Table 1. Overview of smart inhaler interventions tested in randomized controlled trials.
| First author, year | Country | No. | Smart inhaler-based intervention and population | Effects |
|---|---|---|---|---|
| O’Dwyer et al. (110) 2020A | Ireland | 152 | Biofeedback in adult asthma and COPD | Adherence: 62% adherence in IG1, which is 18% higher than the adherence in IG2 (P=0.004) and 24% higher than CG (P=0.003) after 2 months. After 6 months, adherence is 14% higher in IG1 than in IG2 (P=0.07) and 31% higher than in CG (P=0.001) |
| Exacerbations: 0.7 (IG1), 1.1 (IG2) and 0.9 (CG) exacerbations/patient/6 months | ||||
| QoL: SGRQ score −5.3 (IG1) and −5.7 (IG2) compared with baseline. Only IG1 had sustained reduction after 6 months (−6.1) | ||||
| Sulaiman et al. (111) 2018B | Ireland | 218 | E-monitoring and biofeedback on adherence and inhalation technique in adult asthma (49.2±16.5 years) | Adherence: 73% (IG) vs. 63% (CG) (P=0.02) |
| Inhaler errors: 11 (IG) vs. 15 (CG) inhaler errors/patient/month | ||||
| Uncontrolled asthma occurred more among non-adherence patients (35%) than among adherent patients (27%) | ||||
| Morton et al. (112) 2017C | UK | 90 | E-monitoring, reminding and feedback in children with asthma (6– 16 years) |
Adherence: 70% (IG) vs. 49% (CG) (P<0.001) |
| Fewer hospitalizations (P<0.001) and fewer courses of oral corticosteroids (P=0.008) in IG vs. CG | ||||
| QoL: ACQ score 1.58 vs. 1.50 | ||||
| Vasbinder et al. (113) 2016D | The Netherlands | 219 | E-monitoring and reminding children with asthma (4–11 years) | Adherence: 69.3% (IG) vs. 57.3% (CG) |
| QoL: PAQLQ no difference between IG and CG | ||||
| Exacerbations: no difference between IG and CG | ||||
| Asthma control: no difference C-ACT between IG and CG | ||||
| Merchant et al. (114) 2016E | USA | 495 | E-monitoring, reminding and feedback in children and adults with asthma (older than 5 years) |
Daily SABA use: improved more in IG (−0.31/person/day) than in CG (−0.41/person/day) (P<0.001) |
| QoL: ACT score not significantly different between IG and CG, but uncontrolled asthma scores improved more in IG than in CG (63% vs. 49%, P<0.05) | ||||
| SABA free days: +21% (IG) vs. +17% (CG) (P<0.01) | ||||
| Chan et al. (25) 2015F | New Zealand | 220 | E-monitoring and reminding children with asthma (6– 15 years) |
Adherence: 84% (IG) vs. 30% (CG) adherence (P<0.0001) |
| Asthma morbidity: changes from baseline to 6 months in IG significantly greater than in CG (P=0.008) | ||||
| Exacerbations: 6% (IG) vs. 24% (CG) in the first 2 months | ||||
| No significant difference between IG and CG in absence from school (children) or work (caregiver) | ||||
| Foster et al. (109) 2014G | Australia | 143 | E-monitoring, reminding and feedback in adult and children with asthma (14–65 years) |
Adherence: 76% (IG) vs. 46% (CG) (P<0.0001) |
| Exacerbations: 11% (IG) vs. 28% (CG) (P=0.013) | ||||
| QoL: significantly improved within IG and CG (P<0.0001), with no significant difference between groups | ||||
| Aptar et al. (115) 2011H | USA | 333 | Individualized problem-solving intervention and UC in adult asthma using electronic monitoring (35–63 years) | Adherence: mean adherence (61%) declined significantly (P=0.0004) over time with 14% (CG) and 10% (IG) |
| Asthma control: improved with 20% (CG) and 18% (IG) (P=0.002) | ||||
| QoL: improved in IG and CG with 18% (P<0.0001) | ||||
| Charles et al. (116) 2007 | New Zealand | 110 | E-monitoring, reminding and feedback in asthma patients (13–65 years) | Adherence: 88% (IG) vs. 66% (CG) (P<0.0001) in the last 12 weeks of the trial |
| Onyirimba et al. (117) 2003I | USA | 30 | Feedback from clinician based on electronically recorded adherence in adult asthma | Adherence: 81% (IG) vs. 47% (CG) in the second week (P=0.003) |
| QoL: AQLQ score improved from baseline with 1.13 (IG) and 0.76 (CG) (P<0.05 within both groups) |
(A) The St. George Respiratory Questionnaire (SGRQ) scores the QoL between 0 (few limitations) and 100 (many limitations). Reduction of SGRQ score in IG1 and IG2 are significant. Exacerbations: no significant between group differences and no significant within group differences after 2 and 6 months compared with baseline. (B) Difference inhaler errors between IG and CG not significant. (C) Asthma control questionnaire (ACQ) scores the QoL with a score between 0 (totally controlled asthma) and 6 (severely uncontrolled asthma). No significant difference in QoL between IG and CG. (D) Pediatric asthma quality of life questionnaire (PAQLQ) scores the QoL of children with a score between 0 (uncontrolled asthma) and 27 (controlled asthma). C-ACT is the childhood asthma control test which scores asthma control between 0 (uncontrolled asthma) and 25 (controlled asthma). (E) The asthma control test (ACT) scores the asthma control between 0 (uncontrolled asthma) and 25 (controlled asthma). Adherence was not measured. Short-acting β-agonists (SABA) free days increased significantly in IG vs. CG. (F) Proportion of patients experiencing more than 1 exacerbation in the first 2 months. No difference in exacerbations between IG and CG after 6 months. Asthma morbidity measured with C-ACT. (G) No significant difference in proportion of patients experiencing more than one exacerbation in 6 months in IG group vs. CG group. QoL measured with ACT. (H) QoL between IG and CG not significant. QoL was measured using the ACQ. (I) No significant differences AQLQ score between IG and CG. Asthma quality of life question (AQLQ) scores the QoL of adult patients with asthma between 0 (not impaired) and 7 (severely impaired). IG1 = intervention group 1, IG2 = intervention group 2. IG, intervention group; CG, control group; QoL, quality of life.