Q&A: Digital inhaler, education program improve adherence, reduce medication burden

Key takeaways:

• 14% of the intervention group and 32% of the controls had a net increase in treatment.
• 11% of the intervention group and 21% of the controls needed add-on biologic therapy.

Patients who used a digital-based strategy for evidence-based asthma control experienced modest improvements in medication adherence with lower cost and treatment burdens, according to a study published in The Lancet Respiratory Medicine.

During the INCA Sun trial, adults with asthma used reliever and preventer medicines outfitted with the Inhaler Compliance Assessment (INCA) device. Patients in the intervention group participated in educational and treatment-adjustment visits, whereas those in the control group received a standardized educational program.

Compared with baseline, 14% of the intervention group and 32% of the controls had a net increase in treatment at week 32. Also, 11% of the intervention group and 21% of the controls needed add-on biologic therapy.

Mean adherence rates during weeks 20 to 32 included 55.5% for the control group and 64.9% for the intervention group, indicating how digital technologies with a corresponding educational program can improve adherence and reduce burdens.

Healio spoke with Richard W. Costello, MD, member of the INCA Research Team and professor of medicine with the Royal College of Surgeons, Dublin, to find out more.

Healio: What prompted this study?

Costello: Asthma became a different disease with the advent of inhaled corticosteroids (ICS). However, adherence to these medications is suboptimal, resulting in poor asthma control. Clinicians struggle to treat this disease, as they lack objective evidence of adherence. This prompted us to investigate why this was the case.

Richard W. Costello

We started with the development of a device that, when attached to a person’s inhaler, measured how and when the inhaler was used. These data were analyzed and, using novel algorithms, we could see behavioral patterns to adherence.

A clinical decision support tool was developed to present data in a visual format that allowed us to give feedback to the person on their adherence.

By combining digital adherence data with lung function data and incorporating these into the structured clinical decision support tool, we could deliver guideline treatment decisions. For example, would we be less likely to increase medications for patients and safely reduce the number of patients receiving step-up therapies?

Healio: Were there any particularly surprising or significant results?

Costello: Our results were so overwhelmingly positive that we double- and triple-checked. More patients in the control group were referred on for biologic therapy. More patients in the control group had their ICS increased. Fewer patients in the control group had their ICS decreased. There was no increase in the rate of exacerbations in those who had their ICS decreased.

Healio: How can doctors use these findings to improve care?

Costello: Patients who are being considered for a biological agent should have a digital assessment of both inhaler adherence and lung function with the data integrated on a digital clinical decision platform.

Healio: What is the next step in this research?

Costello: By using the simultaneous measurement and alignment of inhaler use and lung function, we aim to organize patients with clinical diagnoses of asthma into one of four groups:

1. the good adherence/poor lung function group;
2. the poorly adherent/poor lung function group;
3. the good adherence/normal lung function/symptomatic group; and
4. the good adherence/controlled lung function/controlled symptoms group.

We can use this as the basis for adjustments to treatment and further diagnostic testing as needed.

Reference:

• Mac Hale E, et al. Lancet Respir Med. 2022;doi:10.1016/S2213-2600(22)00534-3.