Digital inhaler provides insights on uncontrolled asthma, impending exacerbations
NEW ORLEANS — Usage patterns collected by a digital inhaler suggest that even patients without asthma exacerbations have a high burden of rescue inhaler use and may require additional therapy based on current guidelines, according to data presented at the CHEST Annual Meeting.
Roy Pleasants, PharmD, reported results of a 12-week, open-label study that describes patterns of albuterol use recorded by the ProAir Digihaler (Teva Pharmaceutical Industries) in patients with asthma prone to exacerbations. The ProAir Digihaler replaced other rescue medications. The device is an albuterol rescue inhaler that delivers 90 µg albuterol per dose and records the time and inhalation profile of each inhalation; typical dosing is two inhalations every 4 hours, as needed. This device is the first FDA-approved inhaler with integrated electronic recording of usage and technique, Pleasants, who is clinical researcher in the pulmonary division of the University of North Carolina at Chapel Hill and Durham VA Medical Center, North Carolina, said here.
The study enrolled 381 patients with at least one severe clinical asthma exacerbation in the previous year who were using moderate-dose inhaled corticosteroids, with or without long-acting beta agonists, and stable doses of asthma controlled for at least 3 months. The mean age of patients was about 50 years and the majority were women.
Overall, 360 patients made at least one valid inhalation during the study period. In this group, 64 patients experienced 78 severe clinical asthma exacerbations. Sixty percent of episodes of inhaler use consisted of a single inhalation, but 35.8% consisted of two inhalations and 3.3% three or more inhalations, according to the results.
When the researchers evaluated rescue albuterol use, Pleasants said patients with exacerbations during the study used the ProAir Digihaler an average of 2.43 times during the exacerbation and 1.87 times per day outside of the exacerbation window, while patients without exacerbations used the rescue inhaler 1.14 times per day. Episode of use was defined as consecutive inhalations within 60 seconds.
“Albuterol usage patterns over 12 weeks suggest that even patients without exacerbations have a high rescue inhaler burden, possibly requiring additional therapy based on asthma guidelines. Patients with daytime symptoms more than twice per day requiring rescue inhaler use may have, at best, partially controlled asthma,” Pleasants said during the presentation.
In other findings, peak inspiratory flow decreased and albuterol use increased prior to exacerbation symptom peak, according to Pleasants.
“Data from the ProAir Digihaler could help identify patients with poor asthma control and impending exacerbations, potentially in real time if information is communicated to patients and/or health care providers via a number of potential methods, for example, the cloud, clinical dashboard, app or email message, etc,” Pleasants said. “These data could help monitor asthma control and long-term outcomes and enable earlier intervention.” – by Katie Kalvaitis
Pleasants R. Getting it right: Personalized strategies for better asthma control. Presented at: CHEST Annual Meeting; Oct. 19-23, 2019; New Orleans.
Disclosure: The study was sponsored by Teva. Pleasants reports he is an adviser for Teva Pharmaceuticals and consults for Boehringer Ingelheim.