The Acoustic Features of Inhalation can be Used to Quantify Aerosol Delivery from a Diskus™ Dry Powder Inhaler

Seheult, Jansen N.; O’Connell, P.; Tee, Kee Chun; Bholah, Tariq; Bannai, Hasan Al; Sulaiman, Imran; MacHale, Elaine; D’Arcy, Shona; Holmes, Martin S.; Bergin, David A.; Reeves, Emer P.; Reilly, Richard B.; Crispino-O’Connell, Gloria; Ehrhardt, Carsten; Healy, Anne Marie; Costello, Richard W.

doi:10.1007/s11095-014-1371-x

Cited by 45 publications

(40 citation statements)

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“…In previous studies we have shown that inhaler errors such as low inspiratory flow and exhalation into the inhaler are easily identified. We have also shown that acoustic features of inhalation are directly proportional to peak inspiratory flow (14,16,17 …”

Section: Electronic Adherence Monitormentioning

confidence: 71%

“…We have previously described the close relationship of acoustically assessed PIF with objectively measured PIF (14,16,17). We have also described the significant effect of both low PIF and that of exhalation into the inhaler on drug delivery (14,16,17,34).…”

Section: Limitationsmentioning

confidence: 91%

“…We have also described the significant effect of both low PIF and that of exhalation into the inhaler on drug delivery (14,16,17,34). …”

Section: Limitationsmentioning

confidence: 99%

“…Technique errors identified by this method include failing to prime the inhaler, dispersing the medication by exhalation into the inhaler after priming and other errors such as dose dumping (14,15). In addition, the acoustic features of inhalation are highly reflective of objectively measured peak inspiratory flow, meaning that the device can estimate the peak inspiratory flow at each inhalation (16), (17).…”

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confidence: 99%

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A Method to Calculate Adherence to Inhaled Therapy that Reflects the Changes in Clinical Features of Asthma

et al. 2016

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Written permission has been obtained from all persons named in the acknowledgment.Author Contributions: EM, SOD and SR were primarily involved in patient recruitment. SD, VR, IK and RBR were primarily involved in the audio analysis required for this manuscript. FB was primarily involved in the statistical analysis for this manuscript. BC, and MCM were involved in data collection and data analysis for this manuscript. IS, JS and RWC were involved in all aspects required for this manuscript including patient recruitment, data management, data analysis and were the primary leads in the design of the work. All co-authors were involved in writing and editing this manuscript. Methods:We attached a digital audio device (INCA TM ) to a dry powder inhaler. This recorded when the inhaler was used and analysis of the audio data indicated if the inhaler had been used correctly. These aspects of inhaler use were combined to calculate adherence over time, as an AUC measure. Over a 3 month period a cohort of asthma patients were studied. Adherence to a twice-daily inhaler preventer therapy using this device and clinical measures were assessed. Measurements and Results:Recordings from 239 patients with severe asthma were analysed.Average Adherence, based on the dose counter was 84.4%, whereas the ratio of expected to observed accumulated AUC, Actual Adherence, was 61.8% (p<0.01). Of all adherence measures, only adherence calculated as AUC reflected changes in asthma quality of life, beta agonist reliever use and PEF, over the three months (p<0.05 compared to other measures of adherence). Conclusion:Adherence that incorporates the interval between doses and inhaler technique, and calculated as AUC, is more reflective of changes in quality of life and lung function than the currently used measures of adherence. Electronic monitors are considered to be the gold standard for objectively quantifying adherence (1). Most studies using electronic recording devices have reported adherence as the mean adherence or, the Mean Daily Dose, over the study period (2) (3) (4) The aim of this study was to test the hypothesis that by including the time of use, the interval between doses and accounting for inhaler technique, we could quantify adherence as an Area Under the Curve (AUC) and, furthermore, determine whether adherence calculated using AUC was more reflective of patient outcomes than current methods of assessing adherence. Some of the results of this study have been previously reported in the form of an abstract(18). Methods

