Digital inhaler can improve long-term asthma control in primary care
Published online March 19, 2025
A large group of patients with uncontrolled asthma may be suffering from non-adherence to their maintenance medication. Indeed, non-adherence has been shown to be prevalent in about half of all patients with asthma. Digital inhalers have shown promising results in enhancing adherence in previous studies. However, these studies were typically short-term, performed in secondary care populations and showed inconsistent results regarding effects on asthma control. This study aimed to assess the 1-year effectiveness of a digital inhaler on long-term medication adherence, clinical outcomes, usability and cost-effectiveness in patients with asthma treated in primary care.
In the ACCEPTANCE trial by Van de Hei et al., recently published in The Journal of Allergy and Clinical Immunology: In Practice, 164 patients ≥ 18 years with suboptimal controlled asthma (Asthma Control Questionnaire-5 [ACQ-5] score of ≥0.75) identified in primary care were randomized to either receive their budesonide/formoterol with digital support or without.
In both groups, inhaler adherence was monitored with a digital add-on to the inhaler. In the intervention group (with digital support), inhaler usage was visualized, reminders were provided, and motivational messages were sent via an accompanying smartphone application. In the control group, only inhaler adherence was monitored without any feedback to patients or healthcare professionals provided. Data collection took place through remote follow-up visits at 6 and 12 months and through self-administered questionnaires at 3 and 9 months. After 1 year, medication adherence (primary outcome), asthma control, usability, and cost-effectiveness were assessed (secondary outcomes).
In the overall study population, 58% were female, mean age was 47.5 years and mean ACQ-5 score was 1.7. Overall, 1-year adherence was 71.4% in the intervention group and 59.9% in the control group. In the intention-to-treat analysis, medication adherence was initially higher in the intervention group versus the control group (odds ratio [OR] week 2 = 2.19; 95% CI, 1.63-2.95), yet the between-group difference in medication adherence declined over time (P < .0001), and no significant difference at 1 year was found (OR 1 year = 1.23; 95% CI, 0.91-1.66). In the per-protocol analysis, medication adherence was significantly higher at 1 year. Importantly, asthma control (ACQ-5) was significantly better at 1-year. After 1 year, 42.9% of the intervention group and 20.0% of the control group participants had an improvement in ACQ-5 that exceeded the minimal clinically important difference (OR = 3.00; 95% CI, 1.13-8.35). Usability was deemed high and the cost per 0.5-point decrease in ACQ-5 score was €278. Thus, use of a digital inhaler led to significant improvements in medication adherence in the short term and to sustained improved asthma control over 1 year.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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