Allen Amedume, PharmD Candidate

Digital health strategically leverages digital technologies, empowering patients to manage their illnesses, reduce health risks, and promote health and wellness. This era of digital innovation within our health care system provides new alternatives for managing chronic conditions, diagnosing diseases earlier, and promoting prevention. The extensive scope of digital health encompasses technologies such as mobile health (mHealth) apps, artificial intelligence (AI)-enabled medical devices, and smart connected devices.

One emerging technology—smart inhalers&mdash;is becoming one of the greatest opportunities for clinical pharmacy engagement. Traditional inhalers have long been the mainstay of therapy for patients with chronic respiratory diseases. Their ability to deliver medication (ie bronchodilators and corticosteroids) directly to the lungs and significantly reduce systemic adverse effects has been well established, making them an effective and ideal treatment option.

However, health care professionals still face several challenges associated with managing respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). The efficacy of inhalers can be negatively impacted by incorrect inhaler technique and poor adherence. A recent study showed worsening dyspnea, greater health condition impairment, and an increased frequency of exacerbations associated with incorrect inhaler technique and non-adherence.

Furthermore, incorrect inhaler technique and non-adherence places an immense burden on the cost of health care for patients with respiratory diseases. In patients with chronic diseases in the United States, the excess costs associated with non-adherence alone are estimated to be $300 billion annually.

 The management and prevention of respiratory diseases are suggested to be among the most cost-effective health interventions available; however, many patients do not optimize their medication therapies.

Inadequate inhaler technique or non-adherence to their medication, consequently, may result in the progression of their condition and unnecessary health care expenses for respiratory disease patients. The CDC states that if all COPD patients were completely compliant with their medication, exacerbations could be decreased by 25% to 30% annually, saving $4 billion per year.

Smart inhalers have the potential to address the challenges faced by patients and health care professionals in the management of respiratory diseases. With digital features designed to connect with mobile applications, smart inhalers and mobile applications work simultaneously to monitor medication schedules and subsequent dosing. Smart inhalers can monitor adherence; accurately record the time, date, and location of each dosage administered; send dosage reminders; and provide access to readily shareable data via Bluetooth. Several smart devices either have sensors built into the body of the inhaler or provide external sensors that can be attached to traditional inhalers.

As the smart inhaler market grows, pharmacists will need to develop a baseline proficiency in the use of digital technology to support patients and health care professionals with tools in the management of respiratory diseases. Nonetheless, approaches to managing respiratory diseases with smart inhalers should be supported by clinical outcomes, be designed as a cost-effective system, and mirror the needs of patients and health care professionals before they can be widely accepted in practice.

Here is a look at some of the smart inhalers currently on the market in the United States:

Smart inhalers available internationally:

Digital Health Center of Excellence. U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/digital-health. Published 2020. Accessed November 7, 2020.

Greene, G. and Costello, R., 2019. Personalizing medicine - could the smart inhaler revolutionize treatment for COPD and asthma patients?. 

Ngo CQ, Phan DM, Vu GV, et al. Inhaler Technique and Adherence to Inhaled Medications among Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Vietnam. 

. 2019;16(2):185. Published 2019 Jan 10. doi:10.3390/ijerph16020185

Lareau SC, Yawn BP. Improving adherence with inhaler therapy in COPD. 

. 2010;5:401-406. Published 2010 Nov 24. doi:10.2147/COPD.S14715

. 2nd ed. Sheffield: European Respiratory Society, p.6.

Pal S. Epidemiology of Chronic Lung Diseases. Uspharmacist.com. https://www.uspharmacist.com/article/epidemiology-of-chronic-lung-diseases. Published 2020. Accessed November 7, 2020.

An Analysis Of The Smart Inhalers Market. Medical Product Outsourcing. https://www.mpo-mag.com/contents/view_online-exclusives/2020-06-09/an-analysis-of-the-smart-inhalers-market/. Published 2020. Accessed November 7, 2020.

