Short-term effect of a smart nebulizing device on adherence to inhaled corticosteroid therapy in Asthma Predictive Index-positive wheezing children

Figures & data

Figure 1 Photographs of an electronic smart device and nebulizer.

Notes: (A) An electronic smart device (red framed) and a nebulizer before assembly. (B) After the 2 devices are assembled.

Table 1 General characteristics of the children before treatment

Characteristics	Conventional nebulization (N=35)	Smart nebulization (N=30)	Total N=65	P-value
Age (months, mean ± SD)	38.54±12.08	37.17±11.68	37.91±11.83	0.644
Gender, N (%)				0.487
Male	25 (71.43)	19 (63.33)	44 (67.69)
Female	10 (28.57)	11 (36.67)	21 (32.31)
Allergen, N (%)				0.767
Mite	29 (82.86)	24 (80.00)	53 (81.54)
Unknown	6 (17.14)	6 (20.00)	12 (18.46)
Eczema, N (%)				0.745
No	7 (20.00)	7 (23.33)	14 (21.54)
Yes	28 (80.00)	23 (76.67)	51 (78.46)
Rhinitis, N (%)				0.841
No	23 (65.71)	19 (63.33)	42 (64.62)
Yes	12 (34.29)	11 (36.67)	23 (35.38)
Parent rhinitis, N (%)				0.749
No	22 (62.86)	20 (66.67)	42 (64.62)
Yes	13 (37.14)	10 (33.33)	23 (35.38)
Parent asthma, N (%)				0.931
No	26 (74.29)	22 (73.33)	48 (73.85)
Yes	9 (25.71)	8 (26.67)	17 (26.15)
Serum IgE, N (%)				0.628
0	6 (17.14)	8 (26.67)	14 (21.54)
1	7 (20.00)	6 (20.00)	13 (20.00)
2	22 (62.86)	16 (53.33)	38 (58.46)

Table 2 Adherence to ICS during the 12-week treatment

Time	Adherence to ICS	Conventional nebulization N (%)	Smart nebulization N (%)	Total N (%)	P-value
At 4th week	Good	22 (62.86)	26 (86.67)	48 (73.85)	0.029
	Poor	13 (37.14)	4 (13.33)	17 (26.15)
At 8th week	Good	18 (51.42)	23 (76.67)	41 (63.08)	0.036
	Poor	17 (48.58)	7 (23.33)	24 (36.92)
At 12th week	Good	14 (40.00)	20 (67.33)	34 (52.31)	0.032
	Poor	21 (60.00)	10 (33.67)	31 (47.69)

Abbreviation: ICS, inhaled corticosteroid.

Table 3 Scoring of the symptoms during the 12-week treatment

Time	Symptom score	Conventional nebulization N (%)	Smart nebulization N (%)	Total N (%)	P-value
Day-time during the 1st week	0	3 (8.57)	1 (3.33)	4 (6.15)	0.911
	1	15 (42.86)	14 (46.67)	29 (44.62)
	2	14 (40.00)	15 (50.00)	29 (44.62)
	3	3 (8.57)	0 (0.00)	3 (4.62)
Night-time during the 1st week	0	8 (22.86)	7 (23.33)	15 (23.08)	0.865
	1	14 (40.00)	10 (33.33)	24 (36.92)
	2	10 (28.57)	11 (36.67)	21 (32.31)
	3	3 (8.57)	2 (6.67)	5 (7.69)
Day-time during the 4th week	0	9 (25.71)	14 (46.67)	23 (35.38)	0.032
	1	9 (25.71)	8 (26.67)	17 (26.15)
	2	12 (34.29)	7 (23.33)	19 (29.23)
	3	5 (14.29)	1 (3.33)	6 (9.23)
Night-time during the 4th week	0	10 (28.57)	15 (50.00)	25 (38.46)	0.037
	1	12 (34.29)	9 (30.00)	21 (32.31)
	2	10 (28.57)	6 (20.00)	16 (24.62)
	3	3 (8.57)	0 (0.00)	3 (4.62)
Day-time during the 8th week	0	9 (25.71)	17 (56.67)	26 (40.00)	0.030
	1	11 (31.43)	5 (16.67)	16 (24.62)
	2	9 (25.71)	6 (20.00)	15 (23.08)
	3	6 (17.14)	2 (6.67)	8 (12.31)
Night-time during the 8th week	0	11 (31.43)	16 (53.33)	27 (41.54)	0.046
	1	11 (31.43)	10 (33.33)	21 (32.31)
	2	10 (28.57)	2 (6.67)	12 (18.46)
	3	3 (8.57)	2 (6.67)	5 (7.69)
Day-time during the 12th week	0	15 (42.86)	18 (60.00)	33 (50.77)	0.031
	1	5 (14.29)	7 (23.33)	12 (18.46)
	2	6 (17.14)	3 (10.00)	9 (13.85)
	3	9 (25.71)	2 (6.67)	11 (16.92)
Night-time during the 12th week	0	15 (42.86)	19 (63.33)	34 (52.31)	0.044
	1	7 (20.00)	6 (20.00)	13 (20.00)
	2	8 (22.86)	4 (13.33)	12 (18.46)
	3	5 (14.29)	1 (3.33)	6 (9.23)

