Feasibility of Deploying Inhaler Sensors to Identify the Impacts of Environmental Triggers and Built Environment Factors on Asthma Short-Acting Bronchodilator Use

Abstract

Background:Epidemiological asthma research has relied upon self-reported symptoms or healthcare utilization data, and used the residential address as the primary location for exposure. These data sources can be temporally limited, spatially aggregated, subjective, and burdensome for the patient to collect.Objectives:First, we aimed to test the feasibility of collecting rescue inhaler use data in space–time using electronic sensors. Second, we aimed to evaluate whether these data have the potential to identify environmental triggers and built environment factors associated with rescue inhaler use and to determine whether these findings would be consistent with the existing literature.Methods:We utilized zero-truncated negative binomial models to identify triggers associated with inhaler use, and implemented three sensitivity analyses to validate our findings.Results:Electronic sensors fitted on metered dose inhalers tracked 5,660 rescue inhaler use events in space and time for 140 participants from 13 June 2012 to 28 February 2014. We found that the inhaler sensors were feasible in passively collecting objective rescue inhaler use data. We identified several environmental triggers with a positive and significant association with inhaler use, including: AQI, PM10, weed pollen, and mold. Conversely, the spatial distribution of tree cover demonstrated a negative and significant association with inhaler use.Conclusions:Utilizing a sensor to capture the signal of rescue inhaler use in space–time offered a passive and objective signal of asthma activity. This approach enabled detailed analyses to identify environmental triggers and built environment factors that are associated with asthma symptoms beyond the residential address. The application of these new technologies has the potential to improve our surveillance and understanding of asthma.Citation:Su JG, Barrett MA, Henderson K, Humblet O, Smith T, Sublett JW, Nesbitt L, Hogg C, Van Sickle D, Sublett JL. 2017. Feasibility of deploying inhaler sensors to identify the impacts of environmental triggers and built environment factors on asthma short-acting bronchodilator use. Environ Health Perspect 125:254–261; http://dx.doi.org/10.1289/EHP266

The Asthma Mobile Health Study, a large-scale clinical observational study using ResearchKit

“…For example, D’Arcy et al 30 developed a Bluetooth inhaler device that used acoustic recordings of inhaler usage to monitor temporal and technique adherence and assess the correlation between clinical outcomes and adherence. Furthermore, studies using the US Food and Drug Administration (FDA)-approved Propellor Health (Madison, WI, USA) digital platform and inhalers demonstrated the feasibility of tracking inhaler usage and triggers 31–34 . Moreover, individuals randomized to the Propeller Health arm had more significant reductions in inhaler usage than those under routine care 35 .…”

Use of a Remote Inhaler Monitoring Device to Measure Change in Inhaler Use with Chronic Obstructive Pulmonary Disease Exacerbations

“…In this pilot study, we demonstrated that (1) a remote inhaler sensor can monitor albuterol inhaler use in older patients with COPD and is associated with high satisfaction, (2) increased albuterol use captured by the sensor was associated with self-reported episodes of moderate-to-severe exacerbations, yet (3) large variation was seen in the daily use of albuterol in this population even in nonexacerbation days. Prior studies have used this inhaler sensor to monitor inhaler use for asthma patients (3) ; however, to our knowledge, this is the first study reporting the use of inhaler sensors in COPD patients during exacerbations.…”

“…There are several Food and Drug Administration (FDA) cleared sensor devices, which attach to the pressurized meter-dose inhalers (MDIs) and additional models that fit to different types of inhalers. (1) Electronic sensors were shown to accurately capture inhaler actuations over a 6-month period (2,3) and their use was demonstrated to improve medication adherence (4,5) and symptom control (6,7) in asthma patients. However, benefit and acceptability of these devices were tested mainly in younger asthma patients.…”

Demystifying Inhaler Use in Chronic Obstructive Airways Disease

“…In fact, it is strongly recommended that healthcare professionals dedicate time for device education in their clinics and review inhalation technique at each patient visit 70 . With the aim to facilitate this guidance, the evidence or lack thereof underlying ten common 'inhaler lores' beliefs, has been recently reviewed in a practical consensus statement by a panel of experts, on the basis of their combined clinical and research expertise 71 .…”