Background Youth with asthma commonly have suboptimal adherence to inhaled corticosteroids (ICS). It is critical to systematically evaluate the effectiveness of ICS adherence promotion interventions and discern which techniques are most effective. Objective This study aims to (1) quantify the extent to which interventions improve ICS adherence in pediatric asthma, (2) explore differences in effect size estimates based on intervention and study characteristics, and (3) characterize the risk of bias across interventions. Methods We conducted literature searches across five databases. Included studies quantitatively measured ICS adherence as an intervention outcome among youth (<18 years old) diagnosed with asthma and were published after 1997. We analyzed aggregate effect sizes and moderator variables using random-effects models and characterized risk of bias using the Cochrane Collaboration tool. Results Thirty-three unique studies met inclusion criteria. At post-intervention, the aggregate effect size for pediatric ICS adherence promotion interventions was small but significant (n = 33, g = 0.39, 95% confidence interval [CI] = 0.24–0.54); however, the aggregate effect size at follow-up was not statistically significant (n = 6, g = 0.38, 95% CI = −0.08 to 0.83). Method of adherence measurement and intervention format were significant moderators. Most interventions had a high risk of performance bias and an unclear risk of bias in one or more domains. Conclusions ICS adherence promotion interventions are effective among youth with asthma. Additional longitudinal research is needed to quantify a more precise measure of intervention effectiveness over time, and moderators of intervention effectiveness should be reassessed as the literature base expands.

中文翻译：

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小儿哮喘依从性促进干预措施的荟萃分析


背景 患有哮喘的青少年通常对吸入皮质类固醇 (ICS) 的依从性不佳。系统地评估 ICS 依从性促进干预措施的有效性并辨别哪些技术最有效至关重要。目的 本研究旨在 (1) 量化干预措施改善儿童哮喘 ICS 依从性的程度，(2) 探讨基于干预措施和研究特征的效应大小估计的差异，以及 (3) 描述干预措施之间的偏倚风险。方法 我们在五个数据库中进行了文献检索。纳入的研究定量测量了 ICS 依从性，作为诊断为哮喘的青少年（<18 岁）的干预结果，并于 1997 年之后发表。我们使用随机效应模型分析了总效应大小和调节变量，并使用 Cochrane 协作工具描述了偏倚风险。结果 33 项独特的研究符合纳入标准。干预后，儿科 ICS 依从性促进干预措施的总效应虽小但显着（n = 33，g = 0.39，95% 置信区间 [CI] = 0.24–0.54）；然而，随访时的总效应大小并不具有统计学意义（n = 6，g = 0.38，95% CI = -0.08 至 0.83）。依从性测量方法和干预形式是重要的调节因素。大多数干预措施都存在很高的绩效偏差风险，并且在一个或多个领域存在不明确的偏差风险。结论 ICS 依从性促进干预措施对青少年哮喘患者有效。需要进行额外的纵向研究来量化随着时间的推移更精确地衡量干预有效性的指标，并且随着文献基础的扩大，应该重新评估干预有效性的调节因素。