Table 4 Comparison on additional drug usage and cost during the 12-week treatment

Parameters for comparison	Conventional nebulization (N=35)	Smart nebulization (N=30)	Total (N=65)	P-value
Respiratory infection, N (%)				0.042
0	6 (17.14)	8 (26.67)	14 (21.54)
1	7 (20.00)	12 (40.00)	19 (29.23)
2	13 (37.14)	8 (26.67)	21 (32.31)
>2 times	9 (25.71)	2 (6.67)	11 (16.92)
Wheezing, N (%)				0.593
0	19 (54.29)	18 (60.00)	37 (56.92)
1	11 (31.43)	9 (30.00)	20 (30.77)
>1 time	5 (14.29)	3 (10.00)	8 (12.31)
Wheezing severity, N (%)				0.194
No	19 (54.29)	18 (60.00)	37 (56.92)
Mild	7 (20.00)	10 (33.33)	17 (26.15)
Severe	9 (25.71)	2 (6.67)	11 (16.92)
Antibiotics usage, median (IQR)	2 (1, 2)	1 (0, 2)	1 (0, 2)	0.038
Steroid usage, N (%)				0.029
No	19 (54.29)	24 (80.00)	43 (66.15)
Yes	16 (45.71)	6 (20.00)	22 (33.85)
Hospitalization, N (%)				0.716
No	30 (85.71)	27 (90.00)	57 (87.69)
Yes	5 (14.29)	3 (10.00)	8 (12.31)
Times of emergency or clinic visit, mean ± SD	8.94±3.82	7.20±2.89	8.14±3.15	0.045
Cost (RMB), median (IQR)	2,271 (1,635, 3,404)	1,531 (1,016, 2,335)	1,948 (1,232, 2,875)	0.006

Abbreviations: IQR, interquartile rate; RMB, RenMinBi (Chinese Yuan).

Table 5 Additional medication for symptom relief and limitation of activity during the treatment

Additional comparison	Time	Conventional nebulization N (%)	Smart nebulization N (%)	Total N (%)	P-value
Additional medication for symptom relief	During 1st week	1 (2.86)	1 (3.33)	2 (3.08)	1.000
	During 4th week	2 (5.71)	0 (0.00)	2 (3.08)	0.495
	During 8th week	1 (2.86)	1 (3.33)	2 (3.08)	1.000
	During 12th week	5 (14.29)	2 (6.67)	7 (10.77)	0.437
Activity limitation	During 1st week	0 (0.00)	3 (10.00)	3 (4.62)	0.093
	During 4th week	0 (0.00)	1 (3.33)	1 (1.54)	0.462
	During 8th week	0 (0.00)	1 (3.33)	1 (1.54)	0.462
	During 12th week	1 (2.86)	1 (3.33)	2 (3.08)	1.000