What's So Smart About Smart Inhalers?

Every so often, Australia-based Adherium, manufacturer of a Smart Inhaler aptly named Smartinhaler crosses my path (lost creativity points for that, on top of having a company name that irritates me—Adherium, reminding patients that someone, somewhere thinks they are non-adherent! Give me a break). And, since apparently, this will be the next best thing in asthma care1 (at least in the UK) since, you know, albuterol, I figured it was time to dig into the Smart Inhaler landscape. After all, it could be exciting: even if I am pessimistic, I am a bit of a diehard for being able to quantify my asthma in as many ways as possible.

What’s a Smart Inhaler?

Simply, a smart inhaler is a device that replaces or adds on to your existing asthma inhaler(s) that tracks metrics surrounding your medication use. These things can include your location (a la Propeller Health, who I believe were the pioneers of the smart inhaler market), when you need a reminder to take your meds or when you last took them (a la CareTRx, formerly Gecko Cap, which glows when a dose is due and tracks when you take your inhaler) and now the Adherium SmartInhaler, which will apparently revolutionize the asthma review process in the UK through tracking, what else, when you take your inhaler, when you didn’t, and reporting to your doctor on adherence.1 Via a Bluetooth connection, the smart inhaler device connects to an app on your phone and does whatever it is meant to with the data.

What’s the value?

More data. Whether that is good for you or your doctor to be the asthma police is another question.

Now, the data you get, or the value you get from the relevance of that data, well, your mileage may vary. Some data is really just for your doctor (which gets an eye-roll from this quantified self-ing ePatient), others will actually put the patient in the drivers’ seat by providing quality feedback. Some smart inhalers seem to have very basic reports available to patients, others a product “ecosystem” for different products, or products that adapt to use with a variety of smart devices (of these that I have read about, so far my favourite is probably Amiko, which I had the opportunity to provide feedback on a few years ago. Amiko uses an attractive, low-profile sticker and is compatible with a variety of medical devices).

Here’s what I think about it.

Not having used any of these devices personally, I can’t give a solid perspective. I would want the data to be for me, however, I would be okay with releasing information to my doctor when I felt valuable. It is still my disease, I am still the patient, and if we’re going to have an asthma “big brother” in our pockets, I want to be able to share my feedback alongside that data. If it’s going to tell my doctor I was non-adherent, fine. Let me have my say too. Because non-adherence is NOT the same as the device broke, I dropped it in the pool, as I got a new inhaler and forgot to switch the device over, or as I failed to sync it for 3 weeks (says she who has a Bluetooth toothbrush but history gaps because it only stores 20 sessions of data).

It’s important to note, too, that whatever studies are done using these devices are probably a bit more real-life than the rigid constraints of clinical trials, but that for devices, I think the clinical/health implications are likely different in a research study population than the general population—“Hi, you’re in a study to measure the effects of smart inhalers,” even without mention of patient adherence, it’s clear that by participating in the study, patients want to at least give back data to research, meaning their motivation to do well (even if just in exchange for cool technology on their inhalers) is impacted by the research being done. Free stuff or compensation can lead to bias, bias can lead to inaccurate data—this is why double-blind placebo-controlled (or non-intervention and/or alternate intervention controlled) studies exist.

Final thoughts.

For me, the integration of a smart inhaler into practice may be revolutionary, but it has to be patient centered. There are reasons patients may be non-adherent and the Smart Inhaler system does not provide enough context about patients to physicians to actually help if patients are less adherent than they should be. For me, if I were to use a smart inhaler, I want that data to be readily available to me (and to share with my physician when I deem useful). Doctors also do not need to be bombarded with needless data unless there is an actual problem that needs to be addressed (whether that is from the app spending an alert or the patient communicating this themselves).

Bottom line: If the data is available to me, A+. But it’s my data, so I should be in control of it. Patient engagement is the smart thing about smart inhalers.

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