Patient organisation comments
Asthma UK provided the following comments on Smartinhaler.
Digitally connected inhaler devices could allow healthcare professionals to provide useful feedback remotely based on the data received to help improve adherence or advice patients on whether they need to have their treatment or action plan reviewed. It is also important to also ensure that the quality of inhaler use is good.
Suboptimal or non-adherence to inhaled asthma medication is associated with poor symptom control, higher healthcare utilisation and healthcare costs, and reductions in health-related quality of life (Mäkeläa et al. 2012).
There is potential for better self-management from this technology and this may result in fewer GP appointments, accident and emergency department attendance and ultimately more targeted interventions identifying who is most at need of annual reviews. Digitally connected inhalers could be of benefit to all people with asthma, and not limited to people with severe asthma.
The data collected could help improve patient experience of the annual asthma review. People with asthma often do not find the annual review useful, and can find it difficult to recall all the occasions in a 12‑month period when their asthma control fluctuated. Some estimates suggest that as many as two-thirds of people do not attend their annual asthma review (Gruffydd-Jones et al. 1999).
Medication monitoring could also aid patients in ensuring they are on the most appropriate treatment. Having reliable adherence data could help clinicians ensure those patients that have severe asthma are referred to specialised services, having ruled out poor adherence to inhaled medication as a factor for their poor control.
Using a short-acting reliever inhaler more than 3 times a week is a strong warning sign of poor asthma control and a predictor of future asthma attacks. These patients are at increased risk of an asthma attack and should be invited in for a review with a GP or nurse, as highlighted in the Asthma UK report highlighting unsafe prescribing (Asthma UK; 2015).
Most people with asthma (over 70%) have shown that they are happy to carry an additional device with them were it designed to monitor their inhaler usage (myAirCoach public deliverable 1.2; 2015).
Unless the digitally connected inhaler device is available for all prescriptions there is a risk that people with asthma will not be able to use it, or need to change prescription to a different inhaler.People with asthma often dislike switching inhalers that they have become accustomed to, and this can negatively impact on care (Scichilone; 2015). Less than half of people with asthma surveyed stated they would be happy to change their inhaler in order to have access to a mobile health (mHEALTH) system (myAirCoach public deliverable 1.2; 2015).
The information obtained needs to interact with existing NHS systems in a standard manner. If patients need to change their treatment, and possibly the digital device, this should not impact on their ability to self-manage their asthma.
There is potential for a large amount of data to be sent to clinicians; this information must be used in effective ways that do not add significantly more to clinicians' time.
Clear guides and support for the devices should be available to patients.