Digital inhaler data help identify reliever medication overuse, predict exacerbations

Key takeaways:

• Digital inhaler data paired with expert-consensus thresholds on reliever medication use shows those who overuse medication.
• Having one exacerbation was frequently found among those who overused medication.

HONOLULU — Analyzing real-world digital inhaler data using expert-consensus thresholds on reliever medication use helped find medication overuse and may predict exacerbations, according to an abstract presented at the CHEST Annual Meeting.

“Applying expert-consensus thresholds on reliever use, combined with patients’ digital reliever use data, may support risk management in clinical practice,” Njira L. Lugogo, MD, MS, associate professor of internal medicine and director of the asthma program within the division of pulmonary and critical care medicine at University of Michigan Health, said during the presentation.

In a single-center, observational study, Lugogo and colleagues assessed 48 adults with severe persistent asthma using a digital reliever inhaler medication (ProAir Digihaler; Teva Pharmaceuticals Industries) over 52 weeks to evaluate how these recorded data could be used when paired with four expert-consensus thresholds on reliever medication use for predicting asthma exacerbations.

Researchers considered the following consensus statements signaling overuse of reliever medication: 598 inhalations or more over 52 weeks, 25 inhalations or more in 1 week, 100% or more of baseline use for at least 1 week, and 200% or more of baseline use for at least 1 week.

The lowest reliever medication use within 3 consecutive or nonconsecutive weeks with at least one inhalation served as a patients’ baseline use, according to researchers.

More than half of the study population (56.3%; n = 27) experienced at least one exacerbation.

Researchers found that eight patients (16.7%) used 598 inhalations or more over 52 weeks, three-quarters of whom (n = 6) experienced at least one exacerbation, making the number needed to identify (NNI) one additional patient with an exacerbation 4.44 using this threshold.

Further, 12 patients (25%) used 25 or more inhalations within 1 week, and all but two of them (n = 10; 83.3%) had one exacerbation or more. The NNI for an additional exacerbating patient in regard to this consensus statement was 2.77.

Among the 44 patients (91.7%) who used 100% or more of baseline use of reliever medication for at least 1 week, 26 of them (59.1%) experienced at least one exacerbation (NNI = 2.93), whereas a higher percentage of patients who used at least 200% of baseline use for 1 week or more (n = 40; 83.3%) had an exacerbation (65%; n = 26; NNI = 1.9).

“Further research is required to understand whether insights provided by the Digihaler inhaler can be supported by other clinical background data, eg, exacerbation history, eosinophil levels, etc,” Lugogo said.