Digitally monitored inhaled therapy: a ‘smart’ way to manage severe asthma?

Abstract

Introduction

One of the fundamental challenges of managing patients with severe asthma is treatment adherence, particularly with inhaled corticosteroids. Adherence is difficult to measure objectively and poor adherence is associated with worse outcomes. In this study, assess the ability of a ‘smart’ inhaler to record adherence in severe asthma patients and measure the impact of this on asthma control.

Methods

Consecutive consenting patients meeting criteria for biologics had their existing high-dose ICS/LABA//LAMA combination inhaler/s switched to mometasone/indacaterol/glycopyrronium (114/46/136). Routine clinical data, including blood eosinophils, FeNO, and ACQ-6 scores were collected at baseline and at 4 wk. Adherence was then checked on the Propeller Health app, and good adherence was defined as >80% of prescribed usage. Participants were then followed-up at 12 months to record the proportion of patients who were initiated on biologics

Results

77 patients (mean [SD] age = 50.4 [15.7] years, 67.5% female [n = 52]) participated. 71 participants were able to use the device and 65% (n = 46) of these attained good asthma control and were not initiated on biologics at 12-month follow-up. Both groups demonstrated a significant reduction in ACQ6 score at follow-up (2.81 vs. 1.92, p < 0.001 and 3.05 vs. 2.60, p < 0.001, respectively), but there was no statistically significant difference in improvement between groups. Patients with optimal adherence also demonstrated a significant reduction in median FeNO at follow-up (47 ppb vs. 40 ppb, p = 0.003).

Conclusions

In severe asthma patients, ‘smart’ inhalers may represent an effective management tool to improve adherence and asthma control, therefore avoiding the need for patients to commence biological therapies.

Keywords:

• Severe asthma
• biologics
• digital inhalers
• adherence

Disclosure statement

MGC has previously received honoraria from Novartis AG. SF has previously been provided with travel reimbursement for conference attendance courtesy of Novartis AG. Novartis AG were not involved in the conception, data analysis, or writing of this manuscript. No other authors declare any COI pertaining to this manuscript.

Additional information

Funding

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