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Browsing by Author "Amaral, R"

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  • Allergen Immunotherapy in MASK‐Air Users in Real‐Life: Results of a Bayesian Mixed‐Effects Model
    Publication . Sousa‐Pinto, B; Azevedo, LF; Sá‐Sousa, A; Vieira, RJ; Amaral, R; Klimek, L; Czarlewski, W; Anto, JM; Bedbrook, A; Kvedariene, V; Ventura, MT; Ansotegui, IJ; Bergmann, KC; Brussino, L; Canonica, GW; Cardona, V; Carreiro‐Martins, P; Casale, T; Cecchi, L; Chivato, T; Chu, DK; Cingi, C; Costa, EM; Cruz, AA; De Feo, G; Devillier, P; Fokkens, WJ; Gaga, M; Gemicioğlu, B; Haahtela, T; Ivancevich, JC; Ispayeva, Z; Jutel, M; Kuna, P; Kaidashev, I; Kraxner, H; Larenas‐Linnemann, DE; Laune, D; Lipworth, B; Louis, R; Makris, M; Monti, R; Morais‐Almeida, M; Mösges, R; Mullol, J; Odemyr, M; Okamoto, Y; Papadopoulos, NG; Patella, V; Pham‐Thi, N; Regateiro, FS; Reitsma, S; Rouadi, PW; Samolinski, B; Sova, M; Todo‐Bom, A; Taborda‐Barata, L; Tomazic, PV; Toppila‐Salmi, S; Sastre, J; Tsiligianni, I; Valiulis, A; Wallace, D; Waserman, S; Yorgancioglu, A; Zidarn, M; Zuberbier, T; Fonseca, JA; Bousquet, J; Pfaar, O
    Background: Evidence regarding the effectiveness of allergen immunotherapy (AIT) on allergic rhinitis has been provided mostly by randomised controlled trials, with little data from real-life studies. Objective: To compare the reported control of allergic rhinitis symptoms in three groups of users of the MASK-air® app: those receiving sublingual AIT (SLIT), those receiving subcutaneous AIT (SCIT), and those receiving no AIT. Methods: We assessed the MASK-air® data of European users with self-reported grass pollen allergy, comparing the data reported by patients receiving SLIT, SCIT and no AIT. Outcome variables included the daily impact of allergy symptoms globally and on work (measured by visual analogue scales-VASs), and a combined symptom-medication score (CSMS). We applied Bayesian mixed-effects models, with clustering by patient, country and pollen season. Results: We analysed a total of 42,756 days from 1,093 grass allergy patients, including 18,479 days of users under AIT. Compared to no AIT, SCIT was associated with similar VAS levels and CSMS. Compared to no AIT, SLIT-tablet was associated with lower values of VAS global allergy symptoms (average difference = 7.5 units out of 100; 95% credible interval [95%CrI] = -12.1;-2.8), lower VAS Work (average difference = 5.0; 95%CrI = -8.5;-1.5), and a lower CSMS (average difference = 3.7; 95%CrI = -9.3;2.2). When compared to SCIT, SLIT-tablet was associated with lower VAS global allergy symptoms (average difference = 10.2; 95%CrI = -17.2;-2.8), lower VAS Work (average difference = 7.8; 95%CrI = -15.1;0.2), and a lower CSMS (average difference = 9.3; 95%CrI = -18.5;0.2). Conclusion: In patients with grass pollen allergy, SLIT-tablet, when compared to no AIT and to SCIT, is associated with lower reported symptom severity. Future longitudinal studies following internationally-harmonised standards for performing and reporting real-world data in AIT are needed to better understand its 'real-world' effectiveness.
