Summary
Recent years has seen an exponential growth in the number of EMDs being developed for patients with airways disease. Devices that started as simple counting tools have now been replaced by highly sophisticated inhaler attachments providing audio-visual reminders, guided inhaler use, inspiratory flow measurements and personalised feedback to patients; whilst offering the HCP detailed insights into patient behaviour. Although experience in their use is only now starting to expand from the research space into routine clinical care, EMDs have demonstrated enormous potential to reduce asthma morbidity and improve the quality of care an HCP is able to deliver. Some EMDs can provide feedback on the elements of inhaler technique that are often difficult to objectively assess, such as whether there was sufficient co-ordination with inhalation or whether sufficient inspiratory force was generated. The combination of both temporal and inhaler technique data provides a composite account of adherence, allowing identification of both intentional and non-intentional non-adherence over time. Critically, this information can assist clinicians in distinguishing difficult-to-control from severe asthma, which will allow appropriate patient-centred interventions and may avoid inappropriate escalation of therapy to systemic corticosteroids and/or expensive biologic agents.
Table 1 : Measures of adherence