CSMS, EAACI-ARIA allergy combined symptom-medication score; DATs, Digital adherence technologies; e-DASTHMA, Electronic daily control score for asthma; EMDs, Electronic monitoring devices; GDPR, General Data Protection Regulation; INCS, Inhaled corticosteroids; LABA, Long-acting b2 agonists; MART, MAintenance and Reliever Therapy; MASK-air, Mobile Airways Sentinel networK for airway diseases; MPR, Medication possession ratio; SABA, Short-acting beta-agonists; VAS, Visual analogue scale Asthma; Adherence; Inhaled corticosteroids; Formoterol; Long-acting-b2 agonist; Pulmonary and Respiratory Medicine
Abstract :
[en] Introduction: Adherence to controller medication is a major problem in asthma management, being difficult to assess and tackle. mHealth apps can be used to assess adherence. We aimed to assess the adherence to inhaled corticosteroids+long-acting b2-agonists (ICS+LABA) in users of the MASK-air Ò app, comparing the adherence to ICS+formoterol (ICS+F) with that to ICS+other LABA. Materials and methods: We analysed complete weeks of MASK-air Ò data (2015-2022; 27 countries) from patients with self-reported asthma and ICS+LABA use. We compared patients reporting ICS+F versus ICS+other LABA on adherence levels, symptoms and symptom-medication scores. We built regression models to assess whether adherence to ICS+LABA was associated with asthma control or short-acting beta-agonist (SABA) use. Sensitivity analyses were performed considering the weeks with no more than one missing day. Results: In 2598 ICS+LABA users, 621 (23.9%) reported 4824 complete weeks and 866 (33.3%) reported weeks with at most one missing day. Higher adherence (use of medication 80% of weekly days) was observed for ICS+other LABA (75.1%) when compared to ICS+F (59.3%), despite both groups displaying similar asthma control and work productivity. The ICS+other LABA group was associated with more days of SABA use than the ICS+F group (median=71.4% versus 57.1% days). Each additional weekly day of ICS+F use was associated with a 4.1% less risk in weekly SABA use (95%CI=-6.5;-1.6%;p=0.001). For ICS+other LABA, the percentage was 8.2 (95%CI=-11.6;-5.0%;p<0.001). Conclusions: In asthma patients adherent to the MASK-air app, adherence to ICS+LABA was high. ICS+F users reported lower adherence but also a lower SABA use and a similar level of control.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Sousa-Pinto, B; MEDCIDS -Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal ; Faculty of Medicine, CINTESIS@RISE -Health Research Network, University of Porto, Porto, Portugal
Louis, Renaud ; Université de Liège - ULiège > Département des sciences cliniques > Pneumologie - Allergologie ; Department of Pulmonary Medicine, CHU Li ege, Belgium ; GIGA I3 Research Group, University of Li ege, Belgium
Anto, J; ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain ; Universitat Pompeu Fabra (UPF), Barcelona, Spain ; CIBER Epidemiología y Salud P ublica (CIBERESP), Barcelona, Spain
Amaral, R; MEDCIDS -Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal ; Faculty of Medicine, CINTESIS@RISE -Health Research Network, University of Porto, Porto, Portugal
S A-Sousa, A
Czarlewski, W; MEDCIDS -Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal ; Faculty of Medicine, CINTESIS@RISE -Health Research Network, University of Porto, Porto, Portugal ; Medical Consulting Czarlewski, Levallois, France ; MASK-air, Montpellier, France
Brussino, L; MEDCIDS -Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal ; Department of Medical Sciences, University of Torino, Torino, Italy ; Allergy and Clinical Immunology Unit, Mauriziano Hospital, Torino, Italy
Canonica, G; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy ; IRCCS Humanitas Research Center, Rozzano, Italy
Chaves Loureiro, C; Department of Pneumology, University of Coimbra, Medicine Faculty, Coimbra, Portugal
