Asthma Treatment Adherence Patterns Determined by Electronic Medication Monitors

The use of electronic medication monitors (EMMs) for establishing treatment adherence patterns in patients with asthma has shown promise, enabling real-time, objective, and passive collection of data regarding medication use.

A study was conducted in patients aged ≥4 years with self-reported asthma. The participants enrolled in a digital health platform in which they used EMM-compatible controller medications from August 2012 through February 2018. Results of the analysis were published in Respiratory Medicine.

Recognizing that nonadherence to treatment regimens in individuals with asthma has been well described, investigators sought to evaluate temporal patterns of medication use in patients with asthma. All of the participants who were enrolled in the study needed to have ≥20 weeks of controller medication monitoring, which included the first week of trial enrollment (the training week). All of the patients received EMMs for their inhaled controllers (eg, dry powder and metered dose inhalers) and short-acting β-agonist (SABA) medications.

A total of 1745 individuals (median age, 24) were included in the study. Overall, 58% of the patients were prescribed inhaled corticosteroids (ICS) only, 36% received ICS/long-acting β-agonists only, and 7% were treated with other combinations of controller medications. In 83% of the patients, EMMs were used for SABA inhalers. The mean patient adherence rate during weeks 2 to 6 (baseline) was 48%, whereas the mean patient adherence rate over the entire study period (weeks 2 to 20) was 38%.

At baseline, optimal, moderate, suboptimal, and poor adherence was reported in 20%, 28%, 25%, and 27% of the participants, respectively. During the course of the 20-week study period, all 4 adherence groups experienced a decline in adherence rates, with the largest absolute decreases in baseline (week 2 vs week 6) reported in participants with moderate treatment adherence. Lower relative decreases in overall adherence rates (week 2 vs week 20), however, were reported in the optimal adherence group (-28%) compared with the moderate, suboptimal, and poor adherence groups (-46%, -58%, and -50%, respectively).

Additionally, patients in the optimal adherence groups were on average 4.6 years older than patients in the lower adherence groups (95% CI, 2.6-6.5; P <.01). Furthermore, the poor adherence group had an 8.1% (95% CI, 2.9%-13.3%; P <.01) higher percentage of patients prescribed ICS only compared with patients in the other adherence groups (63.7% vs 55.6%). During the 20-week study period, the mean weekly use of rescue medication was the lowest in participants with poor adherence.

The investigators concluded that once certain patterns demonstrating greater declines in adherence have been identified in patients with asthma, a more detailed assessment of disease control can be determined, thus helping to guide the development of improved interventions.

Disclosure: This study was supported by Propeller Health. Please see the original reference for a full list of authors’ disclosures.

Reference

De Keyser HEH, Kaye L, Anderson WC, et al. Electronic medication monitors help determine adherence subgroups in asthma Respir Med. 2020;164:105914.