Smart Inhaler for Asthma Misses the Mark for Boosting Adherence

MILAN -- An electronic monitoring device (EMD) increased adherence to asthma medication in the short-term but still left patients needing more assistance in the long run, a cluster-randomized trial found.

In adult primary care patients with subpar adherence to medication, those using the Turbu+ Insights digital inhaler platform achieved a better adherence rate at 2 weeks compared with users of an inhaler with passive monitoring (OR 2.19, 95% CI 1.63-2.95), reported Susanne van de Hei, MS, a PhD candidate at the University of Groningen, the Netherlands, at the European Respiratory Society (ERS) meeting.

However, the difference narrowed over time such that for the study's primary endpoint, intervention and control groups shared similar adherence rates at 12 months (71% vs 60%; OR 1.23, 95% CI 0.91-1.66).

Regardless, overall asthma control was significantly better in the intervention group compared to the control group after 12 months, as indicated by Asthma Control Questionnaire (ACQ-5) scores (P=0.006). Intervention patients were also more likely to meet the minimal important difference of a -0.5 or less change in ACQ-5 scores after a year compared with controls (OR 3.00, 95% CI 1.13-8.35).

There are some unanswered questions as to why asthma control was better in the EMD group despite declining adherence in the present study, van de Hei noted.

The Turbu+ Insights app allows patients to set reminders to take their medications, as well as view their usage, and even set up motivational messages for themselves. Providers were also able to view usage data. Participants in the control group were also given the inhaler plus EMD but were unable to track their usage data.

Digital inhalers have previously been shown to improve adherence and correct administration of medication through recording usage data and providing assistance on inhaler technique -- albeit based on shorter-scaled studies.

Keeping patients involved in their care is a key factor to improving outcomes, van de Hei stressed.

Patients using the digital inhaler were more involved in their own disease, the researcher said during a Q&A session at ERS. "They had that app -- it was confronting them with taking [their] inhalers," she said.

"And even though they probably didn't take their inhaler more at the end of the study, they were still more aware of their disease," said van de Hei. "Asthma control is not only based on adherence. There are many factors that can influence asthma control -- avoiding triggers, or being more active, or avoiding smoking, things like that."

She also explained that both patients and providers appeared to use the devices fairly easily, and feedback was fairly positive.

"After 3 and 12 months, all intervention patients were asked to fill in the system usability scale and an acceptability questionnaire, which we developed ourselves. We did find that patients thought it was a usable device," she said. "We also asked healthcare professionals after 3 and 12 months, and they indicated the usability was 'good' after 3 months, and after 12 months they said it was 'okay,' which is a step lower."

The ACCEPTANCE cluster-randomized trial was conducted at Dutch general practices and pharmacies. Symbicort Turbuhaler users were grouped by center in being randomly assigned an EMD connected to the Turbu+ Insights app (n=82) or no app (n=82). A 6-week run-in period prior to randomization selected for patients who had sub-80% adherence to their medications by weeks 3 and 4.

Baseline demographics were similar between the intervention and control groups, with an average age of 48.1 and 47 years, and a male population of 39% and 43.9%, respectively.

In order to be considered for the study, patients needed to have an ACQ score of 0.75 or higher. At baseline, patients in control and intervention groups had a ACQ-5 score of 1.7 and 1.6, as well as an adherence of 65.4% and 62.6%, respectively.

Participants had no other respiratory diagnoses besides asthma and were not on biologic therapy.

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