A60-12 Electronic Monitoring of Spacer and Controller Inhaler Use in Children With Asthma

Abstract Rationale Electronic monitoring devices (EMD), such as Hailie Smart Inhaler and Smart valve-holding chamber (VHC)/Spacer, offer innovative, technology-driven methods to monitor and support inhaler adherence and correct technique. These devices provide objective, real-time data that can overcome the shortcomings of self-report, which may overstate adherence. Additionally, EMDs can identify inhalation technique errors that patients might not be aware of. This pilot study compared self-reported adherence with EMD-measured adherence and described common spacer technique errors in inner-city children with asthma. Methods We enrolled children with physician-diagnosed asthma from clinics and followed them for one month. For the first 2 weeks, participants used Hailie “light app version” to acquire baseline data. At 2 weeks, participants were trained on the MDI-VHC/Spacer technique and received the “full app version,” which enabled medication reminders. Medication adherence was measured by parental report and objectively by Hailie sensors. Mean total errors in spacer technique were calculated using Smart VHC/Spacer data. A satisfaction survey was administered at study exit. Statistical analyses included paired t-tests and Wilcoxon signed-rank tests to compare pre- and post-intervention measures, and Spearman’s rho to examine correlations among self-reported and device-measured adherence. Results Twenty-three children participated (mean age 8.6 years (SD 2.3), 61% female, 73.9% Hispanic/Latino. At 2 weeks post-intervention, self-reported adherence was significantly higher than objectively measured adherence (79.0% vs. 37.6%, p 0.001). Medication Adherence Report Scale for Asthma (MARS-A) scores did not correlate with EMD-measured adherence (p = 0.14). The most common inhaler technique errors were “taking shallow breaths” (352 errors) followed by “inhaling with a too high flow” (315 errors). Mean total errors decreased significantly after intervention (152.6 vs. 114.6, p = 0.0049) (Figure 1). Overall, satisfaction with EMDs was high, with most participants finding the Smart VHC/Spacer easy to use and reporting that the Hailie app’s reminders enhanced their child’s adherence to medication. Notwithstanding some technical challenges with device pairing and connectivity, most caregivers perceived a positive impact on asthma management and expressed a willingness to continue using the devices. Conclusion Adherence to daily controller medication measured objectively remained low in this population. Parental self-reported adherence substantially overestimated true adherence. Inhaler technique errors improved significantly following the educational intervention, demonstrating the effectiveness of targeted training and electronic support tools. A combination of objective monitoring and continued technique reinforcement may be required to achieve sustained asthma control outcomes. This abstract is funded by: Monaghan Medical Corporation