    2022Journal article Open access Show more
  • Behavioural Patterns in Allergic Rhinitis Medication in Europe: A Study Using MASK‐Air ® Real‐World Data
    Publication . Sousa‐Pinto, B; Sá‐Sousa, A; Vieira, RJ; Amaral, R; Klimek, L; Czarlewski, W; Antó, JM; Pfaar, O; Bedbrook, A; Kvedariene, V; Ventura, MT; Ansotegui, IJ; Bergmann, KC; Brussino, L; Canonica, GW; Cardona, V; Carreiro‐Martins, P; Casale, T; Cecchi, L; Chivato, T; Chu, DK; Cingi, C; Costa, EM; Cruz, AA; De Feo, G; Devillier, P; Fokkens, WJ; Gaga, M; Gemicioğlu, B; Haahtela, T; Ivancevich, JC; Ispayeva, Z; Jutel, M; Kuna, P; Kaidashev, I; Kraxner, H; Larenas‐Linnemann, DE; Laune, D; Lipworth, B; Louis, R; Makris, M; Monti, R; Morais‐Almeida, M; Mösges, R; Mullol, J; Odemyr, M; Okamoto, Y; Papadopoulos, NG; Patella, V; Pham‐Thi, N; Regateiro, FS; Reitsma, S; Rouadi, PW; Samolinski, B; Sova, M; Todo‐Bom, A; Taborda‐Barata, L; Tomazic, PV; Toppila‐Salmi, S; Sastre, J; Tsiligianni, I; Valiulis, A; Vandenplas, O; Wallace, D; Waserman, S; Yorgancioglu, A; Zidarn, M; Zuberbier, T; Fonseca, JA; Bousquet, J
    Background: Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. Methods: We analysed 2015-2020 MASK-air® European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1 year. Results: We analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p < .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H1 -antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more. Conclusions: Allergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.
    2022Journal article Open access Show more
  • Comparison of Rhinitis Treatments Using MASK-air ® Data and Considering the Minimal Important Difference
    Publication . Sousa‐Pinto, B; Schünemann, HJ; Sá‐Sousa, A; Vieira, RJ; Amaral, R; Anto, JM; Klimek, L; Czarlewski, W; Mullol, J; Pfaar, O; Bedbrook, A; Brussino, L; Kvedariene, V; Larenas‐Linnemann, D; Okamoto, Y; Ventura, MT; Agache, I; Ansotegui, IJ; Bergmann, KC; Bosnic‐Anticevich, S; Brozek, J; Canonica, GW; Cardona, V; Carreiro‐Martins, P; Casale, T; Cecchi, L; Chivato, T; Chu, DK; Cingi, C; Costa, EM; Cruz, AA; Del Giacco, S; Devillier, P; Eklund, P; Fokkens, WJ; Gemicioglu, B; Haahtela, T; Ivancevich, JC; Ispayeva, Z; Jutel, M; Kuna, P; Kaidashev, I; Khaitov, M; Kraxner, H; Laune, D; Lipworth, B; Louis, R; Makris, M; Monti, R; Morais‐Almeida, M; Mösges, R; Niedoszytko, M; Papadopoulos, NG; Patella, V; Pham‐Thi, N; Regateiro, FS; Reitsma, S; Rouadi, PW; Samolinski, B; Sheikh, A; Sova, M; Todo‐Bom, A; Taborda‐Barata, L; Toppila‐Salmi, S; Sastre, J; Tsiligianni, I; Valiulis, A; Vandenplas, O; Wallace, D; Waserman, S; Yorgancioglu, A; Zidarn, M; Zuberbier, T; Fonseca, JA.; Bousquet, J
    Background: Different treatments exist for allergic rhinitis (AR), including pharmacotherapy and allergen immunotherapy (AIT), but they have not been compared using direct patient data (i.e., "real-world data"). We aimed to compare AR pharmacological treatments on (i) daily symptoms, (ii) frequency of use in co-medication, (iii) visual analogue scales (VASs) on allergy symptom control considering the minimal important difference (MID) and (iv) the effect of AIT. Methods: We assessed the MASK-air® app data (May 2015-December 2020) by users self-reporting AR (16-90 years). We compared eight AR medication schemes on reported VAS of allergy symptoms, clustering data by the patient and controlling for confounding factors. We compared (i) allergy symptoms between patients with and without AIT and (ii) different drug classes used in co-medication. Results: We analysed 269,837 days from 10,860 users. Most days (52.7%) involved medication use. Median VAS levels were significantly higher in co-medication than in monotherapy (including the fixed combination azelastine-fluticasone) schemes. In adjusted models, azelastine-fluticasone was associated with lower average VAS global allergy symptoms than all other medication schemes, while the contrary was observed for oral corticosteroids. AIT was associated with a decrease in allergy symptoms in some medication schemes. A difference larger than the MID compared to no treatment was observed for oral steroids. Azelastine-fluticasone was the drug class with the lowest chance of being used in co-medication (adjusted OR = 0.75; 95% CI = 0.71-0.80). Conclusion: Median VAS levels were higher in co-medication than in monotherapy. Patients with more severe symptoms report a higher treatment, which is currently not reflected in guidelines.
