Technologies to monitor adherence to treatment will “transform” the respiratory field, doctors at the British Thoracic Society Winter Meeting predicted.
Lack of compliance, whether of inhaled corticosteroids in asthma, mechanical ventilation in respiratory failure or antimicrobial treatment in TB, is a major issue. Now mobile applications to enable remote monitoring are starting to make a difference to management.
“I suspect in few years we will all be adherence monitoring,” said Dr James Paton, Reader in Paediatric Respiratory Medicine at the University of Glasgow, at a symposium to discuss the latest iteration of SIGN/BTS asthma guidelines.
He later described a service in Northern Ireland which uses a video app to monitor children’s compliance and inhaler technique, with the video sent by mobile phone to the asthma clinic’s secure server. “The nurse can see them take it, and see their technique. If we can do it for inhaled therapies, there’s no reason we can’t do it for oral tablets,” he said.
One presentation at the meeting showed how use of a mobile phone video app greatly improved adherence to TB therapy among people considered at high risk of not taking their treatment. These people – often people with complex social needs such as homelessness or drug use – are traditionally asked to take part in directly observed therapy (DOT), where they attend a centre to be observed taking the medicine, three or five times a week.
A randomised controlled trial in London, carried out by University College London, randomised people to DOT or video-observed therapy (VOT). Patients in the VOT group used an app to film themselves taking the tablet and sent it to the clinic. If no video was received, the clinic would be contacted with a reminder.
The results were impressive – more than 70% of VOT patients completed more than 80% of their scheduled treatments, compared to less than half of DOT patients.
Professor Andrew Hayward, who led the study, said: “Attending clinics and appointments for directly observed treatment can be inconvenient, intrusive and costly.” VOT was “less stigmatising” as well as more effective, he said.
Professor Liam Heaney of Queens University Belfast, speaking about personalised medicine for asthma, said that non-adherence to ICS was common and might account for a large proportion of asthma thought to be resistant to treatment. “Non-adherence is still a major problem but technologies will be very helpful,” he said.
He described a technology which made a sound recording when the inhaler was activated, allowing clinicians to monitor adherence during treatment trials.
“All I want to know in clinic is, are you taking treatment and I need to give you more, or are you not taking it?” he said.