Yuan Zhou,1,* Yanming Lu,1,* Haojin Zhu,2 Yanhan Zhang,1 Yaqin Li,1 Qing Yu1 1Department of Pediatrics, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201112, People’s Republic of China; 2School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 201112, People’s Republic of China *These authors contributed equally to this work Objective: To explore the effect of a smart nebulizing device on the rate of adherence to inhaled corticosteroid (ICS) in children with positive Asthma Predictive Index. Methods: In total, 65 children with positive Asthma Predictive Index and under the age of 5 years who visited our hospital from October 2015 through October 2016, were randomly assigned to receive conventional nebulization or smart nebulization. The smart nebulizer was connected to smart phones via an App. The following information was collected: rate of adherence to ICS, frequency of emergency visits or hospitalizations, application of antibiotics or oral steroids, and wheezing progression or improvement. Results: The rate of adherence to ICS was 86.67% (26/30), 76.67% (23/30), and 67.33% (20/30) in the smart nebulization group, and 62.86% (22/35), 51.42% (18/35), and 40.00% (14/35) in the conventional nebulization group after 4-, 8-, and 12-week therapy, respectively. There were significant differences between the 2 groups at all of the time points (P<0.05). Both day- and night-time wheezing scores were significantly lower in the smart nebulization group than those of the conventional nebulization group after 4-, 8-, and 12-week therapy (P<0.05). The frequency of emergency visits, comorbidity of respiratory infection, antibiotics or systemic steroid usage, and therapeutic cost for additional treatment during the 12-week study period, was significantly lower in the smart nebulization group than that in the conventional nebulization group (P<0.05). Conclusion: A smart electronic nebulization device could significantly improve the rate of adherence to ICS in children under the age of 5 years, and thus could significantly reduce the frequency of emergency visits and respiratory infections as well as the usage of antibiotics or systemic steroids. Keywords: smart nebulizer, adherence, inhaled corticosteroid, wheezing