To Determine the Efficacy of Mobile Direct Observed Therapy for Preventive Therapy in Children with Recurrent Wheeze

Abstract

Background: Recurrent wheeze in young children often requires preventive therapy, but caregiver-dependent medication administration and incorrect inhaler technique can compromise adherence. Mobile Direct Observed Therapy (MDOT) permits remote observation of medication administration and feedback on inhaler technique.

Aim: To determine the efficacy of mobile Directly Observed Therapy vs routine follow up for preventive therapy in children with recurrent wheeze in pediatric department of Northern Railway Central Hospital, New Delhi

Objective: To compare adherence to preventive therapy and clinical outcomes in children with recurrent wheeze receiving MDOT-supported follow-up versus conventional follow-up.

Methods: This prospective comparative cohort study included 80 children aged 6 months to 5 years with recurrent wheeze who were newly initiated on preventive therapy. Forty children received MDOT-supported follow-up and 40 received conventional care. In the MDOT cohort, caregivers submitted videos of therapy administration daily for the first week and weekly thereafter; healthcare providers reviewed the videos and provided reminders and corrective feedback. The conventional cohort received routine telephonic follow-up. Participants were assessed at 4, 8, and 12 weeks.

Results: Mean adherence was higher in the MDOT cohort than in the conventional cohort at 4 weeks (92.4 ± 6.8% vs 71.3 ± 11.2%), 8 weeks (90.1 ± 8.4% vs 68.2 ± 13.9%), and 12 weeks (88.5 ± 9.6% vs 65.4

± 15.1%; P<0.001 at all time points). At 12 weeks, good adherence (≥80%) was observed in 77.5% versus 27.5% (P<0.001), and correct inhaler technique in 90.0% versus 60.0% (P=0.002). The MDOT cohort also had fewer wheezing episodes (0.8 ± 0.6 vs 1.6 ± 0.8; P<0.001), lower rescue bronchodilator use (1.3

± 0.9 vs 2.8 ± 1.2 per week; P<0.001), and a greater proportion with well-controlled symptoms (75.0% vs 45.0%; P=0.018) at 12 weeks. No emergency visit occurred in 77.5% versus 52.5% (P=0.019), and no hospital admission occurred in 87.5% versus 67.5% (P=0.031).

Conclusion: MDOT-supported follow-up was associated with higher adherence, better inhaler technique, and better short-term clinical outcomes than conventional follow-up in children with recurrent wheeze.

Larger randomized studies with longer follow-up and comparable adherence measurement methods are warranted.