Evaluating adherence and inhaler monitoring among adolescent asthmatic patients: a systematic review and meta-analysis of interventions

Introduction: Inadequate care for asthma has been linked to higher hospital admissions and morbidity. Researchers have developed several strategies to improve treatment adherence in this specific group. We aimed to investigate the impact of several interventions on the adherence of asthmatic patients to controller inhalers. Data sources: We searched four databases (the Cochrane Library, PubMed, Embase, and Web of Science) for studies published between 1998 and 2022. Study selections: We considered studies that assessed adherence as the main finding of an intervention for asthma patients. Data were extracted and analyzed. Results: The analysis included a total of 40 studies. A diverse range of interventions was identified, including educational sessions on asthma, reminders via text messages, and technology-based feedback systems. The overall efficacy of interventions compared to the control group resulted in a small effect size, but it was statistically significant, with an estimated SMD of 0.44 (95% CI 0.24 to 0.63, P < 0.001). Electronic monitoring achieved a significantly higher effect size [SMD 0.8, 95% CI 0.46 to 1.14, P < 0.001) compared to pharmacy refill and self-report methods [(SMD 0.09, 95% CI - 0.18-0.37, P = 0.51), and (SMD 0.25, 95% CI - 0.03, 0.54, P = 0.08), respectively]. Conclusions: Adherence promotion interventions have been proven effective among patients with asthma. Electronic monitoring modalities have demonstrated superiority and effectiveness in improving patient adherence to asthma inhalers. Additional longitudinal research studies can be conducted to evaluate the cost-effectiveness and identify a more accurate measure of intervention efficiency for prolonged follow-up time.