荟萃分析。

数据源

使用 Cochrane Library、PubMed、Embase、CINAHL、Web of Science、Scopus 和 ProQuest Dissertations and Thess 从开始到 2021 年 4 月 6 日进行了系统搜索。

复习方法

包括评估儿童使用电子依从性监测设备并以英文发表的随机对照试验。结果是吸入器依从性、哮喘恶化、肺功能、哮喘控制和可及性。使用 Hedges' g测量总体效果，并使用 Z 统计量在p < 0.05的显着性水平下确定。异质性评估使用χ ²和I²统计。评估了证据的个体和整体质量。进行了敏感性和亚组分析。当无法对数据进行荟萃分析时，对结果进行叙述性综合。

结果

共确定了 13,429 条记录，荟萃分析纳入了 1,123 名参与者的 11 篇文章中的 10 项随机对照试验。Meta 分析显示，电子依从性监测装置组坚持吸入器的可能性是对照组的 1.50 倍，具有中到大的效应量（g = 0.64）。一系列亚组分析表明，在电子依从性监测设备的不同人群、比较器、设置、监测期持续时间、提醒和反馈功能之间，没有发现吸入器依从性的显着亚组差异。孩子们发现这些设备用户友好，可访问性得分很高。然而，在哮喘发作、肺功能和哮喘控制方面，干预组和对照组之间没有观察到显着差异。

结论

这项研究的结果表明，电子依从性监测设备可以提高吸入器的依从性。未来的设备应包含驱动和吸入功能，有助于确认哮喘儿童的实际吸入情况。结果的总体证据范围从非常低到高。此外，建议在临床实施之前进行未来的大规模试验。