Electronic adherence monitoring devices for children with asthma: A systematic review and meta-analysis of randomised controlled trials

Background: Asthma is a common chronic condition amongst children. Poor adherence to asthma medications can increase asthma exacerbations, absence from school, healthcare utilisation and costs and decrease quality of life. Emerging evidence suggests the use of electronic adherence monitoring devices in improving children's adherence to medications. Objectives: This study aimed to evaluate the effectiveness of electronic adherence monitoring devices in improving inhaler adherence amongst children with asthma. Design: This study is a systematic review and meta-analysis. Data sources: A systematic search using Cochrane Library, PubMed, Embase, CINAHL, Web of Science, Scopus and ProQuest Dissertations and Theses from inception up to April 6, 2021, was conducted. Review methods: Randomised controlled trials evaluating the use of electronic adherence monitoring devices amongst children and published in English were included. The outcomes were inhaler adherence, asthma exacerbation, lung function, asthma control and accessibility. The overall effect was measured using Hedges' g and determined using Z-statistics at a significance level of p < 0.05. Heterogeneity was assessed using chi(2) and I-2 statistics. The individual and overall quality of evidence was assessed. Sensitivity and subgroup analyses were conducted. Narrative synthesis of outcomes was performed when meta-analysis could not be conducted on the data. Results: A total of 13,429 records were identified, and 10 randomised controlled trials in 11 articles amongst 1123 participants were included in the meta-analysis. Meta-analysis revealed that the electronic adherence monitoring device group was 1.50 times more likely to adhere to inhalers compared with the control group with medium-to-large effect size ( g = 0.64). A series of subgroup analyses showed that no significant subgroup differences for inhaler adherence were found amongst different populations, comparator, setting, duration of the monitoring period, reminder, and feedback functions of the electronic adherence monitoring devices. Children found the devices as user friendly with high accessibility scores. However, no significant differences were observed between the intervention and control groups for asthma exacerbations, lung function and asthma control. Conclusions: The findings from this study suggested that electronic adherence monitoring devices could improve inhaler adherence. Future devices should contain actuation and inhalation functions that can help to confirm actual inhalation amongst children with asthma. The overall evidence of outcomes ranged from very low to high. Furthermore, future large-scale trials were recommended before clinical implementations. (C) 2021 Elsevier Ltd. All rights reserved.