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Whistles and Apps: Enabling Low-cost Objective Feedback of Inhaler Use

Sanders MJ.

RDD Asia 2018. Volume , 2018: 155-166.

Abstract:

Correct inhaler use by patients remains a significant challenge. Affordable, simple inhaler training based on inspiratory flow reed-whistle tools originated in the 1970s. Mouthpiece training aids (e.g., the Flo-Tone devices) suitable for all pressurized metered dose inhalers (pMDIs) are now available. The advent of smartphones with built-in microphone sensors, and app technology now offers the potential to re-think traditional devices, improving self-training with real-time feedback, and extending training to other critical aspects of technique. Cost, simplicity, and availability, however, remain important. A new reed-less, pMDI-specific, actuator whistle (Clip-Tone, Clement Clarke, United Kingdom) has been developed. When Flo-Tone or Clip-Tone is used in combination with a smartphone, a bespoke app is able to deconstruct, analyze, and report directly to the patient on the inhalation maneuver: detecting actuation “click,” flow rate and duration, and guiding breath-hold. Proof of concept aerosol characterization studies with single (ipratropium, albuterol) and triple pMDI therapies (beclometasone, formoterol, and glycopyrronium) have shown no effect on aerosol delivery and minimal change in device resistance with the Clip-Tone. It is anticipated that this approach can improve patient engagement, with app developments able to provide real time usage, compliance and performance data. No additional device sensors, integrated software or battery are required, and the general principle of using a microphone to listen to the sound of an inhaler whistle enables the benefits of connectivity to a wider market, specifically low-resource countries where electronic training devices may be cost-prohibitive.