Digital measurement of asthma medication adherence, lung function useful to guide management

Evidence-based care informed by digital data collection led to a lower treatment burden among patients with severe, uncontrolled asthma, researchers reported at the European Respiratory Society International Congress.

European Respiratory Society (ERS) Education Council Chair Richard Costello, MD, professor of medicine at the Royal College of Surgeons, Dublin, and colleagues conducted the INCA Sun randomized clinical trial to evaluate the clinical value of digital tools to assess medication and lung function.

The researchers enrolled 216 patients with severe, uncontrolled asthma and at least one exacerbation in the previous year despite treatment (mean age, 47.3 years; 64.8% women). The study was conducted at 10 asthma clinics in Ireland, Northern Ireland and England.

The researchers evaluated objective measurement of inhaler use by an audio recording device attached to the asthma inhaler. The device creates audio files of each step of inhaler use and identifies technique errors, Costello said. Those data are then downloaded and used for both quantification of inhaler adherence and for patient education. Mathematical analysis is used to automatically identify when and how well the inhaler was used, according to Costello.

“So, putting together the remote monitoring device, digital peak flow and our clinical decision support [platform we created], we conceived this study,” Costello said.

Patients were randomly assigned to the active group (n = 109), which received personalized digital feedback on inhaler adherence, technical and peak expiratory flow, or the control group (n = 107), which received usual care. The 32-week trial comprised three patient education visits at 1, 4 and 8 weeks and treatment adjustment visits at 8, 20 and 32 weeks.

Digitally-informed decisions led to less treatment escalation and more ICS reduction compared with usual care, according to the results. Overall, 20% of patients in the control group and 11% in the active group were prescribed an add-on biologic by 32 weeks (OR = 0.42; 95% CI, 0.189-0.95; P = .038), Costello said. Sixteen percent of the active group and 44% of the control group who initiated fluticasone proprionate 500 mcg per day had their dose increased (OR = 0.26; 95% CI, 0.07-0.99; P = .049) and 31% and 18%, respectively, had their dose reduced (OR = 2.11; 95% CI, 1.01-4.74; P = .047), according to the results.

In addition, inhaler adherence was about 10% better among patients in the active group compared to the control group, according to Costello.

Researchers also reported lower direct medical costs (about 3,000 pounds per person) in the active group compared with the control group.

Secondary endpoints were not different between the two groups. Despite a lower treatment burden, asthma control, lung function, T2 inflammation and exacerbations were similar between those assigned to the active group or the control group, according to Costello.

“Evidence-based care informed by digital data leads to significantly lower treatment burden for patients with severe asthma. I think that’s good outcomes for patients and good outcomes for health care systems,” Costello said. “And most importantly, it allows us to identify patients who need a biologic so that they can get access to it.”