Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Nov 19, 2020
Date Accepted: May 20, 2021
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Using Digital Coaching Through Smart Inhaler Technology to Improve Asthma Management in Patients With Asthma in Italy
ABSTRACT
Background:
Reliance on short-acting β2-agonists and nonadherence to maintenance medication are associated with poor clinical outcomes in asthma. Digital health solutions can support optimal medication use and disease management in patients with asthma; however, their use in community settings has not been determined.
Objective:
To investigate community implementation of the Turbu+ program designed to support asthma management, including adherence to budesonide/formoterol (Symbicort) Turbuhaler maintenance therapy or maintenance and anti-inflammatory reliever therapy.
Methods:
Patients with asthma prescribed budesonide/formoterol as maintenance therapy (1 inhalation twice daily [1-BID] or 2 inhalations twice daily [2-BID]) or as maintenance and anti-inflammatory reliever therapy (1-BID and reliever or 2-BID and reliever) received training on Turbu+ in secondary care centers across Italy. An electronic device attached to the patients’ inhaler for ≥90 days (data cutoff) securely uploaded medication-use data to a smartphone application and provided reminders, visualized medication use, and motivational nudge messages. Average medication adherence was defined as the proportion of daily maintenance inhalations taken as prescribed (number of recorded maintenance actuations/day or maintenance inhalations prescribed/day) averaged over the monitoring period. Proportion of adherent days was defined as the proportion of days when all prescribed maintenance inhalations were taken on a given day. The Wilcoxon test compared the proportion of adherent days between patients in the maintenance vs maintenance and anti-inflammatory reliever treatment regimens of a given dose.
Results:
In 661 patients, the mean (±SD) number of days monitored was 217.2 (±109.0) days. Average medication adherence was 70.2% overall and similar across the groups (1-BID, 66.5%; 1 BID and reliever, 71.0%; 2-BID, 67.4%; 2-BID and reliever, 70.7%). The proportion of adherent days was 56.6% overall and higher with maintenance and anti-inflammatory reliever therapy (1-BID and reliever vs 1-BID, 60.0% vs 52.7%, P<.00001; 2-BID and reliever vs 2-BID, 52.9% vs 50.6%, P=.015). Rates of discontinuation from the Turbu+ program were significantly lower with maintenance and anti-inflammatory reliever therapy compared with maintenance therapy alone (P=.0142).
Conclusions:
Overall, the high medication adherence observed during the study may be attributed to the electronic monitoring and feedback mechanism provided by the Turbu+ program.
Citation
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