Hnin Aung, Ronnie Tan, Cara Flynn, Pip Divall, Adam Wright, Anna Murphy, Dominick Shaw, Tom J C Ward, Neil J Greening
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引用次数: 0
Abstract
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 I2 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.
不理想的吸入器依从性破坏了COPD药物治疗的疗效。数字化护理途径越来越多地用于远程改善吸入器使用行为。本综述探讨了远程电子吸入器依从性监测（EIM）和干预平台对COPD临床结局的可行性和影响。方法：进行文献检索，选择使用数字技术调查COPD患者维持性吸入器使用情况的研究。采用两两和比例荟萃分析，采用I2统计量评估异质性。当荟萃分析不可行时，对结果进行叙述综合。结果：我们纳入了10项研究，包括1432名COPD患者，他们的维持性吸入器使用由数字吸入器和具有视听提醒和教育内容的应用程序支持，有或没有与医疗保健提供者（HCPs）合作。吸入器依从率（AR）因计算方法而异，但在COPD患者中观察到总体上的次优依从性。与仅被动EIM相比，hcp主导的依从性干预与EIM联合可使平均AR提高18% （95% CI 9-27）。增强的AR可减少copd相关的医疗保健利用，但对健康相关的生活质量和恶化率影响不大。尽管有14% （95% CI 5-23%）的参与者遇到了技术问题，但85% （95% CI 76-94%）的参与者认为数字平台使用方便，91% （95% CI 79-100%）的参与者认为吸入器提醒是有帮助的。结论：数字化干预可以增强COPD患者的维持性吸入器依从性，但其对临床结果的总体影响仍不确定。需要进一步的工作来调整干预措施，以适应个人的依从行为，并调查其长期影响。
期刊介绍：
The European Respiratory Review (ERR) is an open-access journal published by the European Respiratory Society (ERS), serving as a vital resource for respiratory professionals by delivering updates on medicine, science, and surgery in the field. ERR features state-of-the-art review articles, editorials, correspondence, and summaries of recent research findings and studies covering a wide range of topics including COPD, asthma, pulmonary hypertension, interstitial lung disease, lung cancer, tuberculosis, and pulmonary infections. Articles are published continuously and compiled into quarterly issues within a single annual volume.
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