Video directly observed therapy (v-DOT) for achieving and sustaining mastery of inhaler and nasal spray technique in children and young people: A randomised pilot study.

<bold>Background:</bold> Worryingly a large proportion of children and young people are not receiving the basics of asthma care. Education including empowering patients and their families to actively self-manage is fundamental. <bold>Methods:</bold> A randomised pilot study to compare a novel augmented teaching method (Video directly observed therapy (v-DOT)) with standard training in achieving and sustaining mastery of inhaler +/- nasal spray technique. Participants randomised 1:1 to v-DOT (intervention) or usual care (control). The intervention group immediately commenced on v-DOT and uploaded twice-daily videos. v-DOT continued until the patient had uploaded 3 consecutive days of correct technique. Usual care is up to 3 face to face appointments using teach back methodology in iterative cycles over approximately 8 weeks. <bold>Results:</bold> 45 patients recruited- 24 patients randomised to v-DOT and 21 patients randomised to usual care (control). Age range 1-14 years of age (mean age = 6 years). Recruitment rate 47%. The most common barrier to recruitment was lack of time. 19 patients on the v-DOT arm reached mastery of technique in 21 days or less. Mastery of technique defined as absence of healthcare professional detected errors. 71% of the children achieved moderate adherence to video uploads. 2 patients failed to achieve mastery of technique on v-DOT- both had poor adherence to video uploads. <bold>Conclusion:</bold> Using v-DOT to remotely observe at home technique and to provide next day daily feedback has facilitated children and young people achieving correct technique quicker. This work is funded by Asthma + Lung UK as part of AUKCAR and RBHSC charitable funds.