Systematic review: efficacy and characteristics of effective interventions to improve adherence to inhaled corticosteroids in children with asthma

A systematic review finds adherence interventions in children with asthma have mixed effectiveness

Researchers from the Asthma UK Centre for Applied Research have published a systematic review which aimed to understand the efficacy and characteristics of effective interventions to improve adherence to inhaled corticosteroids (ICS) in children with asthma.

Asthma is the most common non-communicable disease in children worldwide. Rates of asthma are higher in Europe than the rest of the world, but there is variation between countries. Good asthma control can be achieved with maintenance low-dose ICS. However, some children’s asthma remains poorly controlled despite being prescribed high-dose ICS treatment. The UK continues to have high rates of avoidable asthma deaths, with an important factor being low adherence to ICS in the month and/or year leading up to the death.

Many interventions have been developed to address the issue of poor ICS adherence in children. A recent systematic review has investigated:

• ICS interventions in children with asthma
• Quality indicators to identify those studies that may be more informative
• The characteristics of successful adherence interventions to identify features that may be relevant to practice

The Study

The literature review identified 25 randomised control trials for inclusion in the narrative synthesis. This was the first review to summarise effective interventions to increase adherence in children with asthma which has taken into account the reliability of studies and has highlighted commonly used behaviour change techniques which could be used in a clinically meaningful way.

The review also took into consideration the Perceptions and Practicalities Approach (PAPA) which are recommended by the National Institute for Health and Care Excellence national guidelines for adherence support. This review was the first to assess the PAPA approach in a paediatric setting. 

The researchers of the review also wanted to explore the relationship between behaviour change techniques and intervention efficacy.

Results

Only half of the included interventions were effective at significantly increasing adherence. Crucial factors for effective interventions to increase adherence that the review has found included:

• Of the 13 high-reliability intervention studies, nine were effective
• Tailoring to patient group is associated with higher effectiveness
• The use of technology can be a channel to deliver adherence interventions, but should be in combination with face-to-face contact with a healthcare professional
• The use of PAPA based interventions increased effectiveness
• Behaviour change techniques are important to consider when developing a tailored intervention for increasing adherence in children with asthma

Dr Christina Pearce, a former PhD student with the Centre, led on this systematic review. She believes this publication signals new directions for future interventions to improve adherence to ICS in children with asthma. She said:

Childhood intervention for optimal adherence to asthma medication can lead the way for more healthy adults. A great deal of research has been conducted to try to increase adherence. These studies sometimes limit their findings by the measurement of both adherence, the disease itself and targeting only perceptual or practical barriers to adherence. This paper highlights the relevance of using a combination of the two as suggested by the PAPA model. Tailoring of interventions and technology assistance should be prominent features of future interventions to ensure behaviour change in this group of patients.   

Read the paper

This publication is available in Pediatric Pulmonology

Cite as

Pearce, CJ, Chan, AHY, Jackson, T, et al. Features of successful interventions to improve adherence to inhaled corticosteroids in children with asthma: A narrative systematic review. Pediatric Pulmonology. 2022; 57: 822- 847. doi:10.1002/ppul.25838