Will connected technologies help us all breathe easier?
Connected solutions include technologies that turn delivery devices into smart inhalers. They can monitor patient inhaler use by recording the number of times the drug is administered, how much and even whether the device is being used properly. Some of these technologies are already in the market while others are in development. What are the implications of these technologies for patients, physicians and health systems? Are smart inhalers the future of respiratory medicine? Will they truly help improve outcomes as many promise? Take a deep breath and read on.
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The most expensive inhaler is one that is not used properly1
Medication adherence. We know that in the management of COPD it is critical to achieving optimal disease control. Yet, despite our best efforts—from patient education and training to spacers and improvements in inhaler design—adherence remains elusive, with only about 50% of patients adhering to prescribed regimens.2
Improper use of inhalers can lead to poor disease control
Inhaler adherence is primarily based on two criteria:
Temporal adherence
Includes factors such as patient perceptions, beliefs, cost and access to healthcare
Technical adherence
A patient’s ability to use the inhaler correctly
Contributor
Poor technique adherence can impact clinical outcomes1
Inhalation errors can reduce, or prevent entirely, deposition of the medication in the lungs
In a recent survey, 66% of physicians cite "failure to master device" as a primary reason for lack of efficacy in respiratory disease
Increased risk of exacerbations, hospital admissions, and mortality3
A recent study indicates
incorrect inhaler use is still unacceptably high and does not seem to have improved over the past 40 years3
Enter connected technologies. Will they be the breath of fresh air needed to improve inhaler adherence?
Connected inhalers will collect data about patient behaviors, which could help physicians engage patients in a more meaningful way.”
John Pritchard
Chief Technology Officer, Respiratory Drug Delivery Group, Philips Healthcare
As drug and device makers race to bring new technologies to market, the medical community is cautious but hopeful. According to John Pritchard, Chief Technology Officer, Respiratory Drug Delivery Group at Philips Healthcare, new and emerging sensor-based technologies are intended to capture valuable data that physicians can use to assess inhaler adherence. Pritchard explains that consistent use of controller medication is critical in helping patients manage COPD, but prescribing physicians have little control over what happens once patients leave the exam room. A connected inhaler will allow physicians to see actual-use data versus having to rely on patient self-reporting, which may be subject to bias.
Data can be used to better understand patient behaviors
Connected inhalers are intended to help physicians discover insights into patient behaviors by recording the time and frequency of drug administration and revealing patterns of usage. The resulting data can serve as a basis for more productive conversations between physicians and patients. Humans are complex and adherence is multifactorial. Any technology that helps physicians better understand patient behavior as a means to improve medication adherence has the potential to also improve outcomes.4 For patients, the technologies will help them track use of their inhalers and serve as a reminder of when it’s time to treat. This feature can be especially helpful for patients who may have cognitive issues or simply have trouble remembering when to take their medication. In addition, patients who may have poor insight into their condition as a coping mechanism may benefit from objective data that would be more difficult to deny.
While smart devices are an exciting prospect in respiratory medicine, it’s important to remember that their purpose is to help us understand how best to support the patient."
John Pritchard
Chief Technology Officer, Respiratory Drug Delivery Group, Philips Healthcare
Waiting with bated breath. What can we expect?
A handful of connected inhaler accessories are available today, but many more are being developed. Those currently in the market are accessories that clip onto existing inhalers. Sensors record the frequency of use and the time each dose is delivered. An app that has been downloaded onto the patient’s smart phone enables the data to be stored on both the smart phone and on the company’s cloud server. The data can then be downloaded to a dashboard that the physician can access. Other forms of connected technologies are evolving rapidly. Integrated sensors are not far behind, and recent advances in audio-based inhaler monitoring promise to report on actual user technique.
Potential barriers to implementing connected technology
It is likely that apps associated with the new inhalers will be regulated as medical devices in accordance with the FDA’s guidelines on mobile medical apps.5 Systems will need to ensure that critical data processing steps are not carried out on the smart phone processor, but either within the medical device or on a remote server.
There is still a lot of work to do
While emerging smart technologies are still in the development stages, it is an exciting time in respiratory medicine. Efforts to increase inhaler adherence haven’t been what we’d hoped, so perhaps it’s time for new ideas and a different perspective—one that empowers physicians and patients to find solutions to poor inhaler adherence, once and for all. Stay tuned!
Further reading
References
1. Virchow JC, Akdis CA, Darba J, et al. A review of the value of innovation in inhalers for COPD and asthma. J Mark Access Health Policy. 2015;3:1-8.
2. Restropo RD, Alvarez MT, Wittnebel LD, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-384.
3. Sanchis J, Gich I, Pederson S; Aerosol Drug Management Improvement Team (ADMIT). Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150(2):394-406.
4. Granger BB, Bosworth H. Medication adherence: emerging use of technology. Curr Opin Cardiol. 2011;26(4):279-287.
5. US Food and Drug Administration. Mobile Medical Applications: Guidance for Industry and Food and Drug Administration Staff. Silver Spring, MD: US Food and Drug Administration; February 9, 2015.
