Assessing adherence to inhaled therapies in asthma and the emergence of electronic monitoring devices

Infrequent use of inhaled corticosteroids (ICS) and/or over-reliance of short-acting beta agonists (SABA) are recognised as key contributors to increased morbidity and mortality in asthma. The most frequent measures of ICS adherence and SABA use relies on patient reported questionnaires or prescription refill records, neither of which are considered sufficiently reliable. Technological advancements in the development of electronic monitoring of inhaler devices allow for monitoring of use, as well as recording and feedback of inhaler technique for some devices. Most electronic monitoring devices (EMDs) are paired with a smartphone application, allowing patients to set reminders and display both preventer and reliever use over time. This allows identification of intentional and unintentional ICS non-adherence as well as frequency of SABA use. This information assists clinicians in distinguishing difficult-to-control from severe asthma. Although cost currently limits widespread use, the introduction of EMDs into the asthma armoury is a significant step-forward in asthma care and has the potential to improve asthma related outcomes.