STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma

摘要

Background Suboptimal adherence to inhaled steroidsudis common in children with asthma and is associatedudwith poor disease control, reduced quality of life andudeven death. Previous studies using feedback ofudelectronically monitored adherence data haveuddemonstrated improved adherence, but have notuddemonstrated a significant impact on clinical outcomes.udThe aim of this study was to determine whetherudintroduction of this approach into routine practice wouldudresult in improved clinical outcomes.udMethods Children with asthma aged 6–16 years wereudrandomised to the active intervention consisting ofudelectronic adherence monitoring with daily reminderudalarms together with feedback in the clinic regardingudtheir inhaled corticosteroid (ICS) use or to the usual careudarm with adherence monitoring alone. All children hadudpoorly controlled asthma at baseline, taking ICS andudlong-acting β-agonists. Subjects were seen in routineudclinics every 3 months for 1 year. The primary outcomeudwas the Asthma Control Questionnaire (ACQ) score.udSecondary outcomes included adherence and markers ofudasthma morbidity.udResults 77 of 90 children completed the studyud(39 interventions, 38 controls). Adherence in theudintervention group was 70% vs 49% in the controludgroup (p≤0.001). There was no significant difference inudthe change in ACQ, but children in the interventionudgroup required significantly fewer courses of oraludsteroids (p=0.008) and fewer hospital admissionsud(p≤0.001).udConclusions The results indicate that electronicudadherence monitoring with feedback is likely to be ofudsignificant benefit in the routine management of poorlyudcontrolled asthmatic subjects.