Assessing adherence to inhaled therapies in asthma and the emergence of electronic monitoring devices

Abstract

Infrequent use of inhaled corticosteroids (ICS) and/or over-reliance of short-acting β-agonists (SABA) are recognised as key contributors to increased morbidity and mortality in asthma. The most frequent measures of ICS adherence and SABA use rely on patient-reported questionnaires or prescription refill records, neither of which are considered sufficiently reliable. Technological advancements in the development of electronic monitoring of inhaler devices allow for monitoring of use, as well as recording of and feedback on inhaler technique for some devices. Most electronic monitoring devices (EMDs) are paired with a smartphone application, allowing patients to set reminders and display both preventer and reliever use over time. This allows identification of intentional and unintentional ICS non-adherence as well as frequency of SABA use. This information assists clinicians in distinguishing difficult-to-control from severe asthma. Although additional evidence is required to assess the impact of EMDs on clinical outcome measures such as exacerbation rate, the introduction of EMDs into the asthma armoury is a significant step forward in asthma care with the potential to improve asthma-related outcomes.

Clinical Impact of Electronic Monitoring Devices of Inhalers in Adults with Asthma or COPD: A Systematic Review and Meta-Analysis

“…A high degree of variability is inherent in the development of new technologies. In our review, we found 10 different EMDs, in line with previous literature [ 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Technological differences between their inhaler sensors should not pose a differential problem as they are validated systems.…”

“…However, some studies on children have found fewer exacerbations requiring oral corticosteroids at 12 months [ 67 ]. With this in mind, adherence management would be the primary goal of EMDs due to the nature of the data collected by the sensors, but there is a need for further research to assess their real clinical benefits in terms of other health outcomes or to what extent it would be useful to implement specific additional interventions linked to these programmes as a global strategy [ 35 ].…”

“…For example, its employment has been related to a reduction in the use of rescue inhalers, improved results of the Asthma Control Test (ACT), increased rescue inhaler-free days and increased adherence to inhalers [ 23 , 24 , 25 , 26 , 27 , 28 ]. There have been some interesting efforts to summarize the characteristics of EMDs but some of them focus on functionalities, while others are literature or scoping reviews targeting technological interventions in a broad sense or including different types of patients (e.g., paediatrics and adults) that mostly include data from conference abstracts [ 29 , 30 , 31 , 32 , 33 , 34 , 35 ] rather than complete, peer-reviewed articles. Thus, we aimed to explore the characteristics and assess the impact of EMDs and their clinical interventions in adult patients with asthma or COPD by means of a systematic review and meta-analysis.…”

Advancing Digital Solutions to Overcome Longstanding Barriers in Asthma and COPD Management

“…Several other smart inhalers are either licensed for use or undergoing clinical trial evaluation 45 , 53 This includes the recently approved Enerzair ® Breezhaler ® (Novartis Pharmaceuticals UK, Ltd), 54 , 55 which, when paired with the Propeller ® mobile application, is also available to support clinicians and patients with asthma in monitoring and recording inhaler device handling. 54 The key features of digital inhaler devices are summarized in Table 2 .…”

“…31 (164) 210271; DOI: 10.1183/16,000,617.0271–2021 Published 25 May 2022. 53 Abbreviation : pMDI, pressurized metered-dose inhaler. …”