Frontiers in Medical Technology (Jul 2021)

Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies

  • Cristina Jácome,
  • Cristina Jácome,
  • Rute Almeida,
  • Rute Almeida,
  • Ana Margarida Pereira,
  • Ana Margarida Pereira,
  • Ana Margarida Pereira,
  • Rita Amaral,
  • Rita Amaral,
  • Rita Amaral,
  • Rita Amaral,
  • Pedro Vieira-Marques,
  • Sandra Mendes,
  • Magna Alves-Correia,
  • José Alberto Ferreira,
  • Inês Lopes,
  • Joana Gomes,
  • Luís Araújo,
  • Mariana Couto,
  • Cláudia Chaves Loureiro,
  • Lilia Maia Santos,
  • Ana Arrobas,
  • Margarida Valério,
  • Ana Todo Bom,
  • João Azevedo,
  • Maria Fernanda Teixeira,
  • Manuel Ferreira-Magalhães,
  • Manuel Ferreira-Magalhães,
  • Manuel Ferreira-Magalhães,
  • Paula Leiria Pinto,
  • Nicole Pinto,
  • Ana Castro Neves,
  • Ana Morête,
  • Filipa Todo Bom,
  • Alberto Costa,
  • Diana Silva,
  • Maria João Vasconcelos,
  • Helena Falcão,
  • Maria Luís Marques,
  • Ana Mendes,
  • João Cardoso,
  • José Carlos Cidrais Rodrigues,
  • Georgeta Oliveira,
  • Joana Carvalho,
  • Carlos Lozoya,
  • Natacha Santos,
  • Fernando Menezes,
  • Ricardo Gomes,
  • Rita Câmara,
  • Rodrigo Rodrigues Alves,
  • Ana Sofia Moreira,
  • Carmo Abreu,
  • Rui Silva,
  • Diana Bordalo,
  • Diana Bordalo,
  • Carlos Alves,
  • Cristina Lopes,
  • Cristina Lopes,
  • Luís Taborda-Barata,
  • Luís Taborda-Barata,
  • Ricardo M. Fernandes,
  • Rosário Ferreira,
  • Carla Chaves-Loureiro,
  • Maria José Cálix,
  • Adelaide Alves,
  • João Almeida Fonseca,
  • João Almeida Fonseca,
  • João Almeida Fonseca,
  • João Almeida Fonseca

DOI
https://doi.org/10.3389/fmedt.2021.649506
Journal volume & issue
Vol. 3

Abstract

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Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use.Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25–P75) 16–36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3–45] days, translated on a median use rate of 15 [3–38]%. Median inhaler adherence assessed through the app was 34 [4–73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6–83]% and 43 [3–73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen.Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.

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