    2022Journal article Open access Show more
  • Consistent Trajectories of Rhinitis Control and Treatment in 16,177 Weeks: The MASK‐air® Longitudinal Study
    Publication . Sousa‐Pinto, B; Schünemann, HJ; Sá‐Sousa, A; Vieira, RJ; Amaral, R; Anto, JM; Klimek, L; Czarlewski, W; Mullol, J; Pfaar, O; Bedbrook, A; Brussino, L; Kvedariene, V; Larenas‐Linnemann, DE; Okamoto, Y; Ventura, MT; Agache, I; Ansotegui, IJ; Bergmann, KC; Bosnic‐Anticevich, S; Canonica, GW; Cardona, V; Carreiro‐Martins, P; Casale, T; Cecchi, L; Chivato, T; Chu, DK; Cingi, C; Costa, EM; Cruz, AA; Del Giacco, S; Devillier, P; Eklund, P; Fokkens, WJ; Gemicioglu, B; Haahtela, T; Ivancevich, JC; Ispayeva, Z; Jutel, M; Kuna, P; Kaidashev, I; Khaitov, M; Kraxner, H; Laune, D; Lipworth, B; Louis, R; Makris, M; Monti, R; Morais‐Almeida, M; Mösges, R; Niedoszytko, M; Papadopoulos, NG; Patella, V; Pham‐Thi, N; Regateiro, FS; Reitsma, S; Rouadi, PW; Samolinski, B; Sheikh, A; Sova, M; Todo‐Bom, A; Taborda‐Barata, L; Toppila‐Salmi, S; Sastre, J; Tsiligianni, I; Valiulis, A; Vandenplas, O; Wallace, D; Waserman, S; Yorgancioglu, A; Zidarn, M; Zuberbier, T; Fonseca, JA; Bousquet, J
    Introduction: Data from mHealth apps can provide valuable information on rhinitis control and treatment patterns. However, in MASK-air®, these data have only been analyzed cross-sectionally, without considering the changes of symptoms over time. We analyzed data from MASK-air® longitudinally, clustering weeks according to reported rhinitis symptoms. Methods: We analyzed MASK-air® data, assessing the weeks for which patients had answered a rhinitis daily questionnaire on all 7 days. We firstly used k-means clustering algorithms for longitudinal data to define clusters of weeks according to the trajectories of reported daily rhinitis symptoms. Clustering was applied separately for weeks when medication was reported or not. We compared obtained clusters on symptoms and rhinitis medication patterns. We then used the latent class mixture model to assess the robustness of results. Results: We analyzed 113,239 days (16,177 complete weeks) from 2590 patients (mean age ± SD = 39.1 ± 13.7 years). The first clustering algorithm identified ten clusters among weeks with medication use: seven with low variability in rhinitis control during the week and three with highly-variable control. Clusters with poorly-controlled rhinitis displayed a higher frequency of rhinitis co-medication, a more frequent change of medication schemes and more pronounced seasonal patterns. Six clusters were identified in weeks when no rhinitis medication was used, displaying similar control patterns. The second clustering method provided similar results. Moreover, patients displayed consistent levels of rhinitis control, reporting several weeks with similar levels of control. Conclusions: We identified 16 patterns of weekly rhinitis control. Co-medication and medication change schemes were common in uncontrolled weeks, reinforcing the hypothesis that patients treat themselves according to their symptoms.
