i-Nhaler i-Mprovement?

Asthma is one of the world’s most common chronic diseases, affecting some 300 million people and almost 5 percent of the world’s population. It’s also the 5th most costly condition in the US  – an estimated at $56 billion annually. But as we’ve reported here previously, a significant number of people with asthma either don’t use their asthma medications or use them incorrectly.

Improving asthma control is known to reduce the cost of treating asthma by eliminating unnecessary hospitalizations, ED visits, and office visits. The additional cost of an uncontrolled asthma patient compared to a controlled asthma patient is estimated at $3,000-$4,000  per patient annually.

So, we were interested to learn last week that the FDA approved a sensorized asthma inhaler that can track usage and transmit the data to a smartphone and the web. The manufacturer – Asthmapolis will begin to market the asthma sensor and both English and Spanish language versions of the companion software in the US very soon.

“Our mission is to make it easier for patients and their physicians to do a better job of managing asthma with less effort than traditionally required.” said David Van Sickle, co-founder and CEO of Asthmapolis.

The small and lightweight device attaches to the end of most inhalers, and the app tracks the time and location of each medication discharge and reminds patients to use it if they forget.

In clinical studies of the Asthmapolis system, uncontrolled asthma declined by 50%, and more than 70% of patients improved their level of control.  In addition it can identify trends in a patients asthma triggers and symptoms over time and provide patients with personalized education on how to improve their asthma.

Not only will the device talk directly to the patients, physicians and other health care providers will be able to identify, in near-real-time, patients with uncontrolled disease and attend to them before they suffer a severe exacerbation.

“Despite all we know about asthma and how to treat it, the majority of patients still do not have the disease under control, and traditional approaches to self-management have been time-consuming and complicated,” said Inger Couture, chief regulatory officer of Asthmapolis. “The Asthmapolis technology makes it much easier to track symptoms and use of metered dose inhalers, allowing patients, their families and their doctors to gain a valuable new perspective on the disease.”

And that can only be a good thing.

What Not to Do With Your Asthma Inhaler

As most people know, inhalers are an important part of most successful asthma management programs. Considering how many people use them and how critical they are to managing asthma and preventing asthma attacks, the number of patients who make mistakes with their inhalers is shocking.

In a recent survey of 1,000 people with asthma, about half of the respondents weren’t even using controller medications, such as asthma inhalers. And, among the half who did use inhalers, an overwhelming amount – 86%, had trouble controlling their asthma symptoms.  This seems to suggest that most asthmatics simply aren’t using their inhalers correctly.

Though alarming, the statistics aren’t necessarily surprising. According to Summit Shah MD, an allergist at Nationwide Children’s Hospital in Columbus, Ohio, “It is actually very difficult to use an inhaler properly.”

As we’ve blogged about before, improper technique tops the list.

Overuse of inhalers is a close second.  When using a rescue inhaler, one to four puffs should be sufficient. More than that and the patient should consult his health care provider, who may need to adjust the medication or treatment plan.

Similarly, the frequency of rescue inhaler use should be monitored. Rescue inhalers are intended for occasional use to stave off acute asthma attacks. Using a rescue inhaler more than two days a week suggests that the patient also needs to be on a prophylactic (maintenance or controller) inhaler.

Although all patients are encouraged to talk to their own provider, SRxA’s Word on Health is  pleased to provide a number of simple asthma inhaler tips to help people use them correctly:

• Sit upright
• Shake the inhaler
• Exhale completely
• Use an inhaler with a spacer [device]
• If you’re using a spacer device, spray the medicine into the spacer and then take in a slow, deep breath through the spacer while creating a tight seal around the mouth of the spacer with your lips
• After breathing in the medication, hold your breath for 10 seconds
• Repeat after one minute

Other asthma inhaler tips really come down to common sense, such as keeping inhalers in a safe place away from pets and children and where it won’t get damaged.

Here’s to better puffing!

Improving Inhaler Instruction

Many of us have never been properly trained on how to do or use certain things we really should be good at. Putting on condoms and wearing seat belts are just two that come to mind.  And when we get them wrong, the health consequences can be serious.

The same goes for asthma inhaler use.  Do you shake the device first? Did you breathe in with sufficient force? Did you press the canister at the right time?

Improper use of inhalers is a serious and expensive problem. In the US, 3 patients are admitted to the emergency room with asthma every minute, that’s >5,000 people a day!  Worse still, according to the Asthma and Allergy Foundation of America, 11 people die from asthma every day.

One study estimated up to 94% of patients use their inhalers incorrectly.  The most common mistakes include failure to exhale before actuation, failure to breath-hold after inhalation, incorrect positioning of the inhaler, incorrect rotation sequence, and failure to execute a forceful and deep inhalation. Those of us in healthcare have even seen patients who fail to take the cap off the inhaler before use, and others who use it nasally rather than orally.

This is hardly surprising given that many patients never receive instructions on how to use their inhalers and even those that do, are not routinely followed.  And let’s face it, some of these devices could use training wheels.

Enter the T-Haler, a digital asthma inhaler training device  developed by researchers at Cambridge Consultants.

