Digital technology for monitoring adherence to inhaled therapies in people with cystic fibrosis

Smith, Sherie; Calthorpe, Rebecca J; Herbert, Sophie; Smyth, Alan

doi:10.1002/14651858.cd013733.pub2

Cited by 9 publications

(3 citation statements)

References 49 publications

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“…Current digital medication management methods of adherence assessment include reminder apps for mobile phone, embedded chip in packaging to detect pill removal, dispensing machines, and even a sensor incorporated in the pill itself to confirm it has been swallowed ( 14 ). There is also digital monitoring to inhaled therapies via chipped nebulizers plus tailored support via an online platform, which probably improves adherence and reduces treatment burden in pwCF ( 15 ). Using technological interventions for children with chronic lung disease suggest better adherence to treatment ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Optimizing CFTR modulator therapy management for cystic fibrosis through the ReX platform

Yaacoby-Bianu,

Cohen-Cymberknoh,

Shoseyov

et al. 2023

Front. Pediatr.

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BackgroundCystic fibrosis (CF) is a chronic multi-systemic disease that requires a complex daily treatment regimen. Therefore, there is sub-optimal adherence to CF therapies, and it was shown to impact its clinical and economic burden. Cystic fibrosis transmembrane conductance regulator modulators (CFTRm) are high-cost medications that demonstrated significant benefit in clinical trials. The aim of this study was to evaluate the safety, usability, and efficacy of the ReX platform in medication management of CFTRm for the treatment of people with CF (pwCF).MethodsReX is a patient engagement platform consisting of a cloud-based management system and a cell-enabled handheld device intended to dispense oral medication into the patient's mouth, following a pre-programmed treatment protocol. It provides real-time adherence data to caregivers and timely, personalized reminders to patients. This is a prospective multi-center open study for pwCFs older than 12 years, who had been prescribed CFTRm [elexacaftor/tezacaftor/ivacaftor (ETI) or tezacaftor/ivacaftor (TI)], and provided consent to use ReX platform to receive CFTRm and record their health condition. Study duration was 12–24 months, with clinic visits where physical examination, body mass index (BMI), and pulmonary function tests were performed, and user experience questionnaires were filled in.ResultsTen pwCFs from two CF centers in Israel were included. The mean age was 31.5 years (range 15–74 years); eight were taking ETI and two TI. Median adherence to CFTRm was 97.5% (range 70%–100%) in the first year and 94% (range 84%–99%) in the second year, which is higher than the previously reported CFTRm adherence of ∼80%. No adverse events related to the use of the platform were reported. Patients reported ReX to be valuable to their treatment management and user friendly. Estimated mean forced expiratory volume in 1 s (FEV1%) increased from 74.4% to 80.8% (p = 0.004) over 2 years. Similarly, estimated BMI percentile increased from 53.5 to 59.0 (p < 0.001).ConclusionsUsing the ReX platform in medication management of pwCF treated by CFTRm is safe, easy to use, and effective in improving the adherence to treatment and the clinical outcomes. Consequently, this device may potentially reduce costs to healthcare providers. Further larger and long-term studies are required to examine the clinical benefits of the ReX platform.

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Section: Discussionmentioning

confidence: 99%

Optimizing CFTR modulator therapy management for cystic fibrosis through the ReX platform

Yaacoby-Bianu,

Cohen-Cymberknoh,

Shoseyov

et al. 2023

Front. Pediatr.

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“…Implications of DHT should be considered, as changing one aspect may influence (positively or negatively) other areas of care [ 53 ], and the introduction of DHTs in managing children and adolescents with CF will be significantly different to adults and those with multimorbidities. Some people with CF are digital natives, growing up with an appreciation of DHTs; others have lower levels of digital literacy and trust in digital services and, consequently, the uptake of opportunities to influence their health using this technology may be lower [ 54 55 ].…”

Section: Can We Future-proof and Optimize The Use Of Dhts Within The ...mentioning

confidence: 99%

Revolutionizing Care: Unleashing the Potential of Digital Health Technology in Physiotherapy Management for People With Cystic Fibrosis

Morrison,

Saynor,

Kirk

et al. 2024

JMIR Rehabil Assist Technol

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This viewpoint paper explores the dynamic intersection of physiotherapy and digital health technologies (DHTs) in enhancing the care of people with cystic fibrosis (pwCF), in the context of advancements such as highly effective modulator therapies (HEMTs) that are enhancing life expectancy and altering physiotherapy needs. The role of DHTs, including telehealth, surveillance, home monitoring, and activity promotion, has expanded, becoming crucial in overcoming geographical barriers and accelerated by the recent pandemic. Physiotherapy, integral to CF care since 1946, has shifted towards patient-centred approaches, emphasising exercise training and a physically active lifestyle. The reduction in inpatient admissions due to HEMTs has led to increased homecare and virtual consultations, and DHTs have revolutionised service delivery, offering flexibility, selfmanagement, and personalised care options, however there is a need to comprehensively understand user experiences from both people with CF (pwCF) and physiotherapists. The paper highlights the essential exploration of user experiences to facilitate clinician adaptation to the digital requirements of modern clinical management, ensuring equitable care in the "Future Hospitals" arena. Identifying research gaps, the paper emphasises the need for a thorough evaluation of DHT utilisation in CF physiotherapy education, training, and self-monitoring, as well as the experiences of pwCF with virtual consultations, self-monitoring and remote interventions. Online group exercise platforms address historical challenges relating to infection control, but necessitate comprehensive evaluations of user experiences and preferences. Future-proofing DHTs within the physiotherapy management of CF demands a shift towards full integration, considering stakeholder opinions and addressing barriers. While DHTs have the potential to extend physiotherapy beyond the hospital, the paper stresses the importance of understanding user experiences, addressing digital poverty, and working towards more equitable healthcare access. A flexible approach in the 'future hospital' is advocated, emphasising the need for a nuanced understanding of user preferences and experiences to optimise the integration of DHTs in CF care.

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“…Moves to digital and remote methods to deliver care have already been reported in a range of chronic respiratory diseases across a breath of clinical management areas i.e. telerehabilitation (7), remote consultations (4), home monitoring (8), home management and monitoring treatment adherence (4) . Specifically in bronchiectasis, Congrete and Metersky detailed their experience of telemedicine and remote monitoring in a commentary including these areas of management (9).…”

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confidence: 99%

Digital technologies in bronchiectasis physiotherapy services: a survey of patients and physiotherapists in a UK centre

O'Neill,

McLeese

et al. 2024

ERJ Open Res

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Digital technology for monitoring adherence to inhaled therapies in people with cystic fibrosis

Cited by 9 publications

References 49 publications

Optimizing CFTR modulator therapy management for cystic fibrosis through the ReX platform

Optimizing CFTR modulator therapy management for cystic fibrosis through the ReX platform

Revolutionizing Care: Unleashing the Potential of Digital Health Technology in Physiotherapy Management for People With Cystic Fibrosis

Digital technologies in bronchiectasis physiotherapy services: a survey of patients and physiotherapists in a UK centre

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