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Eur Respir J. 2018 Jan 4;51(1). pii: 1701126. doi: 10.1183/13993003.01126-2017. Print 2018 Jan.

A randomised clinical trial of feedback on inhaler adherence and technique in patients with severe uncontrolled asthma.

Author information

1
Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland.
2
Trinity Centre for Bioengineering, Trinity College, The University of Dublin, Dublin, Ireland.
3
Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.
4
HRB Clinical Research Facility-Cork, University College Cork, Cork, Ireland.
5
Dept of Respiratory Medicine, AMNCH, Dublin, Ireland.
6
Dept of Medicine, Johns Hopkins University Hospital, Baltimore, USA.
7
UBC Institute for Heart and Lung Health, University of British Columbia, Vancouver, BC, Canada.
8
Population Health Sciences (Psychology), RCSI, Dublin, Ireland.
9
School of Engineering, Trinity College, The University of Dublin, Dublin, Ireland.
10
School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland.
11
Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland rcostello@rcsi.ie.
12
Dept of Respiratory Medicine, RCSI, Dublin, Ireland.

Abstract

In severe asthma, poor control could reflect issues of medication adherence or inhaler technique, or that the condition is refractory. This study aimed to determine if an intervention with (bio)feedback on the features of inhaler use would identify refractory asthma and enhance inhaler technique and adherence.Patients with severe uncontrolled asthma were subjected to a stratified-by-site random block design. The intensive education group received repeated training in inhaler use, adherence and disease management. The intervention group received the same intervention, enhanced by (bio)feedback-guided training. The primary outcome was rate of actual inhaler adherence. Secondary outcomes included a pre-defined assessment of clinical outcome. Outcome assessors were blinded to group allocation. Data were analysed on an intention-to-treat and per-protocol basis.The mean rate of adherence during the third month in the (bio)feedback group (n=111) was higher than that in the enhanced education group (intention-to-treat, n=107; 73% versus 63%; 95% CI 2.8%-17.6%; p=0.02). By the end of the study, asthma was either stable or improved in 54 patients (38%); uncontrolled, but poorly adherent in 52 (35%); and uncontrolled, but adherent in 40 (27%).Repeated feedback significantly improved inhaler adherence. After a programme of adherence and inhaler technique assessment, only 40 patients (27%) were refractory and adherent, and might therefore need add-on therapy.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01529697.

Conflict of interest statement

Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com

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