Mobile Direct Observed Therapy (MDOT) for Inhaler Therapy in Children With Newly Diagnosed Asthma: A Pilot Study.

Abstract

Objective: We aimed to assess the acceptability of Mobile Direct Observed Therapy (MDOT) amongst the parents/caregivers of children with asthma.

Methods: This open-label pilot randomized controlled trial enrolled newly diagnosed children aged 5-15 years with asthma, who were followed up telephonically for six weeks. Parents of children in the intervention arm were requested to record a video of the metered dose inhaler with spacer (MDI-S) technique of their child on a mobile phone and share it through WhatsApp with investigator who then provided corrective measures as required by a text/video message. The children in the control arm continued follow-up telephonically without exchange of any videos for six weeks. The primary outcome measures were the acceptability of MDOT and the effect of such interaction on the correctness of the MDI-S technique. Secondary outcome measures were the level of asthma control as per GINA guidelines and the caregivers' perception and feedback about MDOT.

Results: A total of 30 children were enrolled, 15 in each arm. Thirteen (86%) parents uploaded good-quality videos. The average number of incorrect steps decreased from 2.64 in the first video to 0.18 after the fourth video and nil after the fifth video in the MDOT group. At six weeks of follow-up, the average number of incorrect steps was significantly lower in the MDOT group compared to the control group (0 vs 2.9; P < 0.001). The proportion of children having controlled asthma was better in the MDOT group compared to controls (85% vs 70%) (P = 0.39). All parents liked MDOT.

Conclusion: MDOT was well accepted by caregivers of children with asthma and was helpful in improving the MDI-S technique.