A pragmatic randomized controlled trial to improve inhaler technique using mHealth
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Clinical and Translational Allergy Open Access
LETTER TO THE EDITOR
A pragmatic randomized controlled trial to improve inhaler technique using mHealth Anna Vanoverschelde1 , Paulien van der Wel1, Barbara Putman1,2 and Lies Lahousse1*
To the editor Non-adherence and suboptimal inhaler technique are major problems in patients with obstructive lung disease. Less than one third of patients use their inhaler correctly, and the inhaler technique has not improved over the past 40 years despite innovations in devices [1]. Suboptimal inhaler use leads to more side effects, poor symptom control, reductions in health-related quality of life, exacerbations and consequently, increased healthcare costs [2, 3]. In order to achieve and maintain a correct inhaler technique, innovative approaches for education including mobile health applications (mHealth apps) are being explored [4]. The My Puff app, in which patients can choose their inhaler to watch instruction videos, could be an innovative approach to continue inhaler technique training between care visits. However, to date, the feasibility to integrate this app in patient care as well as the effectiveness of this app has not yet been evaluated. Therefore, we aimed to measure inhaler technique and disease control improvement three months after a pharmaceutical care intervention, comparing aid to install and use the My Puff app to providing standard information leaflets for continued home education. This open randomized controlled trial was carried out between March and December 2018 in nine Belgian community pharmacies. Dutch-speaking adult patients with self-reported chronic asthma or Chronic Obstructive Pulmonary Disease (COPD) on registered inhaler therapy were included. Seventy patients were randomized to *Correspondence: [email protected] 1 Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium Full list of author information is available at the end of the article
the app group (n = 37; 53%) or leaflet group (n = 33; 47%) with a randomized (computer-generated) block design per participating pharmacy. All patients were asked to demonstrate their inhaler technique, and received feedback as well as a demonstration of the correct technique with a similar placebo device. In order to continue inhaler training at home, patients in the control group received a standard leaflet with inhaler instructions developed by the Lung Foundation on behalf of the Lung Alliance Netherlands. Patients in the intervention group received maximum assistance to download and use the My Puff app (version 1.0.3–1.0.4), including a leaflet containing the Quick Response code of the app and guidance to install and use. My Puff is a free app with video-assisted inhaler instructions (≈ 3 min), developed by the Belgian Respiratory Society (BeRS) in 2017 (https://www.belgi anrespiratorysociety.be/nl/mypuff ). Patients’ inhaler technique was rated by the investigator using a checklist per device, and disease control was assessed by t
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