Digital remote maintenance inhaler adherence interventions in COPD: a systematic review and meta-analysis.

Autor:	Aung H; Department of Respiratory Sciences, University of Leicester, Leicester, UK.; Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK., Tan R; Department of Respiratory Sciences, University of Leicester, Leicester, UK.; Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK., Flynn C; Department of Respiratory Sciences, University of Leicester, Leicester, UK.; Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK., Divall P; Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK., Wright A; Department of Respiratory Sciences, University of Leicester, Leicester, UK., Murphy A; Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK.; School of Pharmacy, DeMontfort University, Leicester, UK., Shaw D; Department of Respiratory Sciences, University of Leicester, Leicester, UK.; Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK., Ward TJC; Department of Respiratory Sciences, University of Leicester, Leicester, UK.; Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK.; Co-last authors., Greening NJ; Department of Respiratory Sciences, University of Leicester, Leicester, UK neil.greening@leicester.ac.uk.; Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK.; Co-last authors.
Jazyk:	angličtina
Zdroj:	European respiratory review : an official journal of the European Respiratory Society [Eur Respir Rev] 2024 Dec 04; Vol. 33 (174). Date of Electronic Publication: 2024 Dec 04 (Print Publication: 2024).
DOI:	10.1183/16000617.0136-2024
Abstrakt:	Introduction: Sub-optimal inhaler adherence undermines the efficacy of pharmacotherapy in COPD. Digitalised care pathways are increasingly used to improve inhaler-use behaviour remotely. This review investigated the feasibility and impact of remote electronic inhaler adherence monitoring (EIM) and intervention platforms on clinical outcomes in COPD. Methods: A literature search was conducted and studies investigating maintenance inhaler use among people with COPD using digital technology were selected. Pairwise and proportional meta-analyses were employed with heterogeneity assessed using I 2 statistics. When meta-analysis was not feasible, a narrative synthesis of outcomes was conducted. Results: We included 10 studies including 1432 people with COPD whose maintenance inhaler usage was supported by digital inhalers and apps featuring audiovisual reminders and educational content with or without engagement with healthcare providers (HCPs). Inhaler adherence rate (AR) varied with calculation methods, but an overall suboptimal adherence was observed among people with COPD. HCP-led adherence interventions alongside EIM improved mean AR by 18% (95% CI 9-27) versus passive EIM only. Enhanced AR may reduce COPD-related healthcare utilisation with little impact on health-related quality of life and exacerbation rate. Despite encountering technical issues among 14% (95% CI 5-23%) of participants, 85% (95% CI 76-94%) found digital platforms convenient to use, while 91% (95% CI 79-100%) perceived inhaler reminders as helpful. Conclusion: Digitalised interventions can enhance maintenance inhaler adherence in COPD but their overall effect on clinical outcomes remains uncertain. Further work is required to tailor interventions to individuals' adherence behaviour and investigate their longer-term impact. Competing Interests: Conflict of interest: H. Aung, R. Tan, C. Flynn, P. Divall and D. Shaw have no potential conflicts of interest to disclose. A. Wright has received grant income (paid to the institution) from Sanofi. A.C. Murphy has received funding for research studies, consultancy agreements, and honoraria for presentations from AstraZeneca, Chiesi, Orion, and Sanofi. T.J.C. Ward has received honoraria from Chiesi. N.J. Greening has received honoraria for lectures, conference travel and advisory boards from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Pulmonx, and received grants and consultation fees (paid to institution) from Genentech, Roche and GlaxoSmithKline. (Copyright ©The authors 2024.)
Databáze:	MEDLINE
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