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Section: Electronic Adherence Monitormentioning

confidence: 71%

Section: Limitationsmentioning

confidence: 91%

“…We have also described the significant effect of both low PIF and that of exhalation into the inhaler on drug delivery (14,16,17,34). …”

Section: Limitationsmentioning

confidence: 99%

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confidence: 99%

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A Method to Calculate Adherence to Inhaled Therapy that Reflects the Changes in Clinical Features of Asthma

et al. 2016

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“…For example, the SmartTrack device, which can be attached to a pMDI, delivers reminders for dose administration through customized ringtones [97,98]. While in addition to monitoring adherence, the INCA device monitors Diskus/ Accuhaler inhaler technique using an acousticbased method [95,[99][100][101][102]. Further to monitoring and recording, devices with e-connectivity are being developed enabling patients to receive real-time feedback about their inhaler technique every time they use their inhaler.…”

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confidence: 99%

Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management

et al. 2018

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Medication use has always played a highly significant role in the overall management of asthma, with appropriate use being linked to good asthma control. However, while patients with asthma enjoy the 'luxury' of having medications delivered directly to the lungs via inhaler devices, with that comes the additional challenge of ensuring that inhaler devices are used correctly. Research and practice provides evidence to the challenges associated with inhaler use and the particular steps that patients perform incorrectly. While this problem is well documented, acknowledged and reported, little has changed in 40 years, and the proportion of patients using inhaler devices remains unacceptably high. This review focuses on aspects specific to the errors that patient's make, the significance of these errors, and the important considerations for health care practitioners in supporting patients in correctly using their inhalers. This review highlights the complexities associated with patient's making inhaler technique errors and highlights the opportunities that lie in future technological developments of inhaler devices. Now more than ever, in the era of precision medicine, it is important that we address inhaler technique use once and for all.Keywords: Asthma control; Critical errors; Health behavior; Health care practitioners; Inhaler devices; Maintenance; Mastery; Skills THE IMPORTANCE OF MEDICATION USE IN OUR UNDERSTANDING OF RESPIRATORY DISEASEAfter decades of research, practice, and perceived knowledge, we find ourselves at crossroads in our understanding and management of airway diseases, such as asthma [1]. While asthma is an obstructive airways disease, which Pulm Ther (2018) 4:1-12 https://doi.org/10.1007/s41030-018-0051-0 to our current knowledge can neither be prevented nor cured, it is a disease that fluctuates in severity and 'control', is exacerbated by varying triggers, and its course over an individual's lifetime is essentially unpredictable [1]. While the conversation about asthma and airways disease more broadly is not the focus of this review, it becomes particularly relevant in our consideration of the use of medications. It is critical, now more than ever, that we understand the role of medication use, as it can provide us with further understanding about respiratory disease more broadly [2]. Given that asthma management is reliant on the use of medications [3], ensuring that patients use their medications correctly has become more than just a practical matter; it is a complex and critical issue. Correct medication use has become a fundamental step in our exploration and understanding of disease traits [1,2]: with careful and more precise evaluation of patient's response to treatment becoming integral to our understanding of disease endotypes and our evolution towards precision medicine [1,2]. For this reason, if for no other, it is now more important than ever that we address inhaler use, especially our knowledge of critical errors, which can 'cloud' our understanding of treatment success. T...

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Medication Safety in Chronic Lung Disease with Cardiac Comorbidity

Pleasants

2020

Cardiac Considerations in Chronic Lung Disease

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The Acoustic Features of Inhalation can be Used to Quantify Aerosol Delivery from a Diskus™ Dry Powder Inhaler

Abstract: Acoustically-determined PIFR is a suitable method for estimating drug delivery and for monitoring inhalation technique over time.

Cited by 45 publications

References 19 publications

A Method to Calculate Adherence to Inhaled Therapy that Reflects the Changes in Clinical Features of Asthma

A Method to Calculate Adherence to Inhaled Therapy that Reflects the Changes in Clinical Features of Asthma

Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management

Medication Safety in Chronic Lung Disease with Cardiac Comorbidity

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