Patients with asthma can use the inhaler and, via interactive software linked to the wireless device, get real-time visual feedback on the areas that need improving.

Specifically, whether patients have shaken the device before breathing in; whether they use sufficient force when breathing in; and whether they press down the canister that releases the drug at the optimal time. Click here to see a video of the T-haler in action.

Although still a conceptual product, the company says it has been designed as a training device to be available at pharmacies, schools, and clinics for children and adults alike.

They performed a study on 50 people aged 18 – 60 who had no prior experience with either asthma or inhalers and were given no instruction on how to use an inhaler. When tested, about 80% of the participants used an inhaler incorrectly.

They were then given the T-Haler with no further instruction and told to begin. A three-minute on-screen tutorial guided them through the proper use of an inhaler, and the success rate tripled to more than 60%.

“Without any human direction beyond the word ‘go’, participants went from around a 20% success rate without training to a success rate of more than 60% after only three minutes with the T-Haler device,” said Kate Farrell, a senior design engineer, in a news release. “This is more than twice the compliance rate we have seen in other studies with trained participants. Interestingly, a week later, 55 percent were still correctly using the device-showing that they retained what they learned.”

Whether the T-Haler itself will ever make it to market remains to be seen, but the concept of a 3-minute training device seems a no-brainer when it comes to properly using a device that may very well save the lives of the estimated 235 million asthma sufferers worldwide.

Pediatric Wheezers not such Wizards with Puffers

Regular readers of SRxA’s  Word on Health already know that asthma is the most common chronic childhood disease in the U.S. Direct asthma-related healthcare costs are upwards of $ 6 billion a year and lost productivity costs associated with working parents caring for children who miss school, costs a further billion. Given this huge financial burden we were shocked to learn that fewer than one in 10 children with asthma use their inhalers correctly.

While children have more success with newer inhaler designs, at best, only one child in four gets it completely right, according to the findings published in the journal Pediatrics.

Researchers from the University of North Carolina at Chapel Hill, Eshelman School of Pharmacy studied 296 patients aged 8 to 16 years old who used four different devices to manage their asthma.

The devices were:

• metered-dose inhaler (commonly called a puffer)
• diskus, (a dry-powder inhaler delivering Advair)
• turbuhaler (a dry-powder inhaler delivering Pulmicort or Symbicort)
• peak-flow meter, which does not deliver a drug but is used to measure lung function to determine if medicine is needed

Only 8% of children in the study performed all of the metered-dose inhaler steps correctly. Older children were more likely than younger children to get more of the metered-dose inhaler steps correct. With a diskus, 22% of children performed all steps correctly, and 15.6% performed all of the turbuhaler steps correctly. Children using a peak-flow meter did so correctly 24% of the time.

The researchers also found that the majority of health-care providers who participated in the study did not demonstrate or assess children’s use of the four devices during pediatric asthma visits.

“It is crucial that health-care providers not only show a child how to use an inhaler correctly but also have the child demonstrate the device in front of a physician or pharmacist,” said lead investigator Betsy Sleath Ph.D. “Pediatric practices are extremely busy places so we need innovative ways to demonstrate and assess device technique among asthmatic children.”

Improper use of inhalers and other asthma medication devices can lead to poor control of the condition, more hospitalizations and increased health-care costs.

SRxA’s team of leading asthma experts can help design programs to teach healthcare professionals how to teach patients about their asthma therapy.  These validated programs have been shown to dramatically increase compliance and adherence.  Contact us today to learn more.

Bitter Sweet News for Asthma Sufferers!

In a discovery that could potentially transform asthma treatment, researchers from Maryland have found our lungs carry receptors for bitter tastes.

The study, just published in Nature Medicine, found that receptors in the lung are the same as those that cluster together as taste-buds on our tongue.  In experiments using human and mouse lung tissue and mice with asthma, they found stimulating these receptors in the lungs with bitter substances  opened the airway more extensively than any known drug currently available for the treatment of asthma or chronic obstructive pulmonary disease.

These results came as a surprise to the scientists, who had expected bitter substances to constrict the airways rather than open them.

“I initially thought the bitter-taste receptors in the lungs would prompt a ‘fight or flight’ response to a noxious inhalant, causing chest tightness and coughing so you would leave the toxic environment, but that’s not what we found,” said lead researcher Dr Stephen Liggett.

In their experiments, the researchers tested bitter compounds such as quinine and chloroquine substances commonly used  to treat malaria.  However, there are thousands of other non-toxic, bitter compounds that are known to activate these receptors including natural plant substances and some synthetic agents.

Sadly for the campari, citrus and bitter chocolate lovers among us, the researchers did not find any link between eating bitter foods and improved breathing.  “Based on our research, we think that the best drugs would be chemical modifications of bitter compounds, which would be aerosolized and then inhaled into the lungs with an inhaler,” Liggett said.

Even then, inhaled therapies may not be available for years.

SRxA’s Word on Health will continue to follow this story and bring you all the latest developments.  In the meantime, if you want to spread the word about currently approved asthma treatments, please contact us to learn more about how our world class teams of Clinical Advisors can help.