Video directly observed therapy to improve inhaler technique among pediatric patients with persistent asthma.

Objective: To assess the feasibility of at-home video directly observed therapy (vDOT) among pediatric patients with asthma to learn and retain proper inhaler technique.

Methods: We conducted a randomized pilot study with 22 children with persistent asthma aged 6-11 years who were newly prescribed an asthma controller inhaler. Patients underwent 1:1 randomization into one group receiving standard inhaler education during clinic and another receiving standard education plus vDOT for 30 days. vDOT is a method by which trained professionals observe patients self-administering medications through a virtual platform to monitor adherence and proper medication use. We measured inhaler technique, age-appropriate Asthma Control Test (ACT) score, symptom-free days, and healthcare utilization in both groups at 3 months.

Results: Median inhaler technique accuracy percentage score was 88% (IQR 66, 100) for vDOT participants compared to 75% (IQR 38, 88) for controls (p = 0.11). Technique errors within the vDOT group included inadequate breath-holding (34%), inadequate breathing technique (29%), incorrect/no shaking of inhaler (22%) and failure to rinse mouth (15%). There was no difference between groups in change in ACT score, resource utilization or controller prescription refill rates. In the first 30 days, the median number of days until vDOT participants had no observed technique errors was 10 days (range 0-25).

Conclusion: vDOT is a viable technique to provide initial and continual education and real-time feedback on inhaler technique after the initial education provided in clinic.