Assessing adherence to inhaled therapies in asthma and the emergence of electronic monitoring devices.

Infrequent use of inhaled corticosteroids (ICS) and/or over-reliance of short-acting β-agonists (SABA) are recognised as key contributors to increased morbidity and mortality in asthma. The most frequent measures of ICS adherence and SABA use rely on patient-reported questionnaires or prescription refill records, neither of which are considered sufficiently reliable. Technological advancements in the development of electronic monitoring of inhaler devices allow for monitoring of use, as well as recording of and feedback on inhaler technique for some devices. Most electronic monitoring devices (EMDs) are paired with a smartphone application, allowing patients to set reminders and display both preventer and reliever use over time. This allows identification of intentional and unintentional ICS non-adherence as well as frequency of SABA use. This information assists clinicians in distinguishing difficult-to-control from severe asthma. Although additional evidence is required to assess the impact of EMDs on clinical outcome measures such as exacerbation rate, the introduction of EMDs into the asthma armoury is a significant step forward in asthma care with the potential to improve asthma-related outcomes.
Competing Interests: Conflict of interest: H. Dhruve reports receiving honoraria from Asthma UK Centre for Applied Research, University College London, Pharmacy Management, and Primary Care Respiratory Society, outside the submitted work. Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: Pharmacy Management, Primary Care Respiratory Society, London Respiratory Network, Academic Health Science Network – Severe asthma sub-committee. Conflict of interest: D.J. Jackson reports receiving grants or contracts from AstraZeneca outside the submitted work. Consulting fees from AstraZeneca, GSK, and Sanofi Regeneron, outside the submitted work. Speaker fees received from AstraZeneca, GSK, and Sanofi Regeneron, outside the submitted work.
(Copyright ©The authors 2022.)