Type

Journal Article

Authors

Richard W Costello
Richard B Reilly
Liam G. Heaney
Job F. M. van Boven
J. Mark FitzGerald
Kathy Hetherington
Marcus Butler
John Faul
Desmond M. Murphy
Eoin Hunt
and 11 others

Subjects

Medicine & Nursing

Topics
nebulizers and vaporizers physiopathology adherence drug monitoring severe uncontrolled asthma peak expiratory flow rate clinical patient education as topic asthma protocol cost effectiveness therapeutic use type 2 medication adherence clinical decision making humans lung function adult administration inhalation controlled adrenal cortex hormones ethics committees drug effects decision making inhaler compliance assessment inca device economic impact female psychology electronic prospective study severe randomised controlled trial disease progression bronchodilator agents health knowledge attitudes practice male treatment outcome patients epidemiology drug therapy medicine and health sciences physiology inhaler technique ireland statistics numerical data electronic monitoring prospective studies inca electronic monitor

In patients with severe uncontrolled asthma, does knowledge of adherence and inhaler technique using electronic monitoring improve clinical decision making? A protocol for a randomised controlled trial (2017)

Abstract Many patients with asthma remain poorly controlled despite the use of inhaled corticosteroids and long-acting beta agonists. Poor control may arise from inadequate adherence, incorrect inhaler technique or because the condition is refractory. Without having an objective assessment of adherence, clinicians may inadvertently add extra medication instead of addressing adherence. This study aims to assess if incorporating objectively recorded adherence from the Inhaler Compliance Assessment (INCA) device and lung function into clinical decision making provides more cost-effective prescribing and improves outcomes. This prospective, randomised, multicentre study will compare the impact of using information on adherence to influence asthma treatment. Patients with severe uncontrolled asthma will be included. Data on adherence, inhaler technique and electronically recorded peak expiratory flow rate will be used to promote adherence and guide a clinical decision protocol to guide management in the active group. The control group will receive standard inhaler and adherence education. Medications will be adjusted using a protocol based on Global Initiativefor Asthma (GINA) recommendations. The primary outcome is the between-group difference in the proportion of patients who have refractory disease and are prescribed appropriate medications at the end of 32 weeks. A co-primary outcome is the difference between groups in the rate of adherence to salmeterol/fluticasone inhaler over the last 12 weeks. Secondary outcomes include changes in symptoms, lung function, type-2 cytokine biomarkers and clinical outcomes between both groups. Cost-effectiveness and cost-utility analyses of the INCA device intervention will be performed. The economic impact of a national implementation of the INCA-SUN programme will be evaluated. The results of the study will be published as a manuscript in peer-reviewed journals. The study has been approved by the ethics committees in the five participating hospitals. NCT02307669; Pre-results.
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Full list of authors on original publication

Richard W Costello, Richard B Reilly, Liam G. Heaney, Job F. M. van Boven, J. Mark FitzGerald, Kathy Hetherington, Marcus Butler, John Faul, Desmond M. Murphy, Eoin Hunt and 11 others

Experts in our system

1
Richard W Costello
Royal College of Surgeons in Ireland
Total Publications: 66
 
2
Richard Reilly
Trinity College Dublin
Total Publications: 185
 
3
Marcus W Butler
Royal College of Surgeons in Ireland
Total Publications: 17
 
4
Desmond M. Murphy
University College Cork
Total Publications: 24
 
5
Eoin Hunt
University College Cork
Total Publications: 11