Digital tools improve treatment adherence and among severe asthmatics: The Lancet

The study has addressed the importance of digital data.

There needs to be more data regarding the clinical value of digital tools usage in assessing adherence and lung function in uncontrolled asthma. To evaluate this further, researchers compared treatment decisions guided by digitally acquired data.

The data was related to adherence, inhaler technique, and peak flow with existing methods.

This was a 32-week RCT conducted in ten severe asthma clinics.

( Ireland, Northern Ireland, and England).

The study could be summarised as follows:

• Researchers included participants with a history of uncontrolled asthma of 18 years or older.
• The asthma control test (ACT) score was 19 or less, despite treatment with inhaled corticosteroids in high dose.
• The participants had at least one severe exacerbation in the past year.
• There were two active and control groups, with 108 and 105 participants, respectively.
• Participants in the control group were masked to their adherence and errors in inhaler technique data.
• After a 1-week run-in period, both active and control groups attended three nurse-led education visits and three physician-led treatment adjustment visits over eight weeks (day 7, week 4, week 8) and weeks 8, 20, and 32, respectively.
• In the active group, treatment adjustments were informed by digital data. For the control group, it was made by pharmacy refill rates, ACT questionnaire, exacerbations history and visual management of inhaler technique.
• Digitally enabled Inhaler Compliance Assessment (INCA) and PEF were used in both groups.
• The primary outcomes were asthma medication burden (end of 32 weeks) and adherence rate measured (12 weeks) by the area under the curve in the intention-to-treat population.
• One hundred-two in the active group and 98 in the control group completed the study.
• At week 32, 14 active and 31 control patients experienced net increase in treatment compared to baseline with an odds ratio of 0·31.
• Eleven active and 21 controls required add-on biological therapy adjusted for study site, age, sex, and baseline FeNO.
• 3/19 active and 11/25 control patients increased their medication from fluticasone propionate (500 μg daily to 1000 μg daily) with adjusted OR 0·23.
• 26/83 active and 13/73 controls reduced their medication from fluticasone propionate 1000 μg once daily to 500 μg once daily with adjusted OR 2·43.
• Week 20–32 actual mean adherence was 64·9% and 55.5 % in the active and control group, respectively.
• 29 serious adverse events were recorded (respiratory) and not linked to the study intervention, inhalers, digital PEF or INCA usage.

The researchers finally interpreted that Evidence-based care informed by digital data causes modest improvement in medication adherence. It also reduces the treatment burden significantly.

As acknowledged, the study was funded by the Health Research Board of Ireland, INTEREG Europe, and project grant from GlaxoSmithKline.

Further reading:

Use of digital measurement of medication adherence and lung function to guide the management of uncontrolled asthma (INCA Sun): a multicentre, single-blinded, randomised clinical trial. March 21, 2023DOI:https://doi.org/10.1016/S2213-2600(22)00534-3