Blakey JD, Bender BG, Dima AL, Weinman J, Safioti G, Costello RW. Digital technologies and adherence in respiratory diseases: the road ahead. 

. 2018;52(5):1801147. Published 2018 Nov 22. doi:10.1183/13993003.01147-2018

Propeller Health Sensor to Be Co-Packaged With Recently Approved Enerzair® Breezhaler® Asthma Medication in Europe. Businesswire.com. https://www.businesswire.com/news/home/20200706005585/en/Propeller-Health-Sensor-Co-Packaged-Approved-Enerzair%C2%AE-Breezhaler%C2%AE. Published 2020. Accessed November 7, 2020.

Teva Announces Availability of ProAir® Digihaler® (albuterol sulfate 117 mcg) Inhalation Powder for Patients with Asthma and COPD. Businesswire.com. https://www.businesswire.com/news/home/20200713005034/en/Teva-Announces-Availability-of-ProAir%C2%AE-Digihaler%C2%AE-albuterol-sulfate-117-mcg-Inhalation-Powder-for-Patients-with-Asthma-and-COPD. Published 2020. Accessed November 7, 2020.

Teva Launches Two Digital Inhalers in the U.S., AirDuo® Digihaler® (fluticasone propionate and salmeterol) Inhalation Powder and ArmonAir® Digihaler® (fluticasone propionate) Inhalation Powder. Businesswire.com. https://www.businesswire.com/news/home/20200921005170/en/Teva-Launches-Two-Digital-Inhalers-in-the-U.S.-AirDuo%C2%AE-Digihaler%C2%AE-fluticasone-propionate-and-salmeterol-Inhalation-Powder-and-ArmonAir%C2%AE-Digihaler%C2%AE-fluticasone-propionate-Inhalation-Powder. Published 2020. Accessed November 7, 2020.

How It Works | Hailie™. hailie. https://www.hailie.com/pages/how-it-works. Published 2020. Accessed November 7, 2020.

FindAir — Smart Inhaler. Findair.eu. https://findair.eu/#Produkt. Published 2020. Accessed November 7, 2020.

Lupin launches "Adhero," first-of-its-kind connected Smart Device in India to support treatment of Respiratory Disease - Lupin. Lupin. https://www.lupin.com/portfolio/lupin-launches-adhero-first-of-its-kind-connected-smart-device-in-india-to-support-treatment-of-respiratory-disease/. Published 2020. Accessed November 7, 2020.

3M Designs an 'Intelligent Inhaler' System for COPD, Asthma and Other Respiratory Ills - Lung Disease News. Lung Disease News. https://lungdiseasenews.com/2016/04/22/3m-designs-intelligent-inhaler-system-copd-asthma-respiratory-ills/. Published 2020. Accessed November 7, 2020.

BreatheSmart® Mobile App Virtual Tour - HeroTracker® Sensors. Coherohealth.com. https://coherohealth.com/BreatheSmart/demo/sensors.php. Published 2020. Accessed November 7, 2020.

Pharma company Opko acquires smart inhaler startup for at least $10M. MobiHealthNews. https://www.mobihealthnews.com/32207/pharma-company-opko-acquires-smart-inhaler-startup-for-at-least-10m. Published 2020. Accessed November 7, 2020.

Inspair | Biocorp. Biocorpsys.com. https://biocorpsys.com/en/our-products/connected-devices/inspair/. Published 2020. Accessed November 7, 2020.

Pneuma Respiratory debuts smartphone-compatible inhaler. MobiHealthNews. https://www.mobihealthnews.com/content/pneuma-respiratory-debuts-smartphone-compatible-inhaler. Published 2020. Accessed November 7, 2020.

Amiko | Upgrading respiratory care. Amiko. https://amiko.io/. Published 2020. Accessed November 7, 2020.

Articles

Smart inhalers have the potential to address the challenges faced by patients and health care professionals in the management of respiratory diseases.