combination had no overall effect on the adherence of the small group of children in this study, who had existing high baseline rates. This was the first study to use reminder text messages on children with CF, whilst electronically monitoring adherence rates. The data from this study can be used to design future research studies, or this approach can be used in clinical practice and the patient outcomes audited at a departmental level. 7.4 Recommendations and policy change This thesis has shown that sub-optimal adherence to inhaled medication in childhood asthma and CF is a common and significant problem, resulting in detrimental consequences for both the patient and healthcare provider. Subjective methods of adherence monitoring are flawed, and therefore electronic monitoring is essential to record the most accurate rates possible. When guidelines written by the BTS, ICON, and the UK CF registry are updated, they should therefore emphasize the importance of electronic adherence monitoring. For children with poorly controlled asthma, we have shown that the use of these monitors with regular feedback in clinic can significantly reduce the rate of severe exacerbations. These outcomes have been achieved despite the realistic use and misuse of the devices by children in the clinical setting. The BTS has questioned the use of these devices due to their cost, but we have demonstrated that they are likely to be cost effective, even at current prices. With increased use and commercial competition, devices will become cheaper and make them even more financially viable. To optimise the effect and economic benefit of these devices, they should only be used in children with poorly controlled asthma, and if they are found to be ineffective due to breakage or increased patient non-attendance at clinic, they should be removed.
combination had no overall effect on the adherence of the small group of children in this study, who had existing high baseline rates. This was the first study to use reminder text messages on children with CF, whilst electronically monitoring adherence rates. The data from this study can be used to design future research studies, or this approach can be used in clinical practice and the patient outcomes audited at a departmental level. 7.4 Recommendations and policy change This thesis has shown that sub-optimal adherence to inhaled medication in childhood asthma and CF is a common and significant problem, resulting in detrimental consequences for both the patient and healthcare provider. Subjective methods of adherence monitoring are flawed, and therefore electronic monitoring is essential to record the most accurate rates possible. When guidelines written by the BTS, ICON, and the UK CF registry are updated, they should therefore emphasize the importance of electronic adherence monitoring. For children with poorly controlled asthma, we have shown that the use of these monitors with regular feedback in clinic can significantly reduce the rate of severe exacerbations. These outcomes have been achieved despite the realistic use and misuse of the devices by children in the clinical setting. The BTS has questioned the use of these devices due to their cost, but we have demonstrated that they are likely to be cost effective, even at current prices. With increased use and commercial competition, devices will become cheaper and make them even more financially viable. To optimise the effect and economic benefit of these devices, they should only be used in children with poorly controlled asthma, and if they are found to be ineffective due to breakage or increased patient non-attendance at clinic, they should be removed.
Rob_Morton_Thesis_Submission_December_2017.docx