Monitoring of inhaler use at home with a smartphone video application in a pilot study

Abstract

Inhalation therapy is the basis of the pharmacological management of asthma and COPD. Most patients are trained on the correct use of inhalers by health professionals but after that do patients continue to take them correctly at home remains largely unknown. Video recording of the inhalation technique using a smartphone can be used to evaluate the inhaler technique at home. Through this pilot study, we aimed to understand whether inhaler training given to patients in the outpatient clinic translates into good inhalation practices at home by a video application platform using a smartphone. We recruited 70 newly diagnosed asthma and COPD patients and a pulmonologist trained them to use their inhaler until they were able to use it correctly. Videos of inhaler use were captured by a relative or a friend at home and then sent to an independent reviewer via WhatsApp on Days 1, 7, 14 and 28 (±2). Each step of the inhaler technique was evaluated based on a predetermined checklist with a rating scale of 0 to 10 (10 for all steps done correctly). Out of 70 patients recruited, 30 (42%) sent all videos. We found that, although all patients performed all the steps correctly in the clinic, none of them performed all steps correctly at home even on Day 1 itself of the inhaler use. On Day 1, the steps score reduced from 10 to 6.9 with a downward trend until Day 28. The most common mistakes from Day 1 onwards were incorrect inspiratory flow rates and not gargling after the inhaler use. Also, most patients showed partially effective inhalation as per our scoring method. Remote video monitoring of inhaler use in the home environment is possible with a mobile video application that gives us a better insight into the most common inhaler mistakes performed by patients at home. Inhaler errors start appearing immediately on Day 1 after the training, and incorrect inspiratory flow rates and forgetting to do gargles are common errors. Early detection of inhaler errors at home may be possible through this method.

Community lung health service design for COPD patients in China by the Breathe Well group

“…The poor inhaler technique identified in this study is a global issue with little improvement over the past 40 years 49 . Video applications used to monitor patients' inhaler techniques at home have found that errors in technique start appearing as early as the first day after training 50 . WeChat might be a useful tool for improving inhaler technique.…”

Nurse Perspectives Regarding Implementation of an Asthma Monitoring Mobile Health Application in the School Setting

“…[14][15][16] Some of the key features that participants in this study noted for the m-health asthma care application: medication tracking, symptom tracking, video education of inhaler technique, and home assessment of inhaler technique, have been successfully utilized in other m-health applications to improve asthmarelated outcomes. [31][32][33] In addition, a prior study identified that parents of children who receive school-based asthma care valued communication from the school and using a mobile application for asthma care may achieve this goal. 34 Finally, clinicians have previously noted similar concerns to implementation of mobile health regarding access to technology and smart phones.…”

The use of remote video directly observed therapy to improve both inhaler technique and adherence to asthma medications

“…Having been trained to mastery in the clinic, inhaler technique was seen to drop steadily over time (days 1, 7, 14, and 28). However, the method of remotely observing inhaler technique via videos provided a means to intervene to correct and prevent inhaler technique errors ( 20 ).…”