The impact of the clip-tone training device and its smartphone application to pressurized metered-dose inhaler in adult asthmatics

Abstract

Background

Despite traditional inhaler technique counseling, many patients make clinically important mistakes when they use their inhalers. This study investigates the value of using a connected inhalation aid when adults with asthma use their metered-dose inhaler (pMDI).

Methods

Adult asthmatics (n = 221), using a pMDI, were randomly divided into a verbal training group (n = 110) and an enhanced training group (n = 111). 21 subjects were lost during the study, each group included 100 subjects at the end of the study. The study was divided into 3 visits. Traditional pMDI training was delivered at visit 1 to both groups which included an explanation of the steps with special stress on frequently mistaken steps e.g. exhalation before use and inhaling slowly and deeply. The enhanced training group was enhanced by using the Clip-Tone training aid linked to its dedicated smartphone app. enhanced training patients were encouraged to use this connected training aid during real-life use between the study visits. Baseline data were collected at the first visit. At all three visits (baseline, 1 month, and 2 months), subjects first completed all inhaler techniques, health outcome measures, received inhaler training, then took bronchodilators, and 30 min later repeated the lung function outcome measures.

Results

Both groups showed a significant decrease (p < 0.001) in the total mean number of pMDI inhalation techniques mistakes at visits 2 and 3, with a lower number of mistakes (p < 0.05) for slower inhalations for the enhanced training group compared to the verbal training group. Inhalation time (an indicator of a slow inhalation) significantly (p < 0.05) improved at each visit in the enhanced training group. In the enhanced training group, there was a gradual significant increase (p < 0.05) in lung functions while the improvements in the verbal training group were only significant (p < 0.05) at visit 3, and by visit 3, the enhanced training group had significantly higher scores than the verbal training group on both FEV₁ and PEF% predicted. The asthma control test (ACT) score improved at each visit in both groups with a greater increase in the enhanced training group (p < 0.05) and more patients (44 and 21) improved their score by 3 or more in the second and third visit respectively.

Conclusion

The connected Clip-Tone training aid helped patients improve their pMDI inhaler technique and their asthma control compared to traditional methods. These results highlight the potential of connected inhalers in the future management of inhaled therapy.

Keywords:

• Clip-Tone
• counseling
• patient
• inhalation technique
• pMDI
• FEV₁
• PEF
• smartphone application

Data availability statement 

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Role of authors

1. Conception and design: Mohamed E.A. Abdelrahim

2. Administrative support: All authors.

3. Provision of study materials or patients: All authors.

4. Collection and assembly of data: All authors

5. Data analysis and interpretation: All authors.

6. Manuscript writing: All authors.

7. Final approval of manuscript: All authors.

Funding

The author(s) reported there is no funding associated with the work featured in this article.