InspirerMundi—Remote Monitoring of Inhaled Medication Adherence through Objective Verification Based on Combined Image Processing Techniques

Abstract

Background The adherence to inhaled controller medications is of critical importance for achieving good clinical results in patients with chronic respiratory diseases. Self-management strategies can result in improved health outcomes and reduce unscheduled care and improve disease control. However, adherence assessment suffers from difficulties on attaining a high grade of trustworthiness given that patient self-reports of high-adherence rates are known to be unreliable. Objective Aiming to increase patient adherence to medication and allow for remote monitoring by health professionals, a mobile gamified application was developed where a therapeutic plan provides insight for creating a patient-oriented self-management system. To allow a reliable adherence measurement, the application includes a novel approach for objective verification of inhaler usage based on real-time video capture of the inhaler's dosage counters. Methods This approach uses template matching image processing techniques, an off-the-shelf machine learning framework, and was developed to be reusable within other applications. The proposed approach was validated by 24 participants with a set of 12 inhalers models. Results Performed tests resulted in the correct value identification for the dosage counter in 79% of the registration events with all inhalers and over 90% for the three most widely used inhalers in Portugal. These results show the potential of exploring mobile-embedded capabilities for acquiring additional evidence regarding inhaler adherence. Conclusion This system helps to bridge the gap between the patient and the health professional. By empowering the first with a tool for disease self-management and medication adherence and providing the later with additional relevant data, it paves the way to a better-informed disease management decision.

Digital Inhalers for Asthma or Chronic Obstructive Pulmonary Disease: A Scientific Perspective

“…Digital inhalers have the advantage of providing detailed information about medication taking which, when combined with artificial intelligence approaches, can revolutionize asthma and COPD care. For example, InspirerMundi allows remote monitoring of inhaler use via a machine learning approach that can assess medication self-administration [ 102 ]. If these artificial intelligence approaches can be applied to the “big data” captured by digital inhalers, there is potential that the data can help predict and/or mitigate future exacerbations.…”

Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence: Mixed Methods Study (Preprint)

“…When the patient confirms medication was taken, an initial screen with instructions on how to match the inhaler with the template is provided, but in the current version instead of an example figure, we use a short video demonstrating the task (patients can decide to inactivate these instructions whenever they want to accelerate the process). A feature to provide feedback on the identified number in the inhaler was already developed [16] allowing the user to correct the number, and it will be introduced in a future app version. Reasons for deciding not to take a medication can also be registered (eg, medication is empty, this dose is not needed, secondary effects).…”

“…New versions of the app should assess inhaler adherence more objectively by validating inhaler use through dose tracking. The medication detection tool is currently working with 13 inhaler devices containing numeric dose counters available on the Portuguese and Spanish markets [16]. To improve the generalizability of the app and its use in multicenter international studies, inhalers available in other countries will be added in future versions of the app.…”

“…The user's goal is to become an Inspirer to increase the sphere of positive influence by coaching an expanding network of Warriors (as Warriors progress and keep good medication adherence, they can become Inspirers themselves). The most innovative app technology is the medication detection tool based on advanced processing of inhaler images captured with the smartphone camera [16].…”

Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies

“…“Inspirers” can increase the sphere of positive influence by “coaching” an expanding network of users- “Warriors” (that, as they progress and keep good medication adherence, can become “Inspirers” themselves). The most innovative app technology is the medication detection tool based on advanced processing of inhaler images captured with the smartphone camera ( 12 ), which aims to offer an objective adherence measure that can be easily integrated into the lives of patients. It is believed that the app is suitable to be used by real-world patients as its development was grounded in previous research and cooperation with patients with asthma and physicians ( 13 ).…”