Feedback-enhanced electronic monitoring for asthma inhaler adherence: A systematic review and meta-analysis of randomized controlled trials.
Xinrong Chen, Ling Xu, Cui Yang et al.
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In 30 seconds
This systematic review and meta-analysis of randomized controlled trials assessed feedback-enhanced electronic inhaler monitoring versus standard care in people with asthma. Across 28 trials involving 4410 participants, monitoring with feedback improved medication adherence: mean difference 18.43% (95% confidence interval 13.02 to 23.84; 21 trials, 2567 participants; moderate-certainty evidence). The review also found fewer exacerbations, more participants with well-controlled asthma and improved quality of life, although certainty varied by outcome. Asthma Control Test scores did not improve significantly, and adverse events were comparable.
Key findings
- Adherence improved by a mean difference of 18.43% (95% confidence interval 13.02 to 23.84; 21 trials, 2567 participants; moderate certainty).
- Exacerbation rates fell (mean difference -2.65, 95% confidence interval -4.39 to -0.91; 10 trials, 1569 participants; low certainty).
- The proportion with well-controlled asthma increased by 6.67% (95% confidence interval 4.47 to 8.86; 5 trials, 1709 participants; low certainty).
- Quality of life improved, while Asthma Control Test scores did not reach statistical significance; adverse events were comparable.
Why it matters
Electronic recording alone does not provide the active feedback evaluated in these trials. The findings suggest that pairing monitoring with feedback can improve adherence and may also benefit exacerbations, asthma control and quality of life. The differing certainty across outcomes is important when interpreting these potential clinical benefits.
What to keep in mind
Certainty was low for the exacerbation and well-controlled-asthma outcomes; the Asthma Control Test result was not statistically significant. The abstract does not report follow-up duration.