Alerts Dramatically Improve Asthma Inhaler Use: Study

Asthmatics can dramatically reduce their risk of flare-ups with personalised alerts that remind them to use their inhaler, a world-first Australian study has shown.

Researchers at the Woolcock Institute of Medical Research in Sydney are the first to show in a study that patients who use inhalers that remind them if they miss a dose are far more likely to take their medication.

“This is truly exciting because not only are they more likely to take their dose regularly, but they’re less likely to have severe asthma flare-ups as a result,” says Associate Professor Helen Reddel, Woolcock research leader and senior author of the newly-published study.

“Asthma is often poorly controlled because people are so busy and don’t remember to use their preventer inhalers. Finding an easy and effective way to boost usage is a significant step forward.”

Asthma is one of the most common chronic disorders, affecting one in ten Australians. Inhaled corticosteroid medications are highly effective for managing the condition, but studies show adherence rates are low, making patients vulnerable to life-threatening flare-ups.

Professor Reddel and her team investigated the use of a device that clips on to the inhaler, with personalised ring tones and ring times that remind the patient to take a puff if they miss a dose.

The study, published this week in The Journal of Allergy and Clinical Immunology, involved 43 GPs who enrolled 143 patients aged 14 to 65 who had frequent asthma symptoms. The patients were divided into four groups, one which received inhaler reminders if they missed a dose and online feedback about their usage and another that had personalised discussions with their GP about improving their inhaler use. A third group had both interventions and the fourth received active asthma care from their GP.

All patients used an electronic inhaler monitor called SmartTrack that recorded the date and time of each puff and uploaded that information to a secure website.

Results showed patients receiving reminders and feedback took on average 73% of their prescribed daily doses over six months compared to only 46% among patients who did not get the reminders. By six months, the reminder group were taking 60% of their prescribed daily dose, more than double the rate for those who didn’t get alerts.

There was no significant difference in asthma symptom control between the four study groups, possibly because Australian patients are generally prescribed quite high doses of inhaled corticosteroid, Professor Reddel said.

“The modest adherence in the non-reminder groups may have been enough to help control asthma symptoms, so the higher adherence rates in reminder groups could not produce any further improvements,” she said.  However, the researchers hope that with more regular use of these medications, prescribed doses could be reduced.

In addition, severe asthma flare-ups were significantly less common among patients receiving reminders (11%) when compared with those not receiving them (28%).

“This is particularly significant given half of the enrolled patients lived in socially-disadvantaged communities where both medication adherence and disease severity are likely to be worse,” Professor Reddel said.

There were no differences between groups receiving or not receiving personalized discussions with GPs. This is the first study to test the use of reminders for asthma management in primary care, the very setting where they would ultimately be used.

Professor Reddel says reminders and feedback are likely to be effective because patients are able to track their dose history in real-time. “For the first time in their lives they’re able to follow their own inhaler use right there on the screen. That is quite powerful for reinforcing positive medication habits,” she said.

The researchers said results were encouraging but cautioned that longer trials are still needed to ensure reminders are effective for more than six months. This research was first presented at the American Thoracic Society International Conference in San Diego in May. The innovative study recently won the award for Excellence in e-Health Resources at Australia’s biennial National Medicinewise Awards.

Asthma in Australia

• Two million Australians – about one in ten – have asthma
• Asthma is a chronic lung condition that inflames and narrows the airways, causing wheezing, shortness of breath, chest tightness and coughing
• The causes are still not well understood, but triggers are known to include viral infections, exercise, and exposure to allergens and irritants
• New AIHW figures show 38,681 Australians were hospitalised due to asthma in 2011-2012. Deaths totalled 394 people in 2012
• Most asthmatics can manage their effectively condition with an inhaled corticosteroid
• Adherence to medications is poor, with many people failing to use their preventer inhalers as often as needed to manage their condition and reduce the risk of flare-ups

(Source: The Woolcock Institute of Medical Research, The Journal of Allergy and Clinical Immunology)