Daily self-assessments associated with improved inhaler adherence in patients with asthma

SAN ANTONIO — Patients with asthma who used a daily self-assessment with their digital inhalers reported better medication adherence, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“Poor medication adherence is common among patients, and health care professionals identify poor medication adherence by objectively recording inhaler use,” Giselle S. Mosnaim, MD, MS, FAAAAI, allergist and immunologist with the NorthShore University Health System, said during her presentation.

“Digital inhalers can help patients and health care professionals identify poor medication adherence by objectively recording inhaler use,” Mosnaim continued.

The CONNECT2 study compared use of the Maintenance and Reliever Digihaler System (MRDS; Teva Pharmaceuticals) with standard-of-care maintenance and reliever inhalers among patients with asthma.

“The Digihalers and the MRDS have integrated sensors that allow for inhaler usage tracking,” Mosnaim said. “These data can then be transmitted wirelessly to a phone app, which participants can use to track their inhaler usage.”

The app includes a nonrespiratory specific daily self-assessment (DSA) that study participants were introduced to during app onboarding. Participants were not required to use the DSA.

The DSA asked users how they felt each day, and users could select a picture of a face that best represented their response. The three choices included happy, neutral and sad faces. Users could respond one time each day, although they could later change that response.

The study included 242 participants aged 13 years and older (mean age, 47 years; 73% female) with suboptimal asthma control, based on Asthma Control Test (ACT) scores of less than 19 (mean, 14.5) who used the MRDS.

Also, participants reported receiving inhaled corticosteroids or long-acting beta 2 agonists and that they were willing to replace these medications and their reliever treatment with fluticasone propionate/salmeterol and albuterol Digihalers.

Participants were randomly assigned at a 4:3 ratio into a group using the MRDS or a group using the standard of care, including existing maintenance and reliever inhalers, for 24 weeks.

According to the researchers, 181 participants (74.8%) completed the trial, with 147 (81%; mean age, 48.3 years; standard deviation [SD], 18.1; 75% female; mean ACT score, 14.6; SD, 2.8) submitting at least one DSA response.

“Participants with a greater number of DSA responses tended to have a greater percentage adherence to maintenance medication,” Mosnaim said. “Furthermore, participants above the adherence threshold also reported a higher proportion of positive DSA responses.”

There also was an association between 75% or greater adherence to maintenance medication and a higher percentage of positive “happy face” DSA responses compared with adherence percentages below this threshold.

Specifically, 66% of the DSA responses were positive among patients who achieved 75% or greater adherence, compared with 55% of DSA responses among patients who did not achieve 75% adherence.

Similarly, 63% of the DSA responses were positive among those who achieved 45% adherence, whereas 78% of them were positive among the participants who achieved 95% adherence.

“The findings from this study highlight a connection between DSA response and adherence,” Mosnaim said. “Access to information about their adherence in inhaler use along with reminders and feedback may support patients’ use of the app and lead to better adherence and improved outcomes.”

Additionally, the researchers said, this information can support discussions between providers and patients, which could lead to a better understanding of when and why patients use their inhalers.