    2023Journal article Open access Show more
  • Deficiência Mental: Casuística da Unidade de Desenvolvimento do Hospital de Dona Estefânia
    Publication . Amaral, R; Pinto, M; Pimentel, MJ; Martins, M; Vale, MC
    Segundo a DSM IV a Deficiência Mental (DM) define-se como o funcionamento intelectual global inferior à média (QI < 70) associado a perturbações do comportamento adaptativo com início antes dos 18 anos. Procurou-se caracterizar retrospectivamente a população de crianças com DM observadas no Centro de Desenvolvimento do Hospital de Dona Estefânia (CDHDE), entre Janeiro 2005 e Junho 2007. Foram avaliados os dados epidemiológicos, gravidade, etiologia, co-morbilidade e intervenção proposta. Do total de 232 processos clínicos observados, 185 apresentavam DM. Classificaram-se em DM ligeira 112 (61%), DM moderada 54 (29%), DM grave 17 (9%) e profunda 2 (1%). Foram definidas etiologias em 86 crianças (46%) sendo a taxa de diagnóstico mais elevada na DM de maior gravidade. Observou-se uma elevada variabilidade de etiologias: as mais frequentemente encontradas foram as doenças genéticas, prematuridade e patologia associada. Foi detectada co-morbilidade em 123 crianças (66%), sendo a mais frequente as do foro oftalmológico (57 crianças, 46%). Foram propostas e sinalizadas para apoio a totalidade das crianças com DM, 47% em intervenção precoce e 58% em educação especial, das quais 5% usufruiram, por curto período, do apoio simultaneo de educadora de Intervenção Precoce e de docente do Ensino Especial, durante o período inicial de integração em jardim de infância. Observou-se um predomínio do sexo masculino. Foi efectuada caracterização clínica e funcional das crianças seguidas no CDHDE com o diagnóstico de DM e encontraram-se semelhanças entre os dados presentes e os descritos na literatura. Contudo alguns dados diferem de outras casuísticas decorrente, muito provavelmente decorrente da heterogeneidade da população estudada, quer do ponto de vista etiológico, quer no referente aos grupos etários, provavelmente condicionada, pela política assistencial.
    2010Journal article Open access Show more
  • Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies
    Publication . Neves, AL; Jácome, C; Taveira-Gomes, T; Pereira, AM; Prates, S; Almeida, R; Amaral, R
    Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ≤40 years old (66.4%), had at least 10 years of education (57.4%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1%) and the prevalence of anxiety and depression was 34.3% and 11.9%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95%CI 1.05-4.75 and aOR 1.95, 95%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95%CI 2.90-17.40), 10.30 (95%CI 4.28-27.56), and 11.52 (95%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use.
    2021Journal article Open access Show more
  • Digitally‐Enabled, Patient‐Centred Care in Rhinitis and Asthma Multimorbidity: The ARIA‐MASK‐air ® Approach
    Publication . Bousquet, J; Anto, JM; Sousa‐Pinto, B; Czarlewski, W; Bedbrook, A; Haahtela, T; Klimek, L; Pfaar, O; Kuna, P; Kupczyk, M; Regateiro, FS; Samolinski, B; Valiulis, A; Yorgancioglu, A; Arnavielhe, S; Basagaña, X; Bergmann, KC; Bosnic‐Anticevich, S; Brussino, L; Canonica, GW; Cardona, V; Cecchi, L; Chaves‐Loureiro, C; Costa, E; Cruz, AA; Gemicioglu, B; Fokkens, W; Ivancevich, JC; Kraxner, H; Kvedariene, V; Larenas‐Linnemann, DE; Laune, D; Louis, R; Makris, M; Maurer, M; Melén, E; Micheli, Y; Morais‐Almeida, M; Mullol, J; Niedoszytko, M; Okamoto, Y; Papadopoulos, NG; Patella, V; Pham‐Thi, N; Rouadi, PW; Sastre, J; Scichilone, N; Sheikh, A; Sofiev, M; Taborda‐Barata, L; Toppila‐Salmi, S; Tsiligianni, I; Valovirta, E; Ventura, MT; Vieira, RJ; Zidarn, M; Amaral, R; Ansotegui, IJ; Bédard, A; Benveniste, S; Bewick, M; Bindslev‐Jensen, C; Blain, H; Bonini, M; Bourret, R; Braido, F; Carreiro‐Martins, P; Charpin, D; Cherrez‐Ojeda, I; Chivato, T; Chu, DK; Cingi, C; Del Giacco, S; de Blay, F; Devillier, P; De Vries, G; Doulaptsi, M; Doyen, V; Dray, G; Fontaine, JF; Gomez, RM; Hagemann, J; Heffler, E; Hofmann, M; Jassem, E; Jutel, M; Keil, T; Kritikos, V; Kull, I; Kulus, M; Lourenço, O; Mathieu‐Dupas, E; Menditto, E; Mösges, R; Murray, R; Nadif, R; Neffen, H; Nicola, S; O’Hehir, R; Olze, H; Palamarchuk, Y; Pépin, JL; Pétré, B; Picard, R; Pitsios, C; Puggioni, F; Quirce, S; Raciborski, F; Reitsma, S; Roche, N; Rodriguez‐Gonzalez, M; Romantowski, J; Sá‐Sousa, A; Serpa, FS; Savouré, M; Shamji, MH; Sova, M; Sperl, A; Stellato, C; Todo‐Bom, A; Tomazic, PV; Vandenplas, O; Van Eerd, M; Vasankari, T; Viart, F; Waserman, S; Fonseca, JA; Zuberbier, T
    MASK-air® , a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.
