Childhood asthma: the inhaler that moos and miaows

October 2015 Vol 15 (5)

Research on a ‘smart inhaler’ that moos, miaows or rings out pop tunes and makes kids with asthma use their preventer more often won young hospital pharmacist Amy Chan the recent Medicines New Zealand 2015 Value of Medicines award.

Amy ChenNo parent wants their child to end up in ED with an asthma attack. No parent wants their child to end up in ED with an asthma attack. 

Doctoral student and hospital pharmacist Amy Chan led a project to trial the impact of a ringtone smart inhaler on the asthma control of 110 high risk children, aged six to 15, who had already presented at emergency departments with an asthma attack.

She found that the real-time reminder dramatically improved the children’s medication adherence, which markedly reduced their asthma symptoms. The findings of The University of Auckland study (funded by Cure Kids and the Health Research Council) were published in The Lancet early this year and in September won Chan the Medicines New Zealand 2015 Value of Medicines Award for the work.

Chan, who is just finalising her doctoral thesis, hopes that her findings will result in Pharmac looking seriously at funding the Nexus6 smart inhaler reminder device for those children presenting at hospitals with asthma, as they generally have low levels of medication adherence. She is also keen to see whether the device could help children, adolescents and adults with other chronic diseases where taking regular medication is an issue.

“We know from the World Health Organisation that only 50 per cent of people take medications as prescribed, so clearly that is a place where we can intervene (and make a difference).

“I think technology has a major role to play and I’d like to see technology used in chronic conditions to support people’s health.”

She says apps are one part of that. “People would often say to me, ‘Oh can’t you just use a smartphone with a reminder’ but it’s not the same,” says Chan. “As I’m sure you know, if you have a reminder on your device often it will ring and you will just turn off the reminder as it’s very easy to get reminder fatigue.”

Real-time rings prevent reminder fatigue

That is the difference with the ringtone smart inhaler; it only rings when you have actually missed a dose so Chan says you don’t have a chance to get attuned and ‘zone out’, which is the risk with a reminder set for the same time each day whether you have or haven’t take your medication.

Parents chose the times that children took their dose and the children could choose their rotating favourites from the 14 ringtones available – top choices included animal noises, The Simpsons theme tune and the Madagascar movie theme song ‘I like to move it’.

The audio-visual device also has a screen that displays when a child last took their medication and the sensor is set so it only records when the child has taken a “proper puff”.

“This is quite helpful for parents as well, as the child may say ‘yeah, yeah I’ve taken my medicine’ but the parent can press the button on the side, check the screen and say ‘no you haven’t’.”

Exciting research results

The study focused on high risk children and Chan says the research literature shows that generally children who present at ED for asthma attacks have lower rates of medication adherence than the average children’s rate, which is already low at around 40–50 per cent.

That was why the researchers were excited to find that the medication adherence of the 110 children randomly allocated ringtone inhalers was 84 per cent, compared with 30 per cent for the 110 children allocated to the control group, whose inhalers had the audio-visual elements turned off.

The researchers also used a smart device to monitor the impact the increased medication adherence had on the children’s use of their ‘blue’ reliever inhaler.

They found the control kids had to resort to their blue inhaler 17.4 per cent of the days in the six-month trial, which was nearly double the days (9.5 per cent) that the intervention group did. In the first two months nearly a quarter of the control group had asthma attacks, compared with just six per cent of the intervention group.

The intervention group families also reported less coughing, less wheezing, less night-time waking and being better able to participate in daily activities like sport and bouncing on trampolines without parents being frightened that it would trigger an asthma attack.

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