Digital Inhaler Data Shows Frequent Asthma Rescue Treatment

Roy Pleasants, PharmD

Rescue inhaler medication use is highly prevalent among patients with asthma—regardless of their exacerbation rate, according to a new study.

In a new trial presented at the CHEST 2019 Annual Meeting in New Orleans, LA, this week, a team of investigators reported data from digital inhaler use showing that patients with asthma may be eligible for additional therapy in response to high rescue medicine usage rate, which was not found to be associated with their exacerbation rates.

The team, led by Roy Pleasants, PharmD, adjunct assistant professor of Medicine at the Duke University School of Medicine, sought to fulfill an unmet understanding of poor asthma control manifestation in patients.

For their assessment, Pleasants and colleagues used the ProAir Digihaler—approved by the US Food and Drug Administration (FDA) last year as the first marketed inhaler to include an integrated electronic module—for adult patients who had experienced at least 1 severe clinical asthma exacerbation in the last 12 months.

The digital inhaler device, from Teva Pharmaceuticals, administers albuterol sulfate powder while actively monitoring and logging information on patient use. Investigators assigned 381 patients to 90-mcg albuterol ProAir inhaler therapy. Eligible patients were ≥18 years old, were on moderate-dose inhaled corticosteroid (ICS)—with or without accompanying long-acting beta agonist (LABA)—and a stable dose of asthma controller for at least 3 months.

Investigators assessed inhaler use over 12 weeks in the open-label study, with analysis conducted in alignment with assessed clinical asthma exacerbations. Episodes of inhaler use were defined as consecutive inhalations within 60 seconds.

Findings showed 360 (94.5%) patients made ≥1 valid inhalation; 64 patients 78 exacerbations. They found that 60.8% episodes of use comprised a single inhalation; 35.9% with 2 inhalation; and 3.3% with ≥3 inhalations. Mean daily inhaler use was 1.17 among patients without exacerbations, and 1.82 among patients with ≥1 exacerbation.

During a clinical asthma exacerbation—defined as the 14 days surrounding symptom onset—patients used ProAir Digihaler a mean 2.63 times daily.

Investigators concluded these usage patterns indicate even those without difficulty or frequent exacerbations report a high rate of rescue inhaler use. As such, perhaps more patients with asthma should be treated with additional therapy recommended for reduced rescue therapy need per treatment guidelines.

Regarding the data provided by the digital inhaler, investigators praised its benefit in helping to better understand asthma patients’ trends in use.

“ProAir Digihaler provides a picture of patients’ patterns of inhaled rescue medication usage, and offers an opportunity for healthcare providers to identify patients with poor asthma control and possibly an impending exacerbation,” they wrote.

The study, “Patterns of Rescue Medication Usage in Asthma Patients Recorded by the Electronic ProAir Digihaler,” was presented at CHEST 2019.