Clinical guidelines for assessing asthma control may need to be updated to reflect objective patient information obtained from digital medicines like smart inhalers, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice. 

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The study, conducted by Propeller Health, University of Colorado School of Medicine and Children’s Hospital Colorado, shows that both patients and providers gain a more accurate view of a patient’s medication use when digital sensors record the number of “puffs” of rescue medication that were used.

These findings demonstrate how objective digital data can be used to more accurately measure and assess asthma control, compared to patient-reported data that depends on patient recall and can be skewed by recall bias and healthcare provider interpretation of this data.

This new evidence suggests that “occasions of rescue use,” recommended in the 2009 American Thoracic Society (ATS) and European Respiratory Society (ERS) Task Force report as a method for assessing asthma control, be reconsidered. In particular, these data indicate that there is no clear, natural definition of an “occasion.” In comparison, the reporting of puffs is objective and more easily standardized in clinical practice, paralleling the recommendation for clinical research.

“In the past, providers asked patients about their use of rescue medications to determine whether the patient’s asthma was well-controlled, partly-controlled or not well-controlled,” said David Stempel, MD, the SVP of Clinical and Medical Affairs for Propeller Health and a co-author of this study. “Their understanding was based on recall and affected by patient bias, as few patients remember the number of times they used their rescue beyond the prior few days, at best.”

“Now, with data from digital therapeutics, we more accurately know how many puffs of rescue inhaler were used,” he said. “Incorporating digital science into the ATS/ERS recommendations will advance guideline development and hopefully improve patient outcomes.”

In this study of 3,373 patients, Propeller Health used its digital medicine platform to connect patients’ inhalers with an attached sensor that reports the date and time of inhaler use. Using digital medicine data, Propeller was able to objectively assess how many puffs a patient took of their rescue medication, giving a more accurate picture of their medication use. The study found:

  • Within two minutes of the first puff, 30% of rescue events consisted of a single puff, 53% had two puffs and 17% had three or more puffs of rescue medication.
  • Over the next 4-6 hours the pattern of inhalations changed incrementally, indicating no clear cut-off point for an occasion.

“Incorporating digital medicine data into clinical practice relieves the burden on the patient to recall every instance of medication use and relieves the burden on the provider to estimate whether the patient’s reporting is accurate,” said study co-author Stanley Szefler, MD, Director of the Pediatric Asthma Research Program in the Breathing Institute of the Pediatric Pulmonary Section at Children’s Hospital Colorado. “A growing body of research suggests that digital medicines will completely change the way we monitor medication use and disease management.”