Recognizing one’s health can be impacted by reduced adherence, the World Health Organization conducted a comprehensive review on non-adherence.3 It was recognized that non-adherence behaviors as spilt almost equally between conscious and unconscious behaviors, or those where a patient struggles to comply with the regimen due to competing demands on their lifestyle that may lead to forgetfulness or disorientation, and those where a patient makes a deliberate decision to discontinue treatment based on cost or beliefs about effectiveness.3 While unconscious behaviors can be addressed through reminders or training aids, solutions for conscious non-adherence must be tailored to the patient.3
Some ways to motivate non-adherent COPD patients include monitoring, education, goal-setting and management plans, but in order to intervene effectively, nebulizer devices must automatically record adherence patterns and provide feedback.1 New devices now offer the opportunity to monitor both adherence and technique, providing information on the pattern of non-adherence and allowing clinicians to create a customized approach for improved adherence.1
Current mobile and web apps for patient medication management may offer reminders, but these only address unconscious non-adherence behaviors. Most apps rely on the patient to enter information on their adherence, but there are a few products that permit automated and, in most cases, remote tracking of adherence.
Looking forward, nebulizers will offer more opportunities to combine remote management of medication with monitoring of other symptoms of disease to prevent or intercept exacerbations. Data will not only be recorded and monitored, but also transmitted from the nebulizer to a pharmacy to fill repeat electronic prescription requests and deliver the prescription directly to a patient’s home.
Among the most technologically advanced and sophisticated nebulizer systems is the I-neb Adaptive Aerosol Delivery System (Philips Respironics). The I-neb allows for remote monitoring of adherence for nebulized therapies and contains a data-logging system that can be interfaced to a computer.4 First, this allows patients to train themselves to inhale slowly and deeply, thereby maximizing the time spent nebulizing and minimizing treatment time. In a randomized controlled trial by McCormick and McNamara, this feature proved popular with patients, as it resulted in an approximate 40% reduction in treatment time.2 The shorter treatment times also correlate with higher levels of adherence, confirming that the patient appears more likely to take their treatment if it is less of an intrusion into their daily life.1 The healthcare provider can also download the information to observe patterns of behavior, for example missed doses at lunchtimes or weekends, and then hold an informed conversation with the patient as to how they might modify their behaviors in order to improve adherence5. This is currently being used to manage pulmonary arterial hypertension (PAH) patients on nebulized iloprost.1