P205 The measurement of adherence to inhaled corticosteroids in asthma using electronic monitoring devices: A systematic review and meta-analysis. (11th November 2022)

• Record Type: Journal Article
• Authors: Adejumo, I; Chalitsios, CV; Shaw, DE; McKeever, TM
• Is Part Of: Thorax. Volume 77(2022)Supplement 1
• Page Start: A191
• Page End: A191
• Publication Date: 2022-11-11
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2022-BTSabstracts.339
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Underuse of inhaled corticosteroids (ICS) in asthma is a common problem and has been linked to adverse clinical outcomes. Electronic monitoring devices (EMDs or digital inhalers) are increasingly recognised as the gold standard for quantification of inhaler adherence and are likely to play a part in the future digitisation of self-management. This review sought to use EMD measurement to estimate population adherence in asthma and assess standards in EMD-measured adherence. Methods: After database searches, studies were included if they utilised EMDs in adults and were controlled trials or cohort studies. Summary data were extracted to inform narrative review and meta-analysis. The primary outcome was a population estimate of adherence. The study protocol is registered on the Prospero database (CRD42017057708). Initial searches were conducted in 2017 and an update is underway. Results: Thirty-five randomised controlled trials and cohort studies were suitable for inclusion in the initial review. The studies had a high degree of heterogeneity between study designs, study interventions and how studies defined, measured and calculated adherence. A population estimate of mean daily ICS adherence was taken from meta-analysis of pooled control and cohort groups representing 19 studies and 1365 participants. This demonstrated that 64.1% of prescribed doses (95% CI 57.8 – 70.4%, I2 94.4%) were taken. Meta-analysis of eight randomised controlled trials assessing adherence interventions suggested a post-intervention standardised mean difference (SMD) of 0.5 (95% CI 0.2 – 0.8, I 2 75.3%, p<0.01). The SMD provides a pooled measure of effect with 0.2 denoting a small effect, 0.5 a moderate effect and 0.8 a large effect. Conclusion: EMD studies demonstrate differences in methodology and outcome measures. Meta-analysis, limited by study heterogeneity, derives a mean adherence and suggests a moderate effect of adherence interventions. Please refer to page A216 for declarations of interest related to this abstract.