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Despite traditional inhaler technique counseling, many patients make clinically important mistakes when they use their inhalers. This study investigates the value of using a connected inhalation aid when adults with asthma use their metered-dose inhaler (pMDI). Adult asthmatics (n = 221), using a pMDI, were randomly divided into a verbal training group (n = 110) and an enhanced training group (n = 111). 21 subjects were lost during the study, each group included 100 subjects at the end of the study. The study was divided into 3 visits. Traditional pMDI training was delivered at visit 1 to both groups which included an explanation of the steps with special stress on frequently mistaken steps e.g. exhalation before use and inhaling slowly and deeply. The enhanced training group was enhanced by using the Clip-Tone training aid linked to its dedicated smartphone app. enhanced training patients were encouraged to use this connected training aid during real-life use between the study visits. Baseline data were collected at the first visit. At all three visits (baseline, 1 month, and 2 months), subjects first completed all inhaler techniques, health outcome measures, received inhaler training, then took bronchodilators, and 30 min later repeated the lung function outcome measures. Both groups showed a significant decrease (p < 0.001) in the total mean number of pMDI inhalation techniques mistakes at visits 2 and 3, with a lower number of mistakes (p < 0.05) for slower inhalations for the enhanced training group compared to the verbal training group. Inhalation time (an indicator of a slow inhalation) significantly (p < 0.05) improved at each visit in the enhanced training group. In the enhanced training group, there was a gradual significant increase (p < 0.05) in lung functions while the improvements in the verbal training group were only significant (p < 0.05) at visit 3, and by visit 3, the enhanced training group had significantly higher scores than the verbal training group on both FEV1 and PEF% predicted. The asthma control test (ACT) score improved at each visit in both groups with a greater increase in the enhanced training group (p < 0.05) and more patients (44 and 21) improved their score by 3 or more in the second and third visit respectively. The connected Clip-Tone training aid helped patients improve their pMDI inhaler technique and their asthma control compared to traditional methods. These results highlight the potential of connected inhalers in the future management of inhaled therapy. [ABSTRACT FROM AUTHOR]

Objective. Despite training, many patients continue to misuse their metered dose inhaler (MDI). Research Ethics Committee approval was obtained to evaluate two different methods to help patients use a slow inhalation flow when they use their MDI. Methods. Asthmatic children ( n = 17) and adults ( n = 39) prescribed an MDI had their inhaler technique assessed. Those who achieved the recommended inhalation flow rate (IFR) of <90 l/min through their MDI formed the reference group (named (control-CT)). Others that had a poor inhaler technique with an IFR ≥ 90 l/min were randomized into either the verbal counseling (VC) group, who received verbal training on the correct MDI use with emphasis on using a slow IFR or into the 2ToneTrainer (2TT) group, who received the VC and a 2Tone Trainer to take home and use. 2TT is a training aid with audible feedback when the required slow inhalation flow is used. The participants were assessed on two occasions, 0 (baseline) and 6 weeks later. Results. For the asthmatic adults, the median IFR at visit 1 was 68, 200, and 240 l/min for the CT, VC, and 2TT groups, respectively. Whereas on visit 2, the median IFR was 88, 48.5 ( p < .001), and 65 ( p < .001) l/min for the CT, VC, and 2TT groups, respectively. Improvements in asthma quality of life were achieved in VC and 2TT groups. The asthmatic children showed a similar trend. Conclusions. Training by VC and a training aid helps patients use a slow IFR with an MDI and improves asthma -related quality of life. [ABSTRACT FROM AUTHOR]

Background: Adherence to inhalation therapy is a critical determinant of the success of asthma management. Reasons for nonadherence have been well studied, but reasons for good adherence are poorly understood. Understanding the mechanisms of adherence to inhalation therapy is important in developing strategies to promote adherence. The objective of this study was to assess the factors and mechanisms that contribute to and the clinical outcomes relating to adherence to inhalation therapy. Methods: The factors and outcomes related to adherence to inhalation therapy were examined cross-sectionally in 176 adults with asthma using a self-reported adherence questionnaire that consisted of four items dealing with the use of inhaled controller medications. A 5-point Likert scale was used for the responses to each item. Adherence was assessed based on the overall mean adherence score. Results: Of the 176 patients who were potential participants, 146 (83%) responded with usable information. Significant factors associated with the overall mean adherence score were older age ( r = .18, p = .032) and receiving repeated instruction on inhalation techniques ( p = .0016). Of the 146 respondents, 25 (17.1%) patients were given repeated verbal instruction or demonstrations of inhalation technique by a respiratory physician. On logistic regression analysis, good adherence to inhalation therapy was significantly related to the receiving of repeated instruction on inhalation technique, with an odds ratio of 2.90 (95% confidence interval 1.07–7.88; p = .037). Furthermore, less intentional nonadherent behavior was reported in patients with repeated instruction on inhalation technique compared to those without it. A significant correlation was found between the overall mean adherence score and the frequency of asthma exacerbations ( r = −.19, p = .021), emergency room visits ( r = −.19, p = .042), and the health-related quality of life score (St. George's Respiratory Questionnaire: Total, r = −.22, p = .024; Symptoms, r = −.21, p = .022; Impacts, r = −.20, p = .035). Conclusions: Repeated instruction on inhalation techniques may contribute to adherence to inhalation therapy through decreasing intentional nonadherence. Furthermore, good adherence to the therapeutic regimen may offer good asthma-related outcomes. [ABSTRACT FROM AUTHOR]