Feasibility of medication monitoring sensors in high risk asthmatic children

Abstract

Daily controller therapy is a mainstay of asthma treatment(1), however adherence to asthma medications is problematic(2). Traditional methods of measuring adherence do not provide day-to-day objective data. Adherence monitoring sensors that are placed directly on inhaled asthma medications attempt to address this problem(3); however it is unknown how feasible it is to integrate such devices among high-risk, asthmatic children and more evidence is needed on how to integrate these types of devices into real-life clinical practice(4).Our primary objective was to evaluate the feasibility of using a commercially available adherence device in children in a real-life clinical setting. We hypothesized that patients, parents and providers would find the devices easy to use and would continue using them if given the opportunity. MethodsThis study was approved by the Colorado Multiple Institutional Review Board (15-0211) prior to patient recruitment, and is listed on www.clinicaltrials.gov (NCT02617420). Study PopulationTwenty-five children aged 6-17 years old with asthma and at least one hospitalization or 2 emergency room visits for asthma in the last year were recruited. Written consent was obtained. Adherence was monitored for 3 months for each patient. Providers were asked to participate if they had a patient that chose to enroll.

Electronic medication monitors help determine adherence subgroups in asthma

“…Adherence also declined across each group. While this is common [2,8,9], initial adherence may be a robust predictor of long-term adherence [10,11]. Thus, our findings suggest that early intervention, especially among patients with moderate and sub-optimal adherence where the rate of decline was the greatest, might provide insight on patterns of long-term adherence and early opportunities for intervention.…”

“…EMMs (Propeller Health, Madison, WI) were provided to patients for their inhaled controller (including dry powder and metered dose inhalers) and short-acting beta-agonist (SABA) medications [2]. EMMs passively captured the date and time of actuations.…”

Symptom-driven inhaled corticosteroid/long-acting beta-agonist therapy for adult patients with asthma who are non-adherent to daily maintenance inhalers: a study protocol for a pragmatic randomized-controlled trial

“…All participants will then have a Hailie® sensor attached to their inhalers (if in-person) or sent to their address (if using a Zoombased visit) (Figure 3) Once the patient has received their inhaler and sensor, the study team will contact participants to be sure they are comfortable with the set-up process and recommend that they deploy one test inhaler actuation to ensure the sensor is working properly. Of note, the Hailie® device is an FDA-approved electronic inhaler sensor and smartphone application that has been successfully and safely used in other NIH-funded studies to assess inhaler adherence (43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53).…”

Future opportunities for research in rescue treatments

“…Adherence to rescue medication for treating asthma has been studied using electronic medication monitors (EMMs), which can reveal when a medicine has been used. 16,17 The ability to integrate EMMs into smart device applications, 18 such as a seizure diary, could allow for improved, albeit indirect, adherence monitoring of rescue medication. Another approach would be to compare the number of refills with seizure cluster history recorded in the seizure diary over a specified time period.…”

“…Conventional approaches include counting pills or devices and pharmacy records to assess adherence; however, these approaches are not well suited for rescue medications. Adherence to rescue medication for treating asthma has been studied using electronic medication monitors (EMMs), which can reveal when a medicine has been used 16,17 . The ability to integrate EMMs into smart device applications, 18 such as a seizure diary, could allow for improved, albeit indirect, adherence monitoring of rescue medication.…”