    2023Journal article Open access Show more
  • Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study
    Publication . Jácome, C; Almeida, R; Pereira, AM; Amaral, R; Mendes, S; Alves-Correia, M; Vidal, C; López Freire, S; Méndez Brea, P; Araújo, L; Couto, M; Antolín-Amérigo, D; de la Hoz Caballer, B; Barra Castro, A; Gonzalez-De-Olano, D; Todo Bom, A; Azevedo, J; Leiria Pinto, P; Pinto, N; Castro Neves, A; Palhinha, Ana; Todo Bom, F; Costa, A; Chaves Loureiro, C; Maia Santos, L; Arrobas, A; Valério, M; Cardoso, J; Emiliano, M; Gerardo, R; Cidrais Rodrigues, JC; Oliveira, G; Carvalho, J; Mendes, A; Lozoya, C; Santos, N; Menezes, F; Gomes, R; Câmara, R; Rodrigues Alves, R; Moreira, AS; Bordalo, D; Alves, C; Ferreira, JA; Lopes, C; Silva, D; Vasconcelos, MJ; Teixeira, MF; Ferreira-Magalhães, M; Taborda-Barata, L; Cálix, MJ; Alves, A; Almeida Fonseca, J
    Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.
    2021-05-25Journal article Open access Show more
  • Measuring Adherence to Inhaled Control Medication in Patients with Asthma: Comparison Among an Asthma App, Patient Self‐Report and Physician Assessment
    Publication . Cachim, A; Pereira, AM; Almeida, R; Amaral, R; Alves‐Correia, M; Vieira‐Marques, P; Chaves‐Loureiro, C; Ribeiro, C; Cardia, F; Gomes, J; Vidal, C; Silva, E; Rocha, S; Rocha, D; Marques, ML; Páscoa, R; Morais, D; Cruz, AM; Santalha, M; Simões, JA; da Silva, S; Silva, D; Gerardo, R; Todo Bom, F; Morete, A; Vieira, I; Vieira, P; Monteiro, R; Raimundo, MR; Monteiro, L; Neves, Â; Santos, C; Penas, AM; Regadas, R; Varanda Marques, J; Rosendo, I; Abreu Aguiar, M; Fernandes, S; Seiça Cardoso, C; Pimenta, F; Meireles, P; Gonçalves, M; Almeida Fonseca, J; Jácome, C
    Background: Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. Methods: This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). Results: A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). Conclusions: Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.
    2023Journal article Open access Show more
  • Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies
    Publication . Jácome, C; Almeida, R; Pereira, AM; Amaral, R; Vieira-Marques, P; Mendes, S; Alves-Correia, M; Ferreira, JA; Lopes, I; Gomes, J; Araújo, L; Couto, M; Chaves Loureiro, C; Maia Santos, L; Arrobas, A; Valério, M; Todo Bom, A; Azevedo, J; Teixeira, MF; Ferreira-Magalhães, M; Leiria Pinto, P; Pinto, N; Castro Neves, A; Morête, A; Todo Bom, F; Costa, A; Silva, D; Vasconcelos, MJ; Falcão, H; Marques, ML; Mendes, A; Cardoso, J; Cidrais Rodrigues, JC; Oliveira, G; Carvalho, J; Lozoya, C; Santos, N; Menezes, F; Gomes, R; Câmara, R; Rodrigues Alves, R; Moreira, AS; Abreu, C; Silva, R; Bordalo, D; Alves, C; Lopes, C; Taborda-Barata, L; Fernandes, RM; Ferreira, R; Chaves-Loureiro, C; Cálix, MJ; Alves, A; Almeida Fonseca, J
    Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support. Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use. Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use. Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen. Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.
    2021Journal article Open access Show more