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Smart Asthma Management: Revolutionizing Medication Reminders with Cutting-Edge Digital Device


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A chronic respiratory condition called asthma affects the air passages, leading to symptoms such as wheezing, coughing, chest tightness, and difficulty breathing. Severe symptoms indicate an asthma attack. The Asthma and Allergy Foundation of America estimates that approximately one out of every 13 individuals in the United States has asthma. While asthma cannot be cured, it can be managed effectively. Individuals with asthma commonly carry quick-relief inhalers to use during an attack. These inhalers contain bronchodilators, which relax the lung muscles and widen the airways.

People with asthma may also be prescribed long-term control medications, such as inhaled corticosteroids or leukotriene modifiers, which regulate the production of inflammatory molecules known as leukotrienes. During an asthma attack, mast cells release these molecules, causing bronchoconstriction. In some cases, oral corticosteroids are prescribed to reduce airway inflammation during asthma flare-ups. However, it's important to note that oral corticosteroids carry short-term and long-term risks, including high blood pressure and cataracts.

According to the American Lung Association, approximately 5% to 10% of Americans with asthma have severe or difficult-to-control asthma. Medical professionals suggest that improper inhaler usage or failure to adhere to recommended usage frequency may contribute to difficult-to-control asthma. A research study conducted by RCSI University of Medicine and Health Sciences investigated the use of a technological device that measures acoustic or sound-wave signals from inhalers to assess inhaler usage objectively. Published in The Lancet Respiratory Medicine, the study revealed that integrating data from digital devices into a clinical decision platform resulted in fewer medication dosage increases. This approach showed a modest improvement in medication adherence among individuals with asthma.

Gaining Access to Biologics for Asthma

In the treatment of severe asthma, healthcare professionals sometimes prescribe biologics. Biologics belong to a newer category of medications that replicate cellular molecules. For individuals with asthma, these biologics specifically target certain inflammatory pathways, effectively reducing inflammation.

The use of biologics can lead to a decrease in asthma flare-ups, an improvement in lung function, and a reduced reliance on oral corticosteroids. However, it is worth noting that biologics are often associated with high costs.

Approximately 15 years ago, Dr. Richard Costello, a professor at RCSI University of Medicine and Health Sciences and the lead researcher of this recent study, initiated a program for individuals suffering from severe asthma. Dr. Costello recalled the limited access to biologics due to their high costs, stating, "We were really constrained in terms of accessing biologics because of financial considerations."

During an earlier stage of his career, Dr. Costello attended a lecture where the speaker hypothesized that people frequently mismanage their asthma medications. This notion stayed with him, leading him to prioritize selecting the most suitable individuals when making decisions regarding the limited availability of biologics. He explained, "It stuck in my mind that if I had a limited number of people to receive a biologic, I needed to ensure that those I selected were the best candidates."

Around a decade ago, Dr. Costello collaborated with an engineer to develop an acoustic device. He explained, "We devised an acoustic device that not only detects when the inhaler is used but also assesses how it is used." This device allowed doctors to objectively evaluate whether patients were using their inhalers as prescribed and using them correctly. By confirming proper inhaler usage, healthcare practitioners could confidently consider prescribing biologics.

Dr. Costello believes that this approach provides a fair method for accessing biologics, stating, "We believe it offers an equitable way to gain access to biologics."


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Findings from the asthma inhaler study

A study was conducted in 10 specialized asthma clinics located in Ireland and England, involving 200 individuals diagnosed with severe or difficult-to-control asthma. The participants were required to be at least 18 years old and have been using inhaled corticosteroids (ICS) in combination with a long-acting beta-agonist twice daily for a minimum of 12 months.

To be eligible for the study, participants needed to have experienced a severe asthma flare-up within the past year, necessitating treatment with oral corticosteroids, visits to the emergency room, or hospitalization. Individuals already using biologics were excluded from participating.

During the 32-week duration of the study, participants had a total of three educational visits led by nurses and three visits led by physicians, where adjustments to their treatment could be made based on their condition.

The active group of participants utilized a device called the Inhaler Compliance Assessment (INCA) device, which was attached to the top of their inhalers. This device recorded audio each time the inhaler was used. Advanced signal processing algorithms were employed to assess the quality of each inhalation. If the inhaler was not primed, if exhalation occurred into the inhaler before inhalation, or if the inhalation flow peak was below 40 liters per minute, the algorithm marked the usage as an error.

Furthermore, participants recorded their peak expiratory flow (ePEF) twice daily using digital measurement devices. In contrast, the control group had their adherence to the prescribed inhaler regimen and exacerbation events evaluated through pharmacy records, observation of inhaler technique by healthcare practitioners, and completion of a questionnaire.

Digitalizing Approaches to Asthma Treatments

During nurse-led educational visits, participants in the active group were provided with visual feedback on adherence and errors in inhaler usage. They were also presented with information on the correlation between treatment utilization and their ePEF (expiratory peak flow).

Meanwhile, participants in the control group, during nurse-led educational visits, received a standard educational program that included a discussion on the nature of asthma.

For participants in the active group, during physician-led visits, doctors were equipped with asthma and adherence data, which was incorporated into a decision algorithm to determine treatment adjustments.

On the other hand, physicians relied on conventional methods, such as visually assessing inhaler techniques, to decide whether treatment adjustments were necessary during physician-led visits for participants in the control group.

Among the active group, 14% received a net increase in treatment prescriptions, while 32% of the control group received a net increase in treatment prescriptions.

Furthermore, 31% of the active group successfully reduced their medication, compared to 18% in the control group.

Among the 102 patients in the active group, 11 required additional biological therapy, whereas among the 98 control patients, 21 needed add-on biological therapy.

Alleviating Treatment Burden

Dr. Jimmy Johannes, a pulmonologist and critical care medicine specialist at MemorialCare Long Beach Medical Center in California, who was not involved in the study, expressed interest in future clinical trials involving the INCA device, as shared with Medical News Today.

"We have recognized to some extent that adherence can pose significant challenges for our asthma patients," Johannes explained. "However, it would be fascinating to learn the extent to which adherence is problematic and how much improvement in adherence can contribute to reducing treatment burden and the need for biologics."

It is important to note, as Costello emphasized, that the purpose of developing the device is not to catch patients who are non-compliant with instructions.

"Our objective is to provide support to individuals," he stated. "If they struggle to comprehend their condition or face difficulties in using their inhaler correctly, it is unfair to label them as non-adherent. It is also unjust for insurance companies to impose significant barriers on people seeking access to biologics."


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