Digital health data from smart-inhaler manufacturer Propeller Health found that certain clinical guidelines for assessing control of asthma may be outdated—and that the number of rescue inhaler puffs are a more objective measurement of medication usage than patient-reported occasions.
The digital sensors were more accurate than a patient’s memory and healthcare provider assessments, according to the peer-reviewed analysis, completed with the University of Colorado School of Medicine and Children's Hospital Colorado.
"Occasions of rescue use" was recommended in a 2009 report from the American Thoracic Society and European Respiratory Society Task Force as a method for assessing asthma control. However, Propeller Health said its data show that there is no clear, objective definition of "occasion." Its findings were published in the Journal of Allergy and Clinical Immunology: In Practice.
"In the past, providers asked patients about their use of rescue medications to determine whether the patient's asthma was well-controlled, partly-controlled or not well-controlled," said study co-author David Stempel, M.D., senior VP of clinical and medical affairs at Propeller Health, a former Fierce 15 winner.
"Their understanding was based on recall and affected by patient bias, as few patients remember the number of times they used their rescue beyond the prior few days, at best,” Stempel said.
"Now, with data from digital therapeutics, we more accurately know how many puffs of rescue inhaler were used," he said. "Incorporating digital science into the ATS/ERS recommendations will advance guideline development and hopefully improve patient outcomes."
In the study, Propeller Health gathered the dates and times that 3,373 patients took puffs from their rescue inhalers, tracked by the company’s attached digital sensors.
It found that, within the first two minutes of the first use, 30% of rescue events consisted of a single puff, 53% had two and 17% had three or more. Over the following four to six hours, the patterns of inhalations changed incrementally, indicating no clear cut-off point for documenting a single occasion of use, the company said.
"Incorporating digital medicine data into clinical practice relieves the burden on the patient to recall every instance of medication use and relieves the burden on the provider to estimate whether the patient's reporting is accurate," said study co-author Stanley Szefler, M.D., director of the pediatric asthma research program in the Breathing Institute at Children's Hospital Colorado. "A growing body of research suggests that digital medicines will completely change the way we monitor medication use and disease management."