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Monitored Inhaler Treatment to Guide Patient Care: Identifying Patients with Poorly Controlled Asthma

Costello RW, Sulaiman I, Cushen B, Mathedisa M, O’Dwyer S, Doyle F, Pender N, Taylor T, Holmes M, Seheult J, MacHale E, Greene G, Reilly RB.

Respiratory Drug Delivery 2018. Volume 1, 2018: 81-90.

Abstract:

Many patients with respiratory disease remain poorly controlled. A major challenge for clinicians is the need to distinguish which patients have poor control due to poor adherence or inhaler technique and which patients have refractory disease. The INhaler Compliance Assessment (INCA) technology identifies how effectively a patient uses their inhaler. Analysis of the acoustics of inhalation identify how the inhaler has been used, while patterns of inhaler use provide personalized guides to patients and clinicians to master inhaler technique and promote sustained inhaler adherence.

Electronic monitoring using INCA in a community pharmacy setting demonstrated that participants receiving INCA-based interventions had an actual adherence of 63% after six months, compared to 40% for participants receiving regular inhaler technique education from the pharmacist and only 31% for participants who received usual care.

Electronic monitoring using INCA has also been shown to distinguish patients with refractory asthma from patients who were uncontrolled due to poor adherence. Repeated feedback significantly improved inhaler adherence. The mean rate of actual adherence for the patients using INCA was higher (73%) than that for patients who received enhanced education (63%). At the end of the study period, only 40 patients (27%) were refractory and adherent, and identified as potential candidates for add-on therapy. Inhalers adapted with digital technologies such as the INCA have the potential to deliver better clinical and more cost-effective outcomes by providing clinicians objective information on which they can make informed decisions.