A randomised controlled trial of the effect of a connected inhaler system on medication adherence in uncontrolled asthmatic patients

Source: This abstract has been sourced from NZ Respiratory Research Review Issue 188

ABSTRACT 

Suboptimal adherence to maintenance therapy contributes to poor asthma control and
exacerbations. This study evaluated the effect of different elements of a connected inhaler system (CIS),
comprising clip-on inhaler sensors, a patient-facing app and a healthcare professional (HCP) dashboard,
on adherence to asthma maintenance therapy.
This was an open-label, parallel-group, 6-month, randomised controlled trial in adults with
uncontrolled asthma (asthma control test (ACT) score less than 20) on fixed-dose inhaled corticosteroids/
long-acting β-agonist maintenance therapy (n=437). All subjects received fluticasone furoate/vilanterol
ELLIPTA dry-powder inhalers for maintenance and salbutamol/albuterol metered-dose inhalers for rescue,
with a sensor attached to each inhaler. Participants were randomised to one of five CIS study arms
(allocation ratio 1:1:1:1:1) reflecting the recipient of the data feedback from the sensors, as follows:
1) maintenance use to participants and HCPs (n=87); 2) maintenance use to participants (n=88);
3) maintenance and rescue use to participants and HCPs (n=88); 4) maintenance and rescue use to
participants (n=88); and 5) no feedback (control) (n=86).
For the primary endpoint, observed mean±SD adherence to maintenance therapy over months 4–6 was
82.2±16.58% (n=83) in the “maintenance to participants and HCPs” arm and 70.8±27.30% (n=85) in the
control arm. The adjusted least squares mean±SE was 80.9±3.19% and 69.0±3.19%, respectively (study arm
difference: 12.0%, 95% CI 5.2–18.8%; p<0.001). Adherence was also significantly greater in the other CIS
arms versus the control arm. The mean percentage of rescue medication free days (months 4–6) was
significantly greater in participants receiving data on their rescue use compared with controls. ACT scores
improved in all study arms with no significant differences between groups.
A CIS can improve adherence to maintenance medication and reduce rescue medication use in patients
with uncontrolled asthma.

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