Asthma, a persistent respiratory condition marked by airway constriction leading to symptoms like wheezing, coughing, chest tightness, and breathlessness, poses a significant health challenge.
“When symptoms escalate, it culminates in an asthma attack,” states an article in a leading medical publication.
The Asthma and Allergy Foundation of America estimates that approximately one out of every 13 individuals in the United States suffers from asthma.
While asthma cannot be completely cured, it can be effectively managed. Individuals afflicted with this condition often carry quick-relief inhalers to alleviate symptoms during an attack.
Bronchodilators, medications contained within these inhalers, work by relaxing the lung muscles and widening the airways, providing relief.
In addition to quick-relief inhalers, people with asthma are commonly prescribed long-term control medications like Inhaled corticosteroids or leukotriene modifiers. These drugs help modify the production of inflammatory molecules called leukotrienes, released by mast cells during an asthma attack, and responsible for bronchoconstriction.
In some cases, oral corticosteroids are prescribed to reduce airway inflammation during severe asthma flare-ups. However, it is crucial to note that oral corticosteroids entail both short-term and long-term side effects and risks, including high blood pressure and cataracts.
According to the American Lung Association, 5% to 10% of Americans suffering from asthma face the challenge of severe or difficult-to-control asthma.
Doctors have observed that individuals with difficult-to-control asthma may not be using their inhalers correctly or as frequently as recommended.
A recent study conducted by researchers from the prestigious RCSI University of Medicine and Health Sciences delved into the use of a technologically advanced device that measures acoustic or sound-wave signals emanating from inhalers. The device provides an objective assessment of how well an individual uses their inhaler.
As reported in The Lancet Respiratory Medicine, when data from this digital device was integrated into a clinical decision platform, there was a decreased likelihood of increasing medication doses. This approach resulted in a modest improvement in medication adherence among individuals with asthma.
In certain cases of severe asthma, healthcare providers may recommend biologics as part of the treatment regimen.
Biologics are a newer class of drugs designed to mimic specific molecules present in cells. For people with asthma, biologics target specific inflammatory pathways, effectively reducing inflammation and its associated symptoms.
Notably, biologics have been found to decrease asthma flare-ups, improve lung function, and reduce the need for oral corticosteroids. However, their widespread use is impeded by their often exorbitant costs.
Medical News Today recently interviewed Dr. Richard Costello, the lead investigator of the aforementioned study and a professor at RCSI University of Medicine and Health Sciences. Dr. Costello shared his experience of running a program for individuals with severe asthma and the challenges posed by limited access to biologics due to cost constraints.
To address these challenges, Dr. Costello collaborated with an engineer to develop an acoustic-based device capable of objectively determining when and how an inhaler is used.
“We think it’s kind of an equitable way to access biologics,” commented Dr. Costello.
The study, which took place across ten severe asthma clinics in Ireland and England, involved 200 participants diagnosed with severe or difficult-to-control asthma. These individuals had been prescribed inhaled corticosteroids in combination with a twice-daily inhaled corticosteroids (ICS) long-acting beta-agonist for at least a year.
Over the course of 32 weeks, the participants underwent nurse-led education visits and physician-led visits, during which their treatment was adjusted as necessary.
Those in the active group used an Inhaler Compliance Assessment (INCA) device that attached to the inhaler and recorded audio each time it was used. Signal processing algorithms were employed to assess the quality of each inhalation, identifying errors such as improper priming, exhalation into the inhaler before inhalation, or inadequate inhalation flow peak.
The active group also recorded their digital peak expiratory flow (ePEF) twice daily, providing additional data for analysis.
On the other hand, the control group’s adherence and exacerbations were evaluated through pharmacy records, healthcare practitioners’ observation of inhaler technique, and the use of a questionnaire.
During the nurse-led education visits, participants in the active group received visual biofeedback regarding their adherence and inhaler usage errors. They were shown the correlation between treatment use and their ePEF readings.
Conversely, the control group participants attended nurse-led education visits where they received a standard program discussing asthma’s nature.
In the physician-led visits, doctors attending to the active group were provided with asthma and adherence data, which was incorporated into a decision algorithm to guide treatment adjustments.
For the control group, physicians relied on traditional methods like visual assessment of inhaler technique to determine the need for treatment adjustments.
The outcomes of the study revealed intriguing insights. Among the active group, 14% of participants required a net increase in their treatment regimen, while 32% of the control group required such adjustments.
Furthermore, 31% of the active group successfully reduced their medication, compared to 18% in the control group.
In terms of additional therapy, 11 out of 102 patients in the active group required add-on biological treatment, while 21 out of 98 control patients needed the same.
Dr. Jimmy Johannes, a pulmonologist and critical care medicine specialist at MemorialCare Long Beach Medical Center, who was not involved in the study, expressed interest in future clinical trials involving the INCA device. He highlighted the significance of understanding the degree to which adherence impacts treatment burden and the use of biologics.
Dr. Costello emphasized that the purpose of developing the device was not to detect non-adherence but rather to provide support to individuals struggling with understanding their condition or using their inhaler correctly. He also highlighted the unfairness of insurance companies imposing significant barriers to accessing biologics.
The study’s findings suggest that incorporating digital devices like INCA into asthma management could enhance adherence and potentially reduce the need for escalated treatment, offering a more equitable approach to accessing biologics.
As research in this field progresses, future advancements in technology and treatment strategies hold promise for further improving the lives of individuals battling severe asthma, alleviating their symptoms, and reducing the burden of their condition.