The effect of electronic monitoring combined with weekly feedback and reminders on adherence to inhaled corticosteroids in infants and younger children with asthma: a randomized controlled trial

Background Adherence to asthma treatment among children is usually poor. We sought to explore whether electronic adherence monitoring combined with weekly feedback regarding adherence along with a reminder to use inhaled corticosteroids (ICS) would lead to improved compliance with ICS in infants and younger children with asthma. Methods 96 recruited children (aged 6 months to 3 years) with mild or moderate persistent asthma who were on regular inhaled corticosteroids were randomly allocated to receive electronic monitoring combined with instant messaging software (IMS)-based weekly feedback regarding adherence along with a reminder to keep taking the ICS (intervention group) and to receive electronic monitoring only (control group). Results The mean device-monitored adherence was significantly higher in the intervention group (80%) than in the control group (45.9%), with a difference of 34.0% (95% confidence interval [CI], 26.8–41.3%; P < 0.001). No difference in the mean caregiver-reported adherence between the interventional group (89.7%) and the control group (92.7%) was observed ( P = 0.452). Conclusions Electronic monitoring combined with IMS-based weekly feedback regarding adherence along with a reminder to keep taking the ICS significantly improved the treatment compliance of infants and younger children with asthma. Caregiver-reported adherence is an unreliable monitoring indicator. Trial registration ClinicalTrials.gov, NCT03277664. Registered 11 September 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT03277664