Feasibility of remote therapeutic monitoring to increase inhaled corticosteroid adherence in children with high-risk asthma

Abstract

Background: Asthma can be well-controlled with the use of inhaled corticosteroids (ICS), but most children and adolescents do not adhere to recommended treatment, leading to exacerbations, emergency department visits, hospitalizations, and deaths. Remote therapeutic monitoring (RTM) has demonstrated potential to increase ICS adherence and improve asthma outcomes, but few studies have been conducted in young people, and lack of research in minority groups may contribute to health disparities.

Objective: To evaluate the feasibility of RTM in children and adolescents who receive asthma care at an urban mobile clinic serving a predominantly Hispanic population.

Methods: A total of 20 children aged 5 to 17 years participated in RTM for 6 months. Feasibility evaluation included recruitment, retention, implementation factors, and participant and provider satisfaction. ICS adherence and asthma-related outcomes were assessed monthly and analyzed descriptively.

Results: Of 24 eligible participants, 20 (83%) were recruited and 19 (95%) completed the study. Participants found RTM satisfactory with a mean rating of 4.6 of 5. Although some encountered practical challenges, 10 of 14 respondents (71%) indicated that they would continue using RTM. Providers rated their satisfaction 4 of 5, but RTM did not consistently meet patient needs, nor was it well-integrated with their workflow. Overall mean ICS adherence was 53%, and patients requiring emergency department visits decreased from 10 at baseline to 5 during the intervention.

Conclusion: RTM is feasible in underserved children with asthma, but implementation requires additional support from clinical staff. Further research is needed to determine efficacy.