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Asthma inhaler sensors improve pediatric asthma control

Reuters Health - 24/12/2020 - Children whose long- and short-term inhaler use was monitored with sensors that sent data to parents and clinicians had better asthma control than those whose medication use was not monitored, a new study found.

An analysis of data from more than 250 asthmatic children found significant improvement in control of the disease in those using inhalers with sensors, according to the report published in Pediatrics. However, there was an increase emergency room visits in those using the sensors.

"For improving asthma care it's beneficial to move towards sensor based monitoring and to have the data in clinicians hands to improve care," said Dr. Ruchi Gupta, a professor of pediatrics at the Northwestern Feinberg School of Medicine and a clinical attending at the Ann and Robert H. Lurie Children's Hospital of Chicago.

"My dream is for clinicians to have a usage chart, like a growth chart, that they can open up and then use the data to adjust the children's medications," Dr. Gupta said. "One of the biggest things patients told us is they liked the idea of a physician watching over them. This did improve patients' quality of life."

To explore whether the sensor technology could improve patient asthma control, Dr. Gupta and her colleagues ran an unblinded randomized controlled trial between 2016 to 2018 at five medical clinics -- three primary care, one allergy and one pulmonary. Participants were ages 4 to 17, with moderate to severe asthma, a prescription for daily inhaled corticosteroids for a year or more prior to enrollment and one or more exacerbations requiring oral corticosteroids in the previous year.

In total, 252 child/caregiver dyads were enrolled and randomly assigned to a control group or an intervention group. Inhalers used by children in the intervention group were modified with a sensor that sent a signal to the treating clinician and caregivers each time the child used it.

"When children utilize the inhaler, they push down on the sensor on top," Dr. Gupta explained. "That triggers a transmission to the smart phones of their physician and the parents or caregivers so everyone would know when the medication was being utilized."

Alerts were sent out if children did not use their daily medication or if the children used their albuterol inhaler more than four times a day, Dr. Gupta explained. "Then the office would call to see if everything was OK," she said.

Among the children in the intervention group, the average Asthma Control Test score increased from 19.1 to 21.8. The scores in the control group saw a slight uptick: 19.4 versus 19.9. Adjusted rates of emergency department visits and hospitalizations were greater among those in the intervention group than in the controls (incidence ratio for emergency department visits was 2.2; while the incidence rate ratio for hospitalization was 3.4).

Dr. William Anderson, director of the Multidisciplinary Asthma Clinic at Children's Hospital Colorado in Denver, told Reuters Health that clinics at his hospital have started to use the sensors.

"This is a good initial study," Dr. Anderson said. "It shows the promise of the technology. It's good to see that with this technology asthma control and symptom scores did improve. But there was not the impact on exacerbations or emergency room visits we would have hoped to have seen."

The technology may help doctors distinguish between exacerbations due to poor compliance and those that show an adjustment to medication is needed, Dr. Anderson said. "It can help us tailor interventions," he added.

While more research is needed, "I would say that this is the direction we will be heading in," Dr. Anderson said.

SOURCE: https://bit.ly/2JhGMXk Pediatrics, online December 22, 2020.

By Linda Carroll

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