FREQUENCY OF IMPROPER INHALER TECHNIQUE IDENTIFIED BY ELECTRONIC MEDICATION MONITOR (EMM) ACTUATION TIMING

Introduction Inadequate inhalation technique from metered dose inhalers (MDIs) is common. Up to 90% of patients with asthma use techniques that may negatively impact MDI efficacy. Based on guidelines and patient information leaflets >30 seconds are needed between two inhalations to achieve proper MDI use that includes shaking the canister, exhaling completely before inhalation, inhaling slowly, and breath-holding after use. This study aimed to detect inadequate inhalation technique by quantifying the time between two consecutive actuations using EMMs that passively collected time and date of use. Methods Data were collected from patients ≥4 years old with asthma who were using EMM-equipped rescue and/or controller MDIs (2012-18). In patient-days with two actuations within 120 seconds(s), the interval between the first two actuations was quantified and then classified as acceptable (>30s), fair (15 to ≤30s), or poor (≤15s) based on guideline criteria. This study was exempted from IRB approval. Results Of the 7,558 patients, 6,616 used rescue MDIs on 120,882 days, and 3,220 used controller MDIs on 157,492 days. The median (interquartile range) interval between actuations was 9s (16s), and 16%, 17%, and 67% of actuations were classified as acceptable, fair and poor, respectively (Figure 1). Results were similar between rescue and controller MDIs. Conclusions This study demonstrates that most patients have inadequate intervals between MDI actuations. EMMs can be useful to detect inadequate inhalation technique by examining the interval between actuations as a determinant. This information can be used to inform patients and providers that inhalation technique education is needed to improve treatment. Figure 1. Seconds between 1st and 2nd actuation, n =  278,374 patient-days from 7,558 patients.