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).