OBJECTIVES : Suboptimal adherence to inhaled corticosteroids is the most common reason for treatment failure in asthma. In clinical practice, patient self-reporting offers a simple, inexpensive method of assessing adherence, but typically over-estimates it. The Centre for Evidence-Based Medicine published a risks and considerations document relating to asthma and COVID-19, describing how smartinhalers may allow remote monitoring of compliance. This is particularly relevant given the NICE rapid guidance on severe asthma during COVID-19, where one of the recommendations was to give consideration to remote monitoring. This poster aims to explore the scale of the problem posed by non-adherence in asthma, and the key role of improving adherence measurement.

METHODS : A targeted literature review was conducted in standard, recommended search engines – including Medline, Embase, Cochrane and the Health Technology Assessment (HTA) database. This was combined with a range of case studies and other articles. The review included both the scale of the problem non-adherence poses in asthma, and the current techniques used to measure adherence.

RESULTS : Studies reviewed identified a clear disparity between existing measures of adherence, and the objective underlying adherence. For example, Jochmann et al (2017) found there is no correlation between electronic monitoring and records for uptake of prescription. Understanding the extent of non-adherence is critical to interventions and improvement. Analysis of four adult studies concluded that a 25% increase in adherence was associated with an approximately 10% reduction in severe exacerbations.

CONCLUSIONS : It is clear that non-adherence and measuring it is a significant issue in asthma. With the shift towards expensive biological treatments, it is important that the ability to measure and manage adherence is at the core of asthma management in order for therapies to be optimised. Furthermore, given the pressure on health systems posed by COVID-19, the role of remote monitoring in asthma is increasingly important.