A Review of Electronic Devices to Assess Inhaler Technique
- 405 Downloads
Purpose of Review
Multiple electronic devices exist that provide feedback on the accuracy of patient inhaler technique. Our purpose is to describe the inhaler technique feedback provided by these devices, including specific technique steps measured, how feedback is displayed, target of feedback (patient, provider, researcher), and compatibility with inhaler type (metered-dose inhaler [MDI], diskus, etc.).
We identified eight devices that provide feedback on inhaler technique. Only one device assessed all evidence-based MDI technique steps. Most devices provide limited real-time feedback to patients, if any feedback at all.
Technologies to assess inhaler technique are advancing and hold great potential for improving patient inhaler technique. Many devices are limited in their ability to detect all evidence-based technique steps and provide real-time user-friendly feedback to patients and providers. Usability tests with patients and providers could identify ways to improve these devices to improve their utility in clinical settings.
KeywordsInhaler Metered dose inhaler Dry powder inhaler Inhaler competence Inhaler technique mHealth
This study was financially supported in part from the PharmAlliance, a three-way partnership between the schools of pharmacy at UNC, UCL, and Monash.
Compliance with Ethical Standards
Conflict of Interest
Mr. Sage Ms. Roberts, and Dr. Carpenter declare no conflicts of interest relevant to this manuscript.
Dr. George has received in-kind support from Vitalograph in the form of devices (COPD-6; ASMA-1; AIM) for pilot testing.
Dr. Horne was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart’s Health NHS Trust; has undertaken speaker engagements with honoraria with the following companies: Abbvie, Amgen, Biogen Idec, Gilead Sciences, GlaxoSmithKline, Janssen, Pfizer, Roche, Shire Pharmaceuticals, MSD, Astellas, Astrazeneca, DRSU, Erasmus, and Novartis; and is founder and shareholder of a UCL business spin out company (Spoonful of Sugar) providing consultancy on medication-related behaviors to healthcare policy makers, providers, and industry.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 2.Akinbami LJ, Moorman JE, Bailey C, Zahran HS, King M, Johnson CA, et al. Trends in asthma prevalence, health care use, and mortality in the United States, 2001–2010. NCHS data brief, no 94. Hyattsville, MD: National Center for Health Statistics; 2012.Google Scholar
- 3.Centers for Disease Control and Prevention. Asthma's impact on the nation—data from the CDC National Asthma Control Program. 2014. p. 1–4.Google Scholar
- 9.•• Kikidis D, Konstantinos V, Tzovaras D, Usmani OS. The digital asthma patient: the history and future of inhaler based health monitoring devices. J Aerosol Med Pulm Drug Deliv. 2016;29(3):219–32. doi: 10.1089/jamp.2015.1267. This article reviewed inhaler-based monitoring devices and documented that several digital inhaler monitoring devices are available to assess inhaler technique. It shows that digital devices can validly and reliably assess patient inhaler technique, and we extend upon this research.CrossRefPubMedGoogle Scholar
- 17.Toumas-Shehata M, Price D, Basheti IA, Bosnic-Anticevich S. Exploring the role of quantitative feedback in inhaler technique education: a cluster-randomised, two-arm, parallel-group, repeated-measures study. NPJ Prim Care Respir Med. 2014;24:14071. doi: 10.1038/npjpcrm.2014.71.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Crane MA, Jenkins CR, Goeman DP, Douglass JA. Inhaler device technique can be improved in older adults through tailored education: findings from a randomised controlled trial. NPJ Primary Care Respiratory Medicine. 2014;24:14034. doi: 10.1038/npjpcrm.2014.34.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.O’Dwyer SM, MacHale E, Sulaiman I, Holmes M, Hughes C, D’Arcy S, et al. The effect of providing feedback on inhaler technique and adherence from an electronic audio recording device, INCA®, in a community pharmacy setting: study protocol for a randomised controlled trial. Trials. 2016;17(1):226. doi: 10.1186/s13063-016-1362-9.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Inhaler Compliance Assessment. INCA. Available from: http://www.incadevice.com/.
- 26.The Innovation Academy. Martin Holmes—improving inhaler user technique: Youtube; 2013. Available from: https://www.youtube.com/watch?v=azj-6QCdvsw.
- 27.Ditcham W, Murdzoska J, Zhang G, Roller C, von Hollen D, Nikander K, et al. Lung deposition of 99mTc-radiolabeled albuterol delivered through a pressurized metered dose inhaler and spacer with facemask or mouthpiece in children with asthma. J Aerosol Med Pulm Drug Deliv. 2014;27(Suppl 1):S63–75. doi: 10.1089/jamp.2014.1139.CrossRefPubMedGoogle Scholar
- 28.Vitalograph. AIM: for effective inhaler training on dry powder and metered dose inhalers. 2017. Available from: https://vitalograph.com/product/162430/aim.
- 29.Cambridge Consultants. T-Haler—new asthma inhaler training device: YouTube; 2012. Available from: https://www.youtube.com/watch?v=I_2ThiO09Sk.
- 30.Cambridge Consultants. T-haler inhaler training device. 2017. Available from: https://www.cambridgeconsultants.com/projects/t-haler-inhaler-training-device.
- 33.Food and Drug Administration. MDILog, 510(k)Number:K9703441997. Available at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn_template.cfm?id=k970344.
- 34.Aslam T. Inhaler spacer. Google Patents. Central Manchester University Hospitals NHS Foundation Trust Patents. US20150059739A1; 2015.Google Scholar
- 35.Fyne Dynamics. Inhaler trainer: Mag-Flo. 2016. Available from: http://www.fyne-dynamics.com/magflo_inhaler_trainer.htm.
- 36.National Heart Lung and Blood Institute. Expert panel report 3: guidelines for the diagnosis and management of asthma. Bethesda, MD: National Institutes of Health; National Heart, Lung, and Blood Institute, 2007 Publication Number: 08–5846.Google Scholar
- 37.Kamps AWA, van Ewijk B, Roorda RJ, Brand PLP. Poor inhalation technique, even after inhalation instructions, in children with asthma. Pediatr Pulmonol. 2000;29(1):39–42. doi: 10.1002/(sici)1099-0496(200001)29:1<39::aid-ppul7>3.0.co;2-g.CrossRefPubMedGoogle Scholar
- 45.DIS I. 9241-210: 2010. Ergonomics of human system interaction—part 210: human-centred design for interactive systems. International Standardization Organization (ISO) Switzerland. 2009.Google Scholar