P117 Clinical outcomes in people with difficult-to-control asthma using electronic monitoring to support medication adherence

Background Non adherence is common in difficult-to-control asthma, and can be identified using 7-day FeNO suppression testing where patients take additional fluticasone via Diskus™(Accuhaler) with an INCA™electronic monitoring device attached, and self-measure FeNO at home. However, this is inconvenient for patients attending a tertiary centre and limited by FeNO meter availability. It is not known if this approach alters clinical outcomes. Objectives and Methods To examine patient acceptability and the effectiveness of replacing usual combination inhaled corticosteroid (ICS)/long-acting b2-agonist (LABA) therapy with a fluticasone/salmeterol Diskus 500+INCA for 28 days, compared to the 7-day FeNO suppression test. Secondly, to explore the clinical outcomes of patients who have undertaken INCA monitoring. Results Twenty one of 23 subjects offered replacement of their usual ICS/LABA with fluticasone/salmeterol+ INCA accepted and completed 28 days of monitoring. Fourteen (66.6%) patients reduced their FeNO by >42% (FeNO suppressors), accompanied by improvements in FEV1, ACQ and blood eosinophils, similar to the 7-day test (n=74). At 1 year, 33.9% of FeNO suppressors progressed to treatment with a biologic therapy, compared to 72.7% of non suppressors (p=0.0005). FeNO suppressor patients taking maintenance prednisolone (n=13) reduced the median baseline dose from 10 mg to 3 mg, with further reductions limited by adrenal suppression. Conclusion Replacing existing inhaled therapy with fluticasone/salmeterol+INCA for at least 28 days is acceptable to the majority of patients with difficult-to-control asthma, and identifies prior medication non adherence. INCA monitoring coupled with clinical support potentially improves patient adherence and asthma control, and prevents unnecessary progression to biological therapy.