The digital spacer is a tool for the traditional aerochamber that patients with COPD and asthma use. The digital spacer measures each inhalation, checks the quality of the inhalation and provides personal feedback to patients about their medication use in the past month.. The digital spacer provides a complete picture of the patient's medication use. With this data, personalised instructions can be given to prevent inhalation faults. These personalised instructions have proven to be successful in a first proof-of-concept study with COPD patients in secondary care: patients had 30% less inhalation erors. Furthermore, they showed that inhalation medication can be detected in scalp hair.
Randomized controlled trial in real world patients
In a second study Dierick investigated real world asthma patients in primary care. The study aligned as much as possible with the regular check-ups that patients receive in general practice. In this two-month randomized controlled trial (RCT), 42 asthma patients were included. In the intervention group patients received personal education based on data from the digital spacer. In the control group patients only received general education. In the intervention group, inhalation errors per day decreased by 26.2%, while in the usual care group, inhalation errors increased by 14.6%, a significant difference. This RCT demonstrates that personalized education based on data from a smart spacer in patients with asthma in the primary care setting is feasible and leads to better medication adherence.
Several reasons for non-adherence
Since (lack of) adherence is one of the factors that can be influenced and affects the health and well-being of asthma and COPD patients, interventions aimed at improving medication adherence can help reduce the overall burden on patients and society. There are several reasons why patients don’t adhere to their medication. For example, some patients forget to take their medication (sporadic non-adherence), others find it hard to take it correctly (unconscious non-adherence) and some stop taking their medication for certain reasons (deliberate non-adherence).
Toolkit for personalised advice
There are currently various interventions to support medication adherence. To discover which intervention works best for the patient Dierick and his colleague Susanne van de Hei developed a practical adherence toolkit that they used in both studies. The TAI (Test of Adherence of Inhalators) toolkit is based on the TAI questionnaire for patients. This questionnaire gives insight into patients’ reasons for non-adherence. With this tool, a therapy adherence wheel, it is possible to discover a patient’s personal challenge in taking medication as prescribed, together with the patient. Afterwards, the wheel gives intervention strategies to help medication adherence.
Future research is needed to identity the long-term effects of the digital spacer and personalised advice on medication adherence. New studies in children and severe asthma patients will start soon.