Cruz, A; Fundaçao ProAR, GARD/WHO Planning Group, Federal University of Bahia, Salvador, Bahia, Brazil
Gemicioglu, B; Department of Pulmonary Diseases, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
Haahtela, T; Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
Kupczyk, M; Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
Kvedariene, V; Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania ; Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Larenas-Linnemann, D; Center of Excellence in Asthma and Allergy, M edica Sur Clinical Foundation and Hospital, M exico City, Mexico
Okamoto, Y; Chiba Rosai Hospital, Chiba, Japan ; Chiba University Hospital, Chiba, Japan
Ollert, M; Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg ; Department of Dermatology and Allergy Centre, Odense Research Center for Anaphylaxis (ORCA), Odense University Hospital, Odense, Denmark
Pfaar Z, O; Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universit€ at Marburg, Marburg, Germany aa ; Ecole Polytechnique de Palaiseau, Palaiseau, France bb ; IRBA (Institut de Recherche Bio-M edicale des Arm ees), Br etigny sur Orge, France cc ; Universit e Paris Cit e, Paris, France dd ; ee Allergy and Clinical Immunology Unit, IRCCS Humanitas Research Center, Personalized Medicine Asthma & Allergy, Rozzano, Italy ; ff Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, Centro Hospitalar e Universit ario de Coimbra, Coimbra, Portugal ; Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal gg ; University of Coimbra, Coimbra, Portugal ; Department of Allergology, ii Allergy Service, hh Medical University of Gda nsk, Gdansk, Poland ; jj PROMISE Department, Fundacion Jimenez Diaz, Autonoma University of Madrid, CIBERES-ISCIII, Madrid, Spain ; Department of Immunoallergology, University of Palermo, Palermo, Italy kk ; Cova da Beira University Hospital Centre, Covilhã, Portugal ll ; mm Allergy and Clinical Immunology, UBIAir -Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal ; University of Bari Medical School, Bari, Italy ; Faculty of Medicine, nn Institute of Sciences of Food Production, National Research Council (ISPA-CNR), Bari, Italy oo ; Transylvania University of Brasov, Brasov, Romania ; Department of Otorhinolaryngology, pp ARIA, Montpellier, France qq ; University of T€ ubingen, T€ ubingen, Germany ; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, tt Quality Use of Respiratory Medicines Group, rr Institute of Allergology, Charit e À Universit€ atsmedizin Berlin, Corporate Member of Freie Universit€ at Berlin and Humboldt-Universit€ at zu Berlin, Berlin, Berlin, Germany ss, Germany ; uu Macquarie Medical School, Woolcock Institute of Medical Research, Sydney, Australia ; vv Department of Cardiovascular and Respiratory Sciences, Macquarie University, Macquarie Park, Australia ; Department of Neurological, Universita Cattolica del Sacro Cuore, Rome, Italy ww ; ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli -IRCCS, Rome, Italy ; xx National Heart and Lung Institute (NHLI), Imperial College London, London, UK ; Department of Respiratory Medicine, yy Quebec Heart and Lung Institute, Laval University, Quebec City, Canada zz ; Department of Pulmonary Medicine, Ghent University Hospital, Ghent, Belgium aaa ; Mainz University Hospital, Mainz, Germany ; bbb SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy ; ccc Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France ; Chest Disease Department, Federation of Translational Medicine, ddd Allergy Division, University Hospital of Strasbourg, Strasbourg, France eee ; Public Health and Unit of Allergy and Clinical Immunology, Department of Medical Sciences, University of Strasbourg, Strasbourg, France fff ; University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy ; Department of Clinical