Adherence Monitoring and E-Health: How Clinicians and Researchers Can Use Technology to Promote Inhaler Adherence for Asthma

Chan, Amy Hai Yan; Reddel, Helen K.; Apter, Andrea J.; Eakin, Michelle N.; Riekert, Kristin A.; Foster, Juliet

doi:10.1016/j.jaip.2013.06.015

Cited by 102 publications

(93 citation statements)

References 59 publications

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“…The Doser records actuations through an electromechanical switch that is activated when the user applies adequate pressure to the top of the inhaler, instigating actuation [34]. The device contains two different counters, one to count down the number of actuations remaining in the canister and another to count the number of actuations on a single day [31].…”

Section: Dosermentioning

confidence: 99%

“…The second counter resets itself at midnight and stores the total number of actuations for each day in its internal memory [31]. The device will beep to tell a patient when an actuation has been recorded and also beeps when a canister is nearly empty [34]. Data cannot be downloaded from the device, it can only be written out manually [31].…”

Section: Dosermentioning

confidence: 99%

“…When a patient presses downwards and applies pressure to their inhaler, the canister connects with a switch within the device, resulting in the recording of a time and date stamp for the actuation [34]. This process happens for every actuation of the inhaler, with the device capable of recording 1600 data logs in total [34].…”

Section: Smart Inhaler Tracker (Smartmentioning

confidence: 99%

“…This process happens for every actuation of the inhaler, with the device capable of recording 1600 data logs in total [34]. Actuation recordings can be transferred to a PC through a USB (Universal Serial Bus) cable, where 'connection centre' software takes data from the device and uploads it to an online database where it is kept in password protected storage, to be viewed by either the patient, clinician or researcher or other person with granted access [40].…”

Section: Smart Inhaler Tracker (Smartmentioning

confidence: 99%

“…5. ) was developed by Nexus 6, Auckland, New Zealand [34]. The device securely clips around a standard MDI and consists of an LCD screen capable of displaying information about medication taken, battery level and various settings.…”

Section: Relevant Literaturementioning

confidence: 99%

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Electronic Monitoring of Adherence to Inhaled Medication in Asthma

Howard¹,

Lang²,

Patel³

et al. 2014

CRMR

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Abstract:The main treatment of asthma is inhaled corticosteroids. However adherence to these medications in asthma is often poor, with low adherence associated with excessive health care costs and an increased risk of emergency room visits and mortality. Although various methods are used to indirectly assess adherence, all have significant limitations whether used in clinical or research practice. The recent development of electronic monitoring devices (EMDs) for use with inhalers presents an exciting opportunity to easily and accurately measure inhaler adherence. This article summarises the current devices available; for each device features and limitations are considered, followed by a review of both the current clinical literature and data on reliability and accuracy. An overall summary is also provided to aid comparison of capabilities between devices and future issues pertaining to the use of EMDs are discussed, including barriers to adoption, stakeholder involvement, novel methods of communicating adherence data, recording of data and cloud storage. Finally key areas that still require investigation are highlighted.

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Section: Dosermentioning

confidence: 99%

Section: Dosermentioning

confidence: 99%

Section: Smart Inhaler Tracker (Smartmentioning

confidence: 99%

Section: Smart Inhaler Tracker (Smartmentioning

confidence: 99%

Section: Relevant Literaturementioning

confidence: 99%

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Electronic Monitoring of Adherence to Inhaled Medication in Asthma

Howard¹,

Lang²,

Patel³

et al. 2014

CRMR

View full text Add to dashboard Cite

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Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders

et al. 2023

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ImportanceChildhood asthma control largely depends on rigorous and regular monitoring. Although various clinical parameters, biomarkers, and patient-reported outcomes are helpful for monitoring purposes, there is no consensus on the minimum and/or optimal set of parameters and their relative priority.ObjectiveTo assess actual and perceived optimal childhood asthma monitoring practices used globally.Design, Setting, and ParticipantsThis international, multistakeholder survey study surveyed health care professionals and clinical academics with a professional interest in and exposure to childhood asthma between April 12 and September 3, 2021, to test for differences between the frequency that different techniques are actually used in practice vs optimal practice, between-group differences, and differences across medical settings and country economies.Main Outcomes and MeasuresOutcomes were frequency of duration of asthma monitoring visits as well as actual and perceived optimal use and importance of monitoring tools and domains.ResultsA total of 1319 participants with expertise in childhood asthma from 88 countries completed the survey. Participants included 1228 health care professionals with a balanced distribution across different care settings (305 [22.7%] primary care, 401 [29.9%] secondary, and 522 [38.9%] tertiary care) and 91 researchers. Children with mild to moderate asthma attended regular monitoring visits at a median (IQR) of 5.0 (2.5-8.0) months, with visits lasting a median (IQR) of 25 (15-25) minutes, whereas severe asthma required more frequent visits (median [IQR], 2.5 [1.0-2.5] months; median [IQR] duration, 25 [25-35] minutes). Monitoring of symptoms and control, adherence, comorbidities, lung function, medication adverse effects, and allergy were considered to be very high or high priority by more than 75% of the respondents. Different patterns emerged when assessing differences between actual and perceived optimal use of monitoring tools. For some tools, current and optimal practices did not differ much (eg, spirometry), whereas in others, there was considerable space for improvement (eg, standardized control and adherence tests). The largest gap was observed for between-visit monitoring with electronic trackers, apps, and smart devices. Differences across country economies, care settings, and medical specialties were modest.Conclusions and RelevanceThese survey results suggest that pediatric asthma monitoring is performed generally homogeneously worldwide, in most cases following evidence-based standards. Wider use of standardized instruments and the intensification of continuous between-visit monitoring, supported by electronic devices, is needed for further improvement of disease outcomes. The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.

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