Routine clinical use of Electronic Monitoring Devices (EMD) to measure inhaler adherence in children with Difficult Asthma (DA)

Poor adherence to inhaled steroids is a well-recognised factor for poor asthma control. Although use of EMDs to assess adherence is advocated by BTS-SIGN asthma guidelines, their use has been predominantly within research studies (Chan: 2015). Moreover, most commercially available EMD’s in children do not measure the actuation of the drug. A retrospective analysis of the data from EMD monitoring (Smartinhaler®) over a 2 year period was reviewed to asscertain experience of the use of EMD’s to measure inhaled steroid adherence within routine clinical settings. All patients were attending the regional paediatric DA service, on high dose asthma therapies, & for consideration of novel therapies. 40 patients were monitored at median age 12. 7 yr (range 7, 16 yr). The median duration of monitoring = 2.1 month (range 1, 6months). The FEV1 at the start of the monitoring = 84% (range 45, 109%). 23 (57.5%) had adherence In 17 (42.5%) patients, EMD data showed adherence >80%. Further data analysis showed possible poor inhaler technique in 7/17 patients. Only 10 (23.8%) children showed adherence >80% & apparent good inhaler technique. The FEV1 improved by 4.8% (p=0.2) during the monitoring period. Also 3 of the young people wished to continue the use of EDM. Smartinhaler® can be used in routine clinical practice to objectively assess adherence in paediatric DA patients. Clinicians should be aware that the device stores data that can uncover poor inhaler technique/ repeated actuations, providing valuable information for tailoring interventions to patients. The role of EMDs regular clinical practice as a strong monitoring tool needs further exploration.