Digital inhaler programme improves asthma control also in the long term, but not long-term adherence

In a clinical study, a digital inhaler program resulted in significantly improved asthma control with clinical relevance. Unfortunately, adherence improved only in the short-term but was not sustained after a year. However, asthma control remained improved in the long term.

Globally, almost 43% of asthma patients are non-adherent to their inhalation therapy [1]. Digital/smart inhalers provide objective data on adherence and have been shown to improve medication adherence in the short term [2,3]. “We don’t know much about the long-term adherence,” Susanne J van de Hei (University Medal Center Groningen, the Netherlands) explained [4]. To evaluate the effect of a digital inhaler programme (Turbu⁺ Insights^TM) on medication adherence in uncontrolled asthma patients, it was compared with a control group over a 12-month period. Adult asthma patients were recruited via general practices, pharmacies, and via social media. All participants had an Asthma Control Questionnaire (ACQ)-5 score ≥0.57 and used an inhaler (Symbicort^® Turbuhaler^®) ≥8 weeks. They were randomised to either a control or an intervention group. Participants were able to view medication use and set reminders in the digital inhaler programme. Efficacy parameters were medication adherence (primary endpoint), measured by the digital programme, and asthma control, as measured by ACQ-5, where a change of ≤-0.5 in the ACQ-5 score was seen as a minimally important difference.

“Short-term, the adherence was much better in the intervention group, but after a while, it got worse,” Ms van de Hei said. At week 2, there was indeed a significantly higher adherence in the intervention arm (odds ratio (OR) 2.19; 95% CI 1.63–2.95). However, the difference between groups declined over time, and there was no significant difference between the groups at the end of the study. In contrast, asthma control significantly improved in the digital inhaler programme users over time, compared with the control arm (P=0.006). In addition, those using the digital inhaler program were 3 times more likely to reach a minimally important difference in the ACQ-5.

1. Hassan M, et al. J Asthma 2020;57(12):1379–88.
2. Chan AH, et al. Lancet Respir Med 2015;3:210-9
3. Mac Hale E, et al. Lancet Respir Med 2023;11:591-601.
4. Van de Hei S. Effects of a digital inhaler on medication adherence and clinical outcomes in primary care asthma patients: a cluster RCT. Abstract 3211, ERS International Congress 2023, 9–13 September, Milan, Italy.

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Posted on 29 October 202329 October 2023