Electronic medication monitoring versus self-reported use of inhaled corticosteroids and short-acting beta₂-agonists in uncontrolled asthma

ABSTRACT

Objective

Current standard of care, patient self-report and clinician estimation, overestimates true inhaled corticosteroids (ICS) adherence. We compare self-reported inhaled ICS and short-acting beta 2-agonists (SABA) use with objective data from electronic medication monitors (EMMs).

Methods

Adults with uncontrolled asthma and prescribed ICS and SABA were enrolled. At visit one, participants’ ICS and SABA inhalers were fitted with EMMs to track real-time medication usage over 14 days. Participants were asked to complete paper diaries to self-report medication usage over the same period. Participant self-report of ICS adherence and SABA use versus objective ICS adherence and SABA use was compared using Wilcoxon signed-rank tests.

Results

One hundred participants (80% female, mean age 48.5 years, 60% completed college, 80% privately insured) had complete data. Participant self-report (median (IQR): 0.8 (0.0, 2.0)) was greater than objectively measured (median (IQR): 0.43 (0.1, 2.1)) SABA use, but the difference was not statistically significant (P = 0.64). Participant self-report (median (IQR): 97 (67, 100)) was significantly greater than objectively measured (median (IQR): 75 (54, 93)) ICS adherence (P = 0.002).

Conclusions

Significant discrepancies between self-report and objective ICS usage were observed. EMM can provide clinicians with accurate data on ICS medication taking behavior, thus reducing medication regimen complexity, side effects, and costs.

KEYWORDS:

• Asthma
• mhealth
• medication adherence
• apps
• self-management

Acknowledgements

None.

Author contributions

Participated in study concept design: GM, DS, LK, RG, MS. Acquisition of data: CG, BA, NBO. Performed data analysis: RG. Data interpretation: GM, DS, LK, RG, SS. Wrote or contributed to the writing of the manuscript: All authors

Authors’ consent for publication

All authors have reviewed the manuscript and consent to its publication.

Declaration of interest

Giselle Mosnaim receives research grant support from Teva and Sanofi-Regeneron; has received research grant support from Astra-Zeneca, Alk-Abello, Genentech, GlaxoSmithKline and Propeller Health; and has served as a consultant and/or member of an scientific advisory board for GlaxoSmithKline, Sanofi-Regeneron, Teva, Novartis, Astra-Zeneca, Boehringer Ingelheim and Propeller Health. She has also served as a speaker for HCPLive.

Confirmation of unpublished work

The submitted manuscript represents original work, has not been published elsewhere, is not currently being considered for publication at any other journal, and has not been posted as a preprint in any public or private domain.

Ethics approval and consent to participate

The NorthShore University HealthSystem Institutional Review Board approved the study protocol, and all study participants provided written informed consent. The study was also registered on ClinicalTrials.gov (NCT03860519).

Availability of data and materials

The medication use data that supported this study are not publicly available because are considered Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in the US, and as such are only accessible under specific authorization of access following HIPAA guidelines.

Additional information

Funding

This study was funded by Propeller Health, an affiliate of ResMed. Propeller Health was involved in the study design, data collection, analysis and interpretation of the data, as well as writing and decision to submit this manuscript.