Paying teenagers to use their inhalers did not significantly raise adherence

Design

Pilot randomised controlled trial with electronic adherence monitoring

Population

32 young people aged 11 to 17 with asthma after an emergency attendance for severe exacerbation

Primary outcome

Inhaled corticosteroid adherence at 12 weeks, plus feasibility

Effect

Median adherence 73.0% vs 56.0% (p = 0.077); both groups fell afterwards to 39.0% and 31.5%

A pilot randomised trial recruited 32 young people aged 11 to 17 with asthma and a recent emergency visit for a severe exacerbation, all on inhaled corticosteroids and with a smartphone. Everyone used an electronic inhaler monitor with twice-daily reminders. Half were paid £1 for each complete morning and evening dose for 12 weeks, up to £168.

Median adherence at 12 weeks was 73.0% with incentives and 56.0% without, which did not reach significance (p = 0.077). After the incentive period, adherence fell significantly in both groups, to 39.0% and 31.5%. Recruitment was slow and the technology was a problem.

The pilot was not powered to detect a difference, so it neither confirms nor rules out benefit. It does show that adherence in teenagers after a severe attack is low, and that any gain from payments faded once they stopped.

• Assume adherence is lower than reported in teenagers after a severe exacerbation, and ask about it without judgement
• Review inhaler technique and the simplest possible regimen at each visit
• Check for barriers such as cost, school access and fear of side effects
• Reminders alone were not enough in this pilot's control arm
• Do not plan a payment scheme on this evidence

Why it matters

Poor adherence after an emergency visit is a common reason for repeat attacks.

Don't overread it

The pilot was too small to judge effectiveness, and it used English-speaking teenagers with smartphones.

The statistics, in plain English

A p-value of 0.077 in a 32-person pilot reflects too few participants to tell, not necessarily no effect. The median difference of 17 percentage points is the kind of gap a larger trial might confirm or refute.

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