Digital inhalers for COPD and asthma are tantalizing, but more research is needed, says journal

Interest in the use of digital inhalers is increasing as they can provide concrete evidence on how patients monitor and manage their chronic obstructive pulmonary disease (COPD) and asthma at home, but more questions need to be answered, according to a recent review. .

While digital inhalers for chronic obstructive pulmonary disease (COPD) and asthma have been available for over 20 years, they are only now being used more and more. In a recent review, researchers said that many questions remain unanswered regarding their cost-effectiveness, acceptability, and effects on inhaler technique.

These devices, which may consist of a separate electronic sensor attached to an inhalation, or an inhaler with the electronics built into it, have primarily been used in clinical trials.

Obstructive pulmonary disease affects around 15% of people worldwide and yet the inhaled drugs needed to control these diseases require the daily self-administration of inhaled therapies that require specific breathing techniques and good user coordination in order to optimize the taking of the drug. Adherence to these therapies, which could be complicated by a number of factors, is linked to poorer outcomes in COPD and asthma.

Electronic monitoring systems, sensors, and other methods of providing remote feedback to a supplier are one way to help improve grip and see what’s going on in a home environment. In this recent review, the authors reviewed what is known about 3 inhalers and sensors currently on the market, as well as another device that is under investigation in Ireland and the UK but is not currently sold.

The authors searched Ovid MEDLINE, EMBASE, CrossRef, and Google Scholar for English-language publications of randomized controlled trials, systematic reviews, and guidelines published from January 1, 2010 to April 1, 2021.

Studies were included if electronic monitoring devices and associated mobile applications were used as part of an adherence intervention, with the primary outcome being improved drug use.

Over 20 digital inhaler clinical studies have demonstrated improved drug adherence, risk of exacerbation, and patient outcomes, and echoed and expanded upon previous findings on inhaler use and behaviors. of patients, the authors said.

The review included the 4 devices that the authors say are the most commonly used. Two are available worldwide (Propeller Health and Adherium Hailie), 1 is available in the United States (Teva Digihaler) and 1 is available in Italy, Germany, Portugal and the Netherlands (Amiko Respiro). Another device, the INCA device, has been the subject of extensive studies in Ireland and the United Kingdom and the authors have therefore included information on this as well, although it is not yet available.

The Propeller Health and Adherium Hailie are considered devices because they consist of a separate sensor that attaches to an existing inhaler; Digihaler and Respiro are considered drugs with digital capabilities. The latter two are considered “inspiratory digital inhalers” and hold the smallest market share. They have the ability to “guide patients’ appropriate inhalation effort to improve technique and could potentially serve as a physiological measure of lung function,” the authors wrote, and could be considered a “value-added function.” .

Combined with information about symptoms, physiological measurements and environmental conditions, the devices would enable more personal and individualized treatment decisions, they added. In addition, the data could provide greater context when clinicians decide to move patients who fail to control inhaled drugs to another potentially more expensive and complicated level of care, such as bronchial thermoplasty, biologics for asthma and airway stents for COPD. .

As an example, the authors cited the results of a study of adults with uncontrolled asthma who were considered eligible for biologics or bronchial thermoplasty; more than half were not adherent to their digital controller inhalers.

“Ensuring a correct diagnosis and assessing compliance using digital inhalers are important steps to take before adding very expensive biologics to patients’ regimens. Using digital inhalers to gather more information about patients’ drug-taking habits may be the most cost-effective use of these devices, ”the authors noted.

Reference

Chan AHY, RAP Pleasants, Dhand R, et al. Digital inhalers for asthma or chronic obstructive pulmonary disease: a scientific perspective. Pulm Ther. 2021; 7 (2): 345-376. doi: 10.1007 / s41030-021-00167-4

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