The Effect Of Intelligent Device On The Adherence And Efficacy Of ICS Treatment In Asthma Predictive Index-positive Children With Wheezing

Background and objective Wheezing is a common clinical symptom of children under 5 years,the incidence of wheezing gradually increased in recent years.Asthma predictor Index(API)can accurately predict the possibility of progressive asthma in children under 5 years with recurrent wheezing.API-positive children early giving standardization of asthma treatment,can protect children’s lung function,improve children’s quality of life.The Long-term inhaled corticosteroids(ICS)is the first choice for the prevention and control of children under 5 years with recurrent wheezing,its standardized treatment involving adherence,poor adherence is the important reason lead to poor control of wheezing symptoms.The aim of this study was to investigate the effect of intelligent device on the adherence and efficacy of ICS treatment in asthma predictive index-positive children with wheezing.Methods A total of 65 API-positive Children under 5 years with recurrent wheezing who had been treated in the Department of Pediatrics at the the Affiliated Renji Hospital of Shanghai Jiaotong University School of Medicine from October 2015 to October 2016 were recruited.The children who were enrolled in the group were randomly divided into intelligent atomization inhalation group(n=30)and routine atomization inhalation group(n=35),in which the intelligent atomization group was equipped with intelligent device.Two groups using air compression pump models for the Omron or Berry manufacturing products,In the first week were given the budesonide suspension liquid and bricanyl and ipratropium bromide aerosol atomization inhalation therapy,From 2 to 12 weeks,two groups were given the budesonide suspension liquid atomization inhalation therapy.Observed the adherence and efficacy of ICS treatment for a period of 12 weeks.Results(1)Adherence:the adherence rate of intelligent atomization inhalation group was 86.67%,76.67%,66.67%with 4 weeks,8 weeks and 12 weeks of ICS treatment,compared with the routine atomization inhalation group,the adherence rate was62.86%,51.42%,40.00%,difference were statistically significant(χ~2=4.471,P<0.05;χ~2=4.418,P<0.05;χ~2=4.605,P<0.05).(2)Daytime and nighttime asthma symptom:daytime and nighttime asthma symptom score in the intelligent atomization inhalation group were lower than that of the routine atomization inhalation group after 4weeks,8 weeks and 12 weeks of ICS treatment(P<0.05).(3)Clinical control situation:the control rate of intelligent atomization inhalation group was reached 80%,while the routine atomization inhalation group was57.14%,control rate of intelligent atomization inhalation group was significantly better than the routine atomization inhalation group after 12 weeks of ICS treatment(P<0.05).(4)The situation of acute attack of wheezing:there were 12 children in the intelligent atomization group with 15 times of wheezing,13 times of mild episodes and 2 times of episodes.16 children in the routine atomization group had 22 times of wheezing,12times of mild episodes and 10 times of episodes.The total frequency and severity of acute attack of wheezing in the intelligent atomization inhalation group was significantly less than that of the routine atomization inhalation group after 12 weeks of ICS treatment(χ~2=4.77,P<0.05).(5)The situation of the number of emergency treatment and respiratory infections,the use of antibiotic and systemic hormone,hospitalization and the medical expenses:the number of mergency treatment and respiratory infections,the use of antibiotic and systemic hormone and the medical expenses in the intelligent atomization inhalation group were less than that of the routine atomization inhalation group after 12 weeks of ICS treatment(P<0.05).(6)The main reasons for children with poor adherence are concerned about the adverse reaction of inhaled glucocorticoids,drug withdrawal immediately after symptoms relieved,forgotten using drugs,other reasons include:not regularly back to the hospital referra,the high cost of drugs and efficacy improved not obviously.(7)Adverse reaction:it showed no serious adverse systemic or local occurrence during the ICS treatment.Conclusions The use of intelligent advice can significantly improve the adherence of ICS treatment in children with recurrent wheezing can improve children’s daytime and nighttime asthma symptoms;improve the control level of whezzing;reduce the frequency and severity of acute attack of asthma;reduce the number of mergency treatment and respiratory infections,antibiotic and systemic hormone use and the medical expenses in children with recurrent wheezing,worthy of attention by clinicians.