Improving Inhaler Adherence in a Clinical Trial Through the Use of the Nebulizer Chronolog (12)

Moreover smokers in the feedback condition compared with those in the control condition had a significantly higher mean percentage of sets with two actuations (mean, 76.3 vs 52.5; p = 0.0004), a higher mean percentage of prescribed actuations (mean 84.5 vs 62.5; p = 0.0005) and a nonsignificant trend in mean chronolog sets per day (mean, 1.51 vs 1.33; p = 0.51). Thus, despite the difference in success in quitting smoking between the control and feedback groups, the feedback condition itself was associated with better adherence to prescribed patterns of MDI use independent of smoking status.
At baseline, more control than feedback participants exhibited acute bronchodilator responsiveness (ie, >10 percent improvement in FEVi within 10 min after aerosol bronchodilator therapy) and had marginally lower lung function (more obstruction). We are unable to account for the differences in bronchodilator response between the two groups. The sequential enrollment into the two groups raises the possibility that there was some secular trend in bronchodilator response, such as the presence of aeroallergens, environmental irritants, or respiratory infections, or some systematic trend in the testing procedures. If the greater acute response to inhaled bronchodilator treatment was perceived by the control participants with slightly lower lung function, it is possible that this perception of greater benefit from those with active medication might have introduced a bias favoring greater adherence to prescribed inhaler use among the control subjects. On the other hand, the opposite result was observed. Therefore, if any bias were introduced by the differential lung function and acute bronchodilator responsiveness in the two groups of subjects, our data may underestimate the effectiveness of electronic medication monitoring in enhancing compliance to the prescribed regimen.