Modern medical science has made remarkable progress in the treatment of asthma. Inhalers containing steroids are particularly effective in preventing an asthma attack. But getting people to take these preventive medicines long-term remains a challenge.
Because asthma is an ongoing condition, many people struggle to take their medication regularly, due to busy schedules or because the medication may not seem to work right away.
One potential solution lies in digital technologies that can reduce the risks associated with not taking medication as prescribed. These technologies include text message reminders, web-based apps, interactive voice response systems and smart inhalers.
The benefits could be considerable, given that asthma is one of the commonest health problems. It affects as many as 339 million people worldwide. New Zealand has one of the highest rates of asthma, with one in seven children and one in eight adults diagnosed.
Asthma attacks are also the commonest cause of days off school and work for people with the condition. In the UK it’s estimated someone has a potentially life-threatening asthma attack every ten seconds, with similar data in New Zealand. Asthma mortality is highest for Māori and Pacific peoples, with rates 4.3 and 3.2 times higher than for other groups.
While there are inhalers that work well on immediate symptoms, preventive medicines are key for long-term asthma control. These need be taken as prescribed, often once or twice a day. What’s known as “non-adherence” to such regimes is a major health problem and can lead to more symptoms and attacks.
Medication adherence strategies
Achieving adherence is therefore very important to reduce the risk of death. With increasing investment in digital technologies designed to improve health, the research focus with asthma is on improving how existing medications are used and therefore improving outcomes.
Research in New Zealand has shown “smart” inhalers – devices that monitor when doses are taken and can provide reminders and feedback – improved medication adherence by 50% and improved control in children with asthma.
But we still don’t know whether digital technologies in general can improve the situation for all people with asthma and, even if they do, whether this will have a positive impact on asthma symptoms or attacks.
To learn more, we looked at all the randomised controlled trials of digital technologies and their impact on medication adherence in asthma. We found 40 studies around the world, with a collective sample base of more than 15,000 adults and children with asthma.
By pooling the data from all the separate trials, we were able to measure whether people who used digital technologies to improve their medication regime had better adherence – and fewer asthma symptoms and attacks – than those who did not.