Adherence to ICS and control of preschool wheeze symptoms
Although 48 electronic monitoring devices were given to patients
recruited, only 36/48 (75%) were returned. This was despite repeated
reminder phone calls from the nurse and despite waiting for up to 6
months for the device to be returned. There was no difference in the
demographic characteristics at baseline between children whose monitors
were and were not returned. Children were brought to the clinic for
appointments, but families failed to return the monitoring device. The
reported reasons for devices not being returned were loss of device or
forgetting to return the device.
Median period of monitoring for the 36 children who did return the
monitoring device was 112 (range 91-126) days. Median adherence during
this period was 64% (range 0-94%). 12/36 (33%) had >80%
adherence [good], 8/36 (22%) had adherence between 60-79%
[moderate] and 16/30 (44%) had <60% adherence
[poor]. There were no differences in baseline TRACK score, PAQLQ,
FeNO or attacks in the preceding 3 months in those with good or
suboptimal adherence (<80%)
There was a significant increase in TRACK score between baseline and
follow-up visit for the children as a group, median TRACK at baseline 55
(Range 15-95), increasing to median TRACK at follow-up 70 (Range 25-95),
p<0.01 (Fig 1A). However, there was no relationship between
level of adherence and change in TRACK (Fig 1B). There was a significant
improvement in PACQLQ between baseline and follow up visit for the group
as a whole (Fig 1C), but no difference in offline FeNO measurements (Fig
1D) from baseline to follow-up.
The baseline and follow-up assessments were compared in children who had
not returned the monitoring devices to those with sub-optimal
(<80%) and good (> 80%) recorded
adherence. There was no difference in TRACK, PACQLQ, FeNO or unscheduled
healthcare visits between the group who did not return the device and
those with sub-optimal adherence. Comparing the children with recorded
sub-optimal adherence and good adherence, only children with good
adherence had a normal TRACK score (>80), significantly
improved PACQLQ and a significantly lower number of unscheduled
healthcare visits at follow-up (Table 2).