Immunology, ggg Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina hhh ; Wroc»aw Medical University, Wroclaw, Poland ; Department of Otolaryngology, Head and Neck Surgery, iii ALL-MED Medical Research Institute, Wroclaw, Poland jjj ; Center for Rhinology and Allergology, Department of Otorhinolaryngology, Head and Neck Surgery, Universit€ atsmedizin Mainz, Mainz, Wiesbaden, Germany kkk, Germany lll ; Semmelweis University, Budapest, Hungary ; mmm KYomed INNOV, Montpellier, France ; nnn Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal ooo ; Universit e Paris-Saclay, UVSQ, Univ. Paris-Sud, Villejuif, France ppp Inserm ; Equipe d'Epid emiologie Respiratoire Int egrative, CESP, Villejuif, France
Pham-Thi Aa, N
Regateiro, F
Romantowski Hh, J
Sastre Ii, J
Scichilone Jj, N
Taborda-Barata, L
Ventura, M
Agache, I
Bedbrook, A; MASK-air, Montpellier, France
Becker Qq, S
Bergmann, K
Bosnic-Anticevich, S
Bonini, M
Boulet Yy, L.-P
Brusselle Zz, G
Buhl Aaa, R
Cecchi Bbb, L
Charpin Ccc, D
De Blay, F
Giacco, S
Ivancevich, J
Jutel, M
Klimek, L
Kraxner Lll, H
Kuna, P; Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
Laune, D
Makela, M; Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
Morais-Almeida, M
Nadif, R
Niedoszytko Qqq, M
Papadopoulos, N
Papi, A
Patella, V
Pétré, Benoît ; Université de Liège - ULiège > Département des sciences de la santé publique > Education thérapeutique du patient au service des soins intégrés
EIT Health [DE] AHA - American Heart Association [US-TX] EC - European Commission [BE]
Funding text :
MASK-air has been supported by EU grants (POLLAR, EITHealth; Structural and Development Funds, Twinning, EIP on AHA, H2020 and Horizon Europe) and by educational grants from Mylan-Viatris, ALK, GSK, Novartis and Uriach.There was no specific funding for this paper.
Chung, KF, Wenzel, SE, Brozek, JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 43:2 (2014), 343–373, 10.1183/09031936.00202013.
Jansen, EM, van de Hei, SJ, Dierick, BJH, Kerstjens, HAM, Kocks, JWH, van Boven, JFM., Global burden of medication non-adherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers. J Thorac Dis 13:6 (2021), 3846–3864, 10.21037/jtd-20-2360.
McDonald, VM, Yorke, J, Adherence in severe asthma: time to get it right. Eur Respir J, 50(6), 2017, 1702191, 10.1183/13993003.02191-2017.
Huvanandana, J, Nguyen, CD, Foster, JM, Frey, U, Reddel, HK, Thamrin, C., Novel methods of measuring adherence patterns reveal adherence phenotypes with distinct asthma outcomes. Ann Am Thorac Soc 19:6 (2022), 933–942, 10.1513/AnnalsATS.202106-653OC.
Riley, IL, Jackson, B, Crabtree, D, et al. A scoping review of international barriers to asthma medication adherence mapped to the theoretical domains framework. J Allergy Clin Immunol Pract 9:1 (2021), 410–418, 10.1016/j.jaip.2020.08.021 e4.
Tibble, H, Flook, M, Sheikh, A, et al. Measuring and reporting treatment adherence: what can we learn by comparing two respiratory conditions?. Br J Clin Pharmacol 87:3 (2021), 825–836, 10.1111/bcp.14458.
Hew, M, Reddel, HK, Integrated adherence monitoring for inhaler medications. JAMA 321:11 (19 2019), 1045–1046, 10.1001/jama.2019.1289.
Nguyen, E, Miao, B, Pugliese, N, Huang, D, Sobieraj, DM, Systematic review of mHealth applications that interface with inhaler sensors in asthma. J Allergy Clin Immunol Pract 9:2 (2021), 844–852, 10.1016/j.jaip.2020.08.049 e3.
Chan, AH, Harrison, J, Black, PN, Mitchell, EA, Foster, JM, Using electronic monitoring devices to measure inhaler adherence: a practical guide for clinicians. J Allergy Clin Immunol Pract 3:3 (2015), 335–349, 10.1016/j.jaip.2015.01.024 e1-5.
Moore, A, Preece, A, Sharma, R, et al. A randomised controlled trial of the effect of a connected inhaler system on medication adherence in uncontrolled asthmatic patients. Eur Respir J, 57(6), 2021, 2003103, 10.1183/13993003.03103-2020.
