Ye SunFollow

Date of Completion


Embargo Period



Dr. Jane Ungemack, Dr. Jessica Hollenbach, Dr. Chia-Ling Kuo

Field of Study

Public Health


Master of Public Health

Open Access

Open Access


Objective – Non-adherence to asthma medication is a common problem in patients with asthma, especially in children, leading to more frequent asthma exacerbations, ED visits and hospital admissions. Current methods of assessing adherence are unreliable. Electronic monitoring devices (EMDs) are more accurate means of assessing for adherence, but little is known about whether EMDs have a sustained effect on adherence in children. The objective of this study is to determine whether a mobile-based reminder system paired with EMD scan result in sustained improvement in adherence to asthma therapy over six months.

Methods – Children (8-17 years) with physician-confirmed persistent asthma, managed through the pulmonary division of Connecticut Children’s Medical Center, treated with a compatible daily inhaled corticosteroid, and with access to a smartphone were enrolled and randomized 2:1 to the intervention (EMD) or control (standard care) groups. Participants were followed at 3 and 6-months after enrollment. The intervention consists of the BreatheSmart EMD (one for controller and one for rescue inhaler) synced with a mobile application that sends reminders and captures adherence data in real time. The primary outcome was adherence assessed as proportion of days covered (PDC) based on pharmacy refill among children in the intervention group compared to control after 6 months. Secondary outcome was adherence based on EMD data.

Results – 41 patients (29 in intervention, 12 in control) were enrolled. Adherence rates based on pharmacy refill at 6 months did not show any statistical significance between the intervention group compared to the control group (41% vs 31%, respectively; p=0.21). Average adherence rate at 6 months based on EMDs for the intervention group (n=26) was 27.4%. While there was an initial high rate of adherence immediately after enrollment, adherence rates dropped significantly over the span of the 6 months.

Conclusion— Preliminary data suggest that adherence to controller therapy is no different among children utilizing an EMD with daily reminders when compared to a similar group of children receiving standard care. Despite an initial high rate of adherence with implementation of the intervention, such rates of adherence were not sustainable after 6 months.

Major Advisor

Dr. Jane Ungemack