STAAR: a randomised controlled trial of electronic adherence monitoring with reminder alarms and feedback to improve clinical outcomes for children with asthma
Background Suboptimal adherence to inhaled steroids is common in children with asthma and is associated with poor disease control, reduced quality of life and even death. Previous studies using feedback of electronically monitored adherence data have demonstrated improved adherence, but have not dem...
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Zusammenfassung: | Background Suboptimal adherence to inhaled steroids
is common in children with asthma and is associated
with poor disease control, reduced quality of life and
even death. Previous studies using feedback of
electronically monitored adherence data have
demonstrated improved adherence, but have not
demonstrated a significant impact on clinical outcomes.
The aim of this study was to determine whether
introduction of this approach into routine practice would
result in improved clinical outcomes.
Methods Children with asthma aged 6–16 years were
randomised to the active intervention consisting of
electronic adherence monitoring with daily reminder
alarms together with feedback in the clinic regarding
their inhaled corticosteroid (ICS) use or to the usual care
arm with adherence monitoring alone. All children had
poorly controlled asthma at baseline, taking ICS and
long-acting β-agonists. Subjects were seen in routine
clinics every 3 months for 1 year. The primary outcome
was the Asthma Control Questionnaire (ACQ) score.
Secondary outcomes included adherence and markers of
asthma morbidity.
Results 77 of 90 children completed the study
(39 interventions, 38 controls). Adherence in the
intervention group was 70% vs 49% in the control
group (p≤0.001). There was no significant difference in
the change in ACQ, but children in the intervention
group required significantly fewer courses of oral
steroids (p=0.008) and fewer hospital admissions
(p≤0.001).
Conclusions The results indicate that electronic
adherence monitoring with feedback is likely to be of
significant benefit in the routine management of poorly
controlled asthmatic subjects. |
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DOI: | 10.1136/thoraxjnl-2015-208171 |