Introduction: Adherence monitoring to inhaled
corticosteroids is an essential component of asthma
management. Electronic monitoring devices (EMD) provide
objective data on date, time and number of actuations.
However, most give no information on inhalation. Novel
EMD (NEMD) platforms have the potential to monitor both
activation and inhalation.
Aim: To assess the feasibility of NEMDs, in terms
of usability, acceptability to patients and healthcare
professionals and accuracy.
Methods: This was an open-label, prospective, mixedmethods, pragmatic randomised study. Children with
asthma attending specialist tertiary care were randomised
to one of four NEMD: Remote Directly Observed Therapy
(R-DOT), Hailie Smartinhaler, INhaler Compliance
Assessment device (INCA) and the Rafi-tone App. Following
monitoring, participants were invited to focus groups or
one-to-one interviews. Usability and acceptability were
evaluated using themes identified from the focus groups
and interviews. Adherence accuracy was determined using
adherence data from each NEMD.
Results: Thirty-five children were recruited; 18 (51%),
(11 males, median age 13.5 (7–16) years) completed
monitoring, 14 (78%) provided feedback. Participants
identified various features such as ease of use and
minimal effort as desirable criteria for an NEMD. The Hailie
and INCA fulfilled these criteria and were able to record
both actuation and inhalation. Negative themes included a
‘Big Brother’ effect and costs.
Conclusion: There was no ‘one size fits all’, as participants
identified advantages and disadvantages for each NEMD.
Devices that can easily calculate adherence to activation
and inhalation have the potential to have greatest utility in
clinical practice. Each NEMD has different functionality and
therefore choice of platform should be determined by the
needs of the patient and healthcare professional