Digitally enhanced therapy lowers treatment burden and costs in severe asthma 

The treatment burden for patients with severe asthma was significantly reduced by using a digital toolset informing evidence-based care, including data on medication adherence, inhaler technique, and peak flow. Importantly, the lower treatment burden in the digital care group was not associated with a hampered asthma control.

“Medical adherence, inhaler technique, and underlying comorbidities are practical challenges in the assessment of patients with asthma,” stated Prof. Richard Costello (Bon Secours Hospital Dublin, Ireland) [1]. Objective measures are needed to separate patients with difficult-to-treat asthma from those with severe asthma. The INCA-SUN trial (NCT02307669) randomised 216 patients with severe, uncontrolled asthma to the experimental arm, in which participants received personalised biofeedback on inhaler adherence, technique, and peak expiratory flow, with treatment decisions being informed by digital data, or to usual care.

At week 32, 11% of participants in the experimental group and 21% of the participants in the usual care arm required add-on biologic therapy (OR 0.42; P=0.038). In addition, participants in the usual care arm more often received added high doses of inhaled corticosteroids (ICS) compared with the experimental arm (OR 0.26; P=0.049). A reduction in high-dose ICS was more frequently reported in the digital arm than in the usual care arm (OR 2.11; P=0.047; see Figure).

Figure: Digitally-informed decisions lead to better outcomes [1]



OR, odds ratio.

The authors showed that adherence was approximately 10% higher in the digital arm than in the control arm. Importantly, asthma control rates, lung function, T2 inflammation, and exacerbation rates were comparable between the 2 study arms, indicating that the digital approach achieved asthma control more frequently by improving the current therapy instead of escalating therapy.

Finally, Prof. Costello said that the direct medical costs for 1 individual were €3,000 less in the digital arm than in the usual arm.

1. Costello R, et al. Use of digital measurement of medication adherence and lung function to guide the management of uncontrolled asthma: The INCA Sun randomized clinical trial. ALERT 4, RCT4446, ERS International Congress 2022, Barcelona, Spain, 4–6 September.

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Posted on 30 October 2022