Smart inhalers in paediatric asthma: bridging the gap between innovation and clinical practice.

Smart inhaler systems represent a major opportunity to transform paediatric asthma care by potentially addressing three fundamental problems affecting paediatric asthma outcomes: medication adherence, inhalation technique and reliever overuse. The data generated across these domains opens up multiple applications - from supporting patient self-management to enabling early detection of asthma deterioration. In this review, we outline the main categories of smart inhalers - including digital dose counters, smart spacers, and smart nebulisers - and summarise the current evidence surrounding their use in children. We discuss key obstacles to implementation, including technical limitations, behavioural factors, and health system-level challenges. Establishing clear smart inhaler systems quality standards, defining appropriate indications resulting in better asthma outcomes, achieving better integration of smart inhaler data into electronic health care records, and generating robust cost-effectiveness data will be essential to support the widespread clinical adoption of these technologies.