May 31, 2022 – After years of taking and stopping medication for occasional asthma symptoms, things took a turn for the worse for Brian Blome in November 2020. The retired carpenter started feeling short of breath and wheezing during walks by bike. At home, he struggled with chores.
“I was having trouble walking up stairs, just doing laundry,” Blome, who lives in the Chicago suburb of Palatine, says.
To get things under control, he saw an allergist and started taking regular medication – two tablets, two nasal sprays and inhaled corticosteroids each day, plus an albuterol inhaler for flare-ups.
Inhalers have an added feature: an electronic monitor that attaches to the device and automatically tracks where and when the medicine is used. Bluetooth sends this information to an app on the patient’s mobile phone and to a dashboard where the medical team can see, at a glance, when symptoms appear and how often medications are taken – which fact that the devices are often referred to as “smart inhalers”. “
At this year’s American Academy of Allergy, Asthma, and Immunology (AAAAI) conference in Phoenix, AZ, researchers discussed how digital monitoring devices can help diagnose and treat difficult-to-control asthma , potentially reducing the need for oral steroids or biological therapies.
Even though electrical monitors have been on the market for years, their use has been slow to catch on due to uncertainties about insurance coverage, liability, and how best to manage and use the data. A recent study said that these devices cost between $100 and $500, but that price depends on many factors, such as insurance.
About 17% of adults with asthma have “difficult to control” asthma, which means they limit their activity due to respiratory symptoms and use reliever medication several times a week.
But research suggests that correcting inhaler technique and sticking to medication use can reduce that 17% to just 3.7%, says Blome allergist Giselle Mosnaim, MD, of NorthShore University HealthSystem. . Mosnaim spoke about digital surveillance at a conference session on digital technologies for the management of asthma.
A study of more than 5,000 asthma patients “showed that if you have critical errors in inhaler technique, it leads to worse asthma outcomes and increased asthma exacerbations,” she says. It also shows that despite new devices and technology, “we still have poor inhaler technique.”
Yet compliance is poorly assessed by physicians and patient reports. “The ideal measurement of adherence should be objective, accurate, and unobtrusive to minimize impact on patient behavior and enable reliable data collection in real-world settings,” says Mosnaim. “So electronic medication monitors are the gold standard.”
Patients who don’t follow instructions or guidelines “that’s something we’ve seen over and over again with children,” says Caroline Moassessi, founder of allergy and asthma blog Gratefulfoodie.com, who previously sat to a regional council of the American Lung Association. She is also the mother of two asthmatic children, now in college, who years ago used electronic medication monitors in a research trial.
They were “not impressed – mostly because I think they thought their asthma was under control,” she says. “When patients aren’t in crisis, they don’t manage their asthma well.”
Even in research studies like that of Rachelle Ramsey, PhD, presented at the conference, it is not only difficult to determine if better compliance leads to better health, but when.
“For example, does your membership this week impact your asthma control this week, or does it impact your asthma control next week? Or is it even more far? Do you need to have a certain level of adherence over the course of a month in order to have better results at the end of that month?” says Ramsey, a pediatric research psychologist at the hospital’s medical center Cincinnati Children’s “I think it’s a little complicated.”
That said, results from several small studies show a link between remote monitoring and better clinical outcomes. One study recruited asthma patients in the UK, and another was carried out by Mosnaim with patients from the Chicago area.
In the UK’s Quality Improvement Project, nurses asked patients with hard-to-control asthma if they knew how to use their inhalers and if they followed treatment guidelines.
Those who said “yes” were asked to swap their steroids/inhalers for a controller equipped with a device that tracks usage and measures acoustics to test inhaler technique. After 28 days of follow-up, many people in the study had better clinical outcomes.
And after 3 months of digital monitoring, patients didn’t use their rescue medication as often.
Blome has seen a marked improvement in his asthma since he started his regular appointments and resumed his daily medication a year and a half ago. He says that from time to time he has wheezing and shortness of breath, usually when riding a bike or exercising. But these symptoms are no longer as severe or frequent as they used to be.
From a doctor’s perspective, “digital inhalers allow me to discern patterns to determine what triggers his asthma symptoms and adjust medications at different times of the year,” Mosnaim says.
Electronic systems can monitor pollen counts and air quality as well as how often a patient uses rapid rescue medication. So, she says, tracking these metrics throughout the year could draw attention to impending asthma attacks and suggest when to increase the dose of controller medications or add other treatments.