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simple counting tools have now been replaced by highly sophisticated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