Parents report higher inhaler adherence vs. electronic monitor in pediatric asthma

Key takeaways:

• The Hailie Smartinhaler Sensor yielded a median daily adherence of 34%, whereas the median adherence was 75% in parental reports.
• Smart Spacer data revealed an average of 79 total errors in spacer technique.

SAN DIEGO — Among inner-city children with asthma, daily inhaler adherence was “overestimated” by parents when compared with adherence captured via an electronic monitoring device, according to a presentation here.

This pilot study, which also found an average of 79 total errors in inhaler-spacer technique using a Smart Spacer electronic monitoring device (EMD), was presented at the 2025 American Academy of Allergy, Asthma and Immunology/World Allergy Organization Joint Congress.

“For the clinicians, the results underscore the need to rely on objective measures of adherence (from EMDs) instead of self-report, as the latter may not reflect actual medication use,” Marina Reznik, MD, MS, vice chair for clinical and community-based research and professor of pediatrics at Children’s Hospital at Montefiore, Albert Einstein College of Medicine, told Healio.

“The errors in inhaler-spacer technique observed with a Smart Spacer not only highlight the need for targeted education on proper inhaler-spacer technique to patients but also the need to use a spacer, which can avoid the total loss of medication with some technique errors,” Reznik said. “It is necessary to do routine assessments of inhaler-spacer technique at each visit with patients to identify those who need further educational intervention.”

Using patients from Montefiore clinics, Reznik and colleagues evaluated 18 inner-city children (mean age, 8.7 years; 50% girls; 67% Hispanic/Latino; mean Childhood Asthma Control Test score, 18.4) with physician-diagnosed asthma to uncover how adherence differs when it is reported by an EMD (Hailie Smartinhaler Sensor) vs. parents (self-report and Medication Adherence Report Scale for Asthma [MARS-A]).

Researchers used data from the Hailie Smartinhaler Sensor to find daily adherence (number of controller actuations divided by prescribed dose) and data from the Smart Spacer EMD to find total errors in inhaler-spacer technique.

According to the abstract, the Hailie Smartinhaler Sensor yielded a median daily adherence of 34%, whereas reports from parents yielded a median adherence of 75% (P < .001).

“The high discrepancy between self-reported and EMD-measured adherence to asthma controller medication was large and unexpected,” Reznik told Healio. “Parents significantly overestimated their child’s inhaler use, which presents a major challenge as providers make clinical decisions based on self-reported adherence.”

When evaluating EMD adherence data and MARS-A score, researchers reported no correlation.

Smart Spacer data revealed an average of 79 total errors in spacer technique, which Reznik said was surprising. Notably, “taking shallow breaths” resulted in 193 inhaler spacer technique errors and “inhaling with a too high flow” resulted in 142 errors, according to the abstract.

“These inhaler technique errors can contribute to poor asthma control even if children are adherent to their medications,” Reznik told Healio. “Bottom line, if medications aren’t taken as prescribed — or if inhaler-spacer technique is incorrect — symptoms can worsen, which may lead to more ED visits, hospitalizations and disruptions to daily life.”

Based on the above findings, Reznik highlighted the potential of EMD use in patients with asthma.

“The EMDs provide more accurate measure of adherence and also remind patients to take their medication, potentially improving adherence and asthma outcomes,” Reznik told Healio. “In practice — there is a need to develop cheaper EMDs and assess how these devices can be implemented in routine practice by clinicians.”

Looking ahead, Reznik told Healio there are several elements that could be assessed to provide more data on the impact of EMDs on adherence.

“Future studies can validate results from this pilot study by incorporating larger sample size, education on correct inhaler-spacer technique and strategies to improve adherence, and evaluation of long-term asthma-related outcomes,” Reznik said. “Future research could also focus on how real-time feedback from these devices can be used in clinical practice to improve adherence, education and overall asthma outcomes.”

For more information:

Marina Reznik, MD, MS, can be reached at mreznik@montefiore.org.