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Review
. 2021 Aug 18:3:657321.
doi: 10.3389/fmedt.2021.657321. eCollection 2021.

The Effect of Connected "Smart" Inhalers on Medication Adherence

Caroline Zabczyk  1 , John D Blakey  1   2
Affiliations
Review

The Effect of Connected "Smart" Inhalers on Medication Adherence

Caroline Zabczyk et al. Front Med Technol. .

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent worldwide, and major sources of morbidity. Key barriers to reduce the harm from these conditions are the widespread and related issues of low use of prescribed inhaled therapy, use of medicines differently from that prescribed, suboptimal inhaler technique, and lack of adherence are the action plans. Connected smart inhalers show great potential to improve these issues, and thus outcomes from airways disease. In this mini-review, we considered the published evidence that the use of smart inhalers leads to more doses of preventative treatment being taken on time and with appropriate techniques. We found multiple trials across a variety of settings and age groups where smart inhalers were used with audio-visual reminders and healthcare professional feedback, which substantially improved the number of doses of preventative treatment taken. Trial evidence also supports the use of feedback from smart inhalers in improving true concordance (doses taken correctly and on time), though only for a single type of smart device. The relative lack of study is in contrast with the potential impact of smart inhalers. Major research questions remain unresolved, as who might fund future large-scale studies, how guideline committees may consider them, and how to implement effective solutions.

Keywords: adherence; asthma; chronic obstructive pulmonary disease; digital technology; inhaled administration; smart inhalers.

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Conflict of interest statement

In the last 3 years, JB has undertaken educational presentations and advisory boards for companies that manufacture inhaled medicines, with fees going to charitable accounts (Astra Zeneca, Boehringer Ingelheim, Chiesi, GSK). He has benefitted from travel and accommodation relating to conference and educational meeting attendance (Boehringer Ingelheim, GSK). He has investigator initiated grants or involvement in research collaborations with “in kind” benefit (GSK, Novartis, Teva). The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Adherence and competence with respect to inhaler use. Green columns represent inhaler doses correctly administered by the patient, and red columns represent missed or incorrectly administered doses due to poor inhaler technique, insufficient resources or non-adherence.
Figure 2
Figure 2
Common types of add-on devices to create smart inhalers. (A) Detection of device priming; (B) Detection of patient actuating device; (C) Jacket to detect airflow. Not shown are devices such as INhaler Compliance Assessment (INCA) that detect actuation and technique purely acoustically.
See this image and copyright information in PMC

References

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    1. Global Strategy for Asthma Management and Prevention . GINA: Interim Guidance About COVID-19 & Asthma. Global Initiative for Asthma (2020). Available online at: www.ginasthma.org

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