Feasibility of video observed therapy to support controller inhaler use among children in West Baltimore

Abstract

Objective

To assess feasibility of a novel video directly observed therapy (DOT)-based digital asthma program intended to support correct inhaled corticosteroid (ICS) use among children.

Methods

We conducted a 60-day pilot study among patients 2–18 years attending a primary care clinic with prescribed ICS and sub-optimally controlled asthma (recent hospitalization, ICS nonadherence, frequent rescue inhaler use, therapy escalation, or Asthma Control Test <20). Participants used a mobile application to receive reminders, submit videos of ICS doses (video DOT), and receive asynchronous feedback on adherence and inhaler technique. We assessed enrollment, engagement, program metrics, and user experience; adherence and inhaler errors were secondary outcomes.

Results

Of 26 eligible patients, 21 (81%) enrolled and submitted ≥1 video; median age was 11 years (8–15), 71% were male, 90% had Medicaid, and 62% experienced ≥1 exacerbation in the previous 6 months. Retention was 57% and 52% at week 5 and 8, respectively. Participants submitted 810 videos. Missed doses, inhaler errors (n = 247) and adherence issues (n = 107) prompted 543 communications; inadequate inspiration or holding breath were most common. Among 16 patients with engagement >7 days and >4 videos, median inhaler error rate (proportion of videos with ≥1 error) decreased from week 1 to week 2 (73% vs 8%, p ≤ 0.05) with median adherence >80%. Participants experienced the program as long, but easy to use; benefits included building routines, skill, and independence.

Conclusions

This pilot study suggests high program acceptability among our cohort. High engagement with improved inhaler technique over the first 14 days suggests shorter implementation.

Supplemental data for this article is available online at at

Keywords:

• Video directly observed therapy
• adherence
• inhaler errors
• asthma
• inhaler technique
• mobile application

Acknowledgements

The authors would like to acknowledge Margaret Broderick, LifeBridge Health-Greenspring Pediatric Associates, for her contributions regarding participant identification, subject recruitment, and coordination with the emocha team; the staff and providers at Greenspring Pediatric Associates; the LifeBridge Health Innovations Team; and the emocha team: Michelle Mendes, Christina Dahye Yoo, Maythana Paquete, Michael Lopez, Lauren Brown and Sebastian Seiguer.

Declaration of interest

LLY is an employee of emocha Mobile Health (emocha), a private company that licensed the video DOT technology. KM is a paid consultant to emocha. SDK and BW report no conflict of interest.

Funding

The author(s) reported there is no funding associated with the work featured in this article.