Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Pediatrics. 2021 Jan;147(1). doi: 10.1542/peds.2020-1330.
Although sensor-based monitoring of daily inhaled corticosteroids (ICSs) and short-acting β-agonist medications may improve asthma outcomes, the effectiveness of these interventions in diverse pediatric populations remains unclear.
Caregiver and child dyads were randomly assigned to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. End points included Asthma Control Test scores (≥19 indicated asthma control) and asthma health care use. Caregiver quality of life (QoL) and child ICS adherence were also assessed. Multilevel models were used to estimate adjusted changes from baseline.
Dyads were assigned to the control ( = 127) or intervention ( = 125) arms. At the end line, the mean Asthma Control Test score increased from 19.1 (SE = 0.3) to 21.8 (SE = 0.4) among the intervention and from 19.4 (SE = 0.3) to 19.9 (SE = 0.4) among the control (Δ = 2.2; SE = 0.6; < .01). Adjusted rates of emergency department visits and hospitalizations among the intervention were significantly greater (incidence rate ratio = 2.2; SE = 0.5; < .01; incidence rate ratio = 3.4; SE = 1.4; < .01) at endline than the control. Caregiver QoL was greater among the intervention at the endline (Δ = 0.3; SE = 0.2; = .1) than the control.
Findings suggest that sensor-based inhaler monitoring with clinical feedback may improve asthma control and caregiver QoL within diverse populations. Higher health care use was observed among the intervention participants relative to the control, indicating further refinement is warranted.
尽管基于传感器的日常吸入性皮质类固醇（ICS）和短效β-激动剂药物监测可能改善哮喘结局，但这些干预措施在不同儿科人群中的有效性仍不清楚。
护理人员和儿童对被随机分配到接受吸入器传感器，允许护理人员和临床医生对药物进行电子监测。终点包括哮喘控制测试（≥19 分表示哮喘控制）和哮喘保健使用情况。护理人员生活质量（QoL）和儿童 ICS 依从性也进行了评估。使用多层模型来估计从基线的调整变化。
对两组被分配到对照组（n = 127）或干预组（n = 125）。在最后一次随访时，干预组的哮喘控制测试评分从基线时的 19.1（SE = 0.3）增加到 21.8（SE = 0.4），而对照组从 19.4（SE = 0.3）增加到 19.9（SE = 0.4）（Δ = 2.2；SE = 0.6；<0.01）。与对照组相比，干预组的急诊就诊率和住院率在最后一次随访时显著更高（发病率比= 2.2；SE = 0.5；<0.01；发病率比= 3.4；SE = 1.4；<0.01）。与对照组相比，干预组在最后一次随访时护理人员的 QoL 更高（Δ= 0.3；SE = 0.2；= 0.1）。
研究结果表明，基于传感器的吸入器监测和临床反馈可能会改善不同人群的哮喘控制和护理人员的生活质量。与对照组相比，干预组的医疗保健使用率更高，这表明需要进一步改进。
