Sensor-Based Inhalers May Improve Medication Adherence

Samara Rosenfeld

The tech improved asthma symptoms and caregiver quality of life but increased healthcare use.

Healthcare providers may integrate sensor-based inhalers into their workflows to improve medication adherence and support children with asthma.

The inhalers, which leverage Bluetooth sensors that attach to participants’ inhalers to detect medication use and share data with physicians, could proactively detect worsening of asthma symptoms.

“As a result, this may enable healthcare providers to intervene more rapidly — before patients become critically ill — and improve communication between patients, caregivers and asthma providers,” the press release said.

Investigators from Northwestern and Lurie Children’s in Chicago randomly assigned caregiver and children dyads to receive inhaler sensors that allowed for caregiver and clinician electronic monitoring of medications. The 252 children enrolled had moderate or persistent asthma and were recruited from five clinics. Those included in the study were four to 17 years old, had a prescription for daily ICS for at least one year before enrollment per medical record or parent report, and had at least one exacerbation requiring oral corticosteroids the year before trial enrollment. Of the children, 24% were non-Hispanic White, 23% were non-Hispanic Black, and 40% were Hispanic, while 60% were on public insurance.

Participants in the intervention group received Propeller Health’s FDA-cleared inhaler sensors for ICS and SABAs medications that allowed caregivers through an app, and clinicians through a Web portal, to track the child’s SABA and daily ICS use. The app also had personalized insights, educational content, encouragement, surveys, and care team services. Sensors monitored inhaled medication use and captured date, time, and number of uses.

The children were evaluated based on an Asthma Control Test questionnaire. The questionnaire measured the child’s asthma symptom control on a scale from 0 (poor control) to 27 (well-controlled). Over the course of the study, average scores among the intervention increased by 10.1%. The greatest improvements were among non-Hispanic Black participants. E intervention group than in control at all time points (baseline, three months, six months, nine months, and 12 months).

The adjusted mean Asthma Control Test scores significantly increased from 19.1 to 21.8 among the intervention group and from 19.4 to 19.9 among the control group at 12 months after baseline.

Caregivers who participated in the randomized-controlled clinical trial were assessed based on a Pediatric Asthma Caregiver’s Quality of Life questionnaire. The questionnaire measured how the sensor-based monitoring adherence affected their day-to-day involvement with their child’s care. Overall, caregivers reported improvement to their quality of life after the first month of the study. Quality of life was sustained through the year-long trial due to greater ease of asthma management.

While the technology improved asthma symptom control and caregiver quality of life, it did not reduce healthcare use. The intervention group experienced significantly higher 12-month rates of asthma-related hospitalizations and emergency department visits compared to the control group. That may be because intervention participants had increased access to providers due to alerts that triggered provider calls when children had more than four SABA uses per day. Additionally, increased asthma awareness and knowledge might have led to increased vigilance of clinically concerning asthma symptoms.

"This study is another clear example that digital health is here to stay, as it allows for us to stay connected to patients living with chronic disease, provide a level of automated watchfulness, and intercept disease in a timely manner," said Deneen Vojta, M.D., chief physician executive for Optum Labs, part of UnitedHealth Group. "This is a terrific example of moving from the best care out there today to the best care possible."

The study, "Sensor-Based Electronic Monitoring for Asthma: A Randomized Controlled Trial," was published online in the journal Pediatrics.