Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Pediatrics, Herman and Walter Samuelson Children's Hospital of Sinai, Baltimore, MD, USA.
J Asthma. 2022 Oct;59(10):1961-1972. doi: 10.1080/02770903.2021.1984525. Epub 2021 Oct 4.
To assess feasibility of a novel video directly observed therapy (DOT)-based digital asthma program intended to support correct inhaled corticosteroid (ICS) use among children.
We conducted a 60-day pilot study among patients 2-18 years attending a primary care clinic with prescribed ICS and sub-optimally controlled asthma (recent hospitalization, ICS nonadherence, frequent rescue inhaler use, therapy escalation, or Asthma Control Test <20). Participants used a mobile application to receive reminders, submit videos of ICS doses (video DOT), and receive asynchronous feedback on adherence and inhaler technique. We assessed enrollment, engagement, program metrics, and user experience; adherence and inhaler errors were secondary outcomes.
Of 26 eligible patients, 21 (81%) enrolled and submitted ≥1 video; median age was 11 years (8-15), 71% were male, 90% had Medicaid, and 62% experienced ≥1 exacerbation in the previous 6 months. Retention was 57% and 52% at week 5 and 8, respectively. Participants submitted 810 videos. Missed doses, inhaler errors ( = 247) and adherence issues ( = 107) prompted 543 communications; inadequate inspiration or holding breath were most common. Among 16 patients with engagement >7 days and >4 videos, median inhaler error rate (proportion of videos with ≥1 error) decreased from week 1 to week 2 (73% vs 8%, ≤ 0.05) with median adherence >80%. Participants experienced the program as long, but easy to use; benefits included building routines, skill, and independence.
This pilot study suggests high program acceptability among our cohort. High engagement with improved inhaler technique over the first 14 days suggests shorter implementation.
Supplemental data for this article is available online at at.
评估一种新型基于视频直接观察治疗（DOT）的数字哮喘计划的可行性，该计划旨在支持儿童正确使用吸入性皮质类固醇（ICS）。
我们对在初级保健诊所就诊、处方 ICS 且哮喘控制不佳（近期住院、ICS 不依从、频繁使用急救吸入器、治疗升级或哮喘控制测试 <20）的患者进行了一项为期 60 天的试点研究。参与者使用移动应用程序接收提醒、提交 ICS 剂量的视频（视频 DOT），并接收关于依从性和吸入器技术的异步反馈。我们评估了入组、参与度、方案指标和用户体验；依从性和吸入器错误是次要结果。
在 26 名符合条件的患者中，21 名（81%）入组并提交了≥1 个视频；中位年龄为 11 岁（8-15 岁），71%为男性，90%有医疗补助，62%在过去 6 个月中经历了≥1 次哮喘加重。第 5 周和第 8 周的保留率分别为 57%和 52%。参与者提交了 810 个视频。错过剂量、吸入器错误（ = 247）和依从性问题（ = 107）引发了 543 次沟通；最常见的是吸气不足或屏气。在 16 名参与度>7 天且>4 个视频的患者中，从第 1 周到第 2 周，吸入器错误率（视频中至少有 1 个错误的比例）中位数从 73%降至 8%（ ≤ 0.05），依从性中位数>80%。参与者认为该程序耗时但易于使用；其好处包括建立日常习惯、提高技能和独立性。
本试点研究表明，我们的研究对象对该计划的接受度很高。在最初的 14 天内，高参与度和吸入器技术的改善提示实施时间较短。
