Inhaler adherence in severe asthma: is there an electronic solution?

Gaga, Mina; Samitas, Κonstantinos; Ζervas, Εleftherios

doi:10.1183/13993003.02219-2017

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…36 The design and validation of the device have been previously published. 22,46 What's known • Problems of poor adherence and IT are historically reported in the literature among respiratory patients, with no signs of substantial improvement. 22,46 What's known • Problems of poor adherence and IT are historically reported in the literature among respiratory patients, with no signs of substantial improvement.…”

Section: Introductionmentioning

confidence: 99%

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A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

et al. 2019

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Background: Problems related to poor adherence and inhaler technique (IT) are historically reported in the literature. Most common methods used for adherence and IT assessment are reported to be either inaccurate or subjective. Few electronic monitoring devices (EMDs) that provide an objective measure of both adherence and IT while patients use inhalers at home now exist. Therefore, this study aimed to examine adherence level and IT among respiratory patients in community care using such an EMD for the first time in England. Methods:A prospective, multicentre, observational cohort study was conducted.Patients with chronic obstructive pulmonary disease (COPD) or asthma were recruited from independent community pharmacies within West and South London.Patients were provided with a dry-powder inhaler (DPI) mounted with an EMD to use for 1 month. Adherence was also assessed using pharmacy dispensing data, inhaler dose counter and self-reporting.Results: Data were available for 48 patients. Only eight patients used their inhaler in the correct manner at the correct interval as identified by the chosen EMD. The median actual adherence rate, as measured by the EMD, was 42.7%. This was significantly different from the median dose counter adherence (100%), medication refill adherence (MRA) (100%), proportions of days covered (PDC) (97.8%) and self-reported adherence (P < .001, each). Within a 1-month period, there were 2188 files showing attempted use of the DPI, of which 840 had IT errors. The median technique error rate (TER) was 30.1%. Most common errors recorded were as follows: multiple inhalations, drug priming without inhalation and failure to prime the device correctly. Conclusion:The current study demonstrates that measures such as dose counter, prescription refill and self-reporting showed a high level of adherence among the observed patients. However, the objective data provided by the EMD showed a significantly lower actual adherence rate, reflecting how adherence remains variable and problematic among patients in the community.

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Section: Introductionmentioning

confidence: 99%

“…29,36,37,[42][43][44][45] The device is certified (EU registered) 30 and has Food and Drug Administration (FDA) approval. 22,46 What's known • Problems of poor adherence and IT are historically reported in the literature among respiratory patients, with no signs of substantial improvement.…”

Section: Introductionmentioning

confidence: 99%

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

et al. 2019

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“…Adherence assessment is complex and we feel that F ENO suppression alone should not preclude treatment with biologics [11]. Newer technologies, including digital inhaler devices [12], may enhance adherence assessment and enable F ENO suppression testing to be undertaken remotely.…”

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confidence: 99%

Suppression ofF_ENOwith observed inhaled corticosteroid therapy in severe asthma: is it a useful test in clinical practice?

et al. 2019

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“…A comprehensive review of systematic reviews was conducted that captured a large number of outcomes, including cost effectiveness [12]. However, this review was published in 2014, and given the rapid evolution of digital technology [16], the state of the field has changed since the review was conducted; for instance, electronic inhaler monitoring is a relatively new development [17,18], with smart inhalers only recently becoming commercially available [19]. Unni et al's review [9] did analyse studies of children and adults separately, but only 16 studies concerning children were included.…”

Section: Rationalementioning

confidence: 99%

Digital technologies for monitoring and improving treatment adherence in children and adolescents with asthma: A scoping review of randomised controlled trials

Milne‐Ives

Meinert

2021

Preprint

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Background: Inadequate paediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to help monitor and support treatment adherence for children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research around these technologies and how they are being integrated into existing healthcare services and care pathways. Objective: The purpose of this scoping review is to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma. Methods: The review was structured according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Population, Intervention, Comparator, Outcome, and Study (PICOS) frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, EMBASE, and PsycINFO) were systematically searched for studies published in English from 2014 on. One reviewer screened references, selected studies for inclusion based on the eligibility criteria, and extracted the data, which were synthesised in a descriptive analysis. Results: A wide variety in study characteristics - including the number and age of participants, study duration, and type of digital intervention - was identified. There was mixed evidence for the effectiveness of the interventions; 6 of the 9 studies that evaluated treatment adherence found improvements, but the evidence was inconsistent for asthma control (4/9 found no evidence of effectiveness, and only one found significant evidence) and health outcome variables (4/7 found no evidence of effectiveness). The 5 studies that examined patient perceptions and assessments of acceptability and usability had generally positive findings. Conclusions: Despite the range of different digital interventions being developed to support the monitoring and treatment adherence of children and adolescents with asthma, there is limited evidence to suggest that they achieve their range of intended outcomes. Stronger evidence of their effectiveness at achieving their specific aims is needed, as this will support decisions and research about their cost-effectiveness and how these technologies can best integrate with existing clinical care pathways. This research is necessary to determine which interventions are worth supporting and adopting in the clinical care pathways.

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Inhaler adherence in severe asthma: is there an electronic solution?

Cited by 6 publications

References 20 publications

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

Suppression ofF_ENOwith observed inhaled corticosteroid therapy in severe asthma: is it a useful test in clinical practice?

Digital technologies for monitoring and improving treatment adherence in children and adolescents with asthma: A scoping review of randomised controlled trials

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Inhaler adherence in severe asthma: is there an electronic solution?

Cited by 6 publications

References 20 publications

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device

Suppression ofFENOwith observed inhaled corticosteroid therapy in severe asthma: is it a useful test in clinical practice?

Digital technologies for monitoring and improving treatment adherence in children and adolescents with asthma: A scoping review of randomised controlled trials

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Suppression ofF_ENOwith observed inhaled corticosteroid therapy in severe asthma: is it a useful test in clinical practice?