Harada, N, Harada, S, Ito, J, Atsuta, R, Hori, S, Takahashi, K, Mobile health app for Japanese adult patients with asthma: clinical observational study. J Med Internet Res, 22(8), 14 2020, e19006, 10.2196/19006.
Murphy, J, McSharry, J, Hynes, L, Molloy, GJ, A smartphone app to support adherence to inhaled corticosteroids in young adults with asthma: multi-methods feasibility study. JMIR Form Res, 5(9), 2021, e28784, 10.2196/28784.
Jacome, C, Almeida, R, Pereira, AM, et al. Feasibility and acceptability of an asthma app to monitor medication adherence: mixed methods study. JMIR Mhealth Uhealth, 9(5), 2021, e26442, 10.2196/26442.
Jacome, C, Pereira, R, Almeida, R, et al. Validation of app and phone versions of the control of allergic rhinitis and asthma test (CARAT). J Investig Allergol Clin Immunol 31:3 (2021), 270–273, 10.18176/jiaci.0640.
Kaye, L, Gondalia, R, Thompson, A, Stempel, DA, Barrett, MA, The relationship between objective app engagement and medication adherence in asthma and COPD: a retrospective analysis. Sci Rep, 11(1), 2021, 24343, 10.1038/s41598-021-03827-2.
Menditto, E, Costa, E, Midao, L, et al. Adherence to treatment in allergic rhinitis using mobile technology. The MASK Study. Clin Exp Allergy 49:4 (2019), 442–460, 10.1111/cea.13333.
Bousquet, J, Arnavielhe, S, Bedbrook, A, et al. MASK 2017: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma multimorbidity using real-world-evidence. Clin Transl Allergy, 8, 2018, 45, 10.1186/s13601-018-0227-6.
Laune, D, Arnavielhe, S, Viart, F, et al. [Adaptation of the General Data Protection Regulation (GDPR) to a smartphone app for rhinitis and asthma (MASK-air(R))]. Rev Mal Respir 36:9 (2019), 1019–1031, 10.1016/j.rmr.2019.08.003 Reglement general sur la protection des donnees pour MASK-air(R) (application mobile rhinite et asthme).
Bousquet, J, Agache, I, Aliberti, MR, et al. Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - Reference Site Twinning (EIP on AHA). Allergy 73:1 (2017), 77–92, 10.1111/all.13218.
Sousa-Pinto, B, Azevedo, LF, Jutel, M, et al. Development and validation of combined symptom-medication scores for allergic rhinitis. Allergy 77:7 (2022), 2147–2162, 10.1111/all.15199.
Sousa-Pinto, B, Jacome, C, Perreira, A, et al. Development and validation of an electronic daily control score for asthma (e-DASTHMA). Lancet Digital Health 5:4 (2023), e227–e238, 10.1016/S2589-7500(23)00020-1.
Cohen, J, Statistical Power Analysis for the Behavioral Sciences. 1988, Taylor and Francis Group, 567, 10.4324/9780203771587.
Sedgwick, P, Bias in observational study designs: prospective cohort studies. BMJ, 349, 2014, g7731, 10.1136/bmj.g7731.
Bousquet, J, Sousa-Pinto, B, et al. Identification by cluster analysis of patients with asthma and nasal symptoms using the MASK-air® mHealth app. Pulmonology 29:4 (2023), 292–305, 10.1016/j.pulmoe.2022.10.005.
GINA 2019: a fundamental change in asthma management: Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents. Reddel, HK, FitzGerald, JM, Bateman, ED, et al. (eds.) Eur Respir J, 53(6), 2019, 1901046, 10.1183/13993003.01046-2019.
O'Byrne, PM, FitzGerald, JM, Bateman, ED, et al. Inhaled combined budesonide-formoterol as needed in mild asthma. N Engl J Med 378:20 (2018), 1865–1876, 10.1056/NEJMoa1715274.
