Inhaler Monitoring Cuts Hospitalization Usage, Study Finds

Patients with chronic obstructive pulmonary disease whose inhaler use was tracked by a monitoring device were less likely to end up in the hospital, according to new research.

The study found that electronic monitoring allowed healthcare providers to make necessary interventions sooner than had they relied solely on patient-reported distress. It also highlights the role that technology can play in providing data to inform disease management programs.

Investigators from the Cleveland Clinic wanted to know what effects electronic inhaler monitoring (EIM) would have on patients with COPD who also had high healthcare utilization. They enrolled 39 patients (average age: 68.6) who underwent at least one hospitalization or emergency department visit in the previous year, and researchers connected a small sensor to participants’ inhalers.

The sensors, part of an EIM platform by Wisconsin-based Propeller Health, transmit data to the patient’s cellphone, resulting in a cache of data related to medication usage and adherence. The platform then sent alerts to healthcare providers when the data suggested problems like suboptimal use of controller inhalers or a spike in the use of the patient’s rescue inhaler.

After one year, investigators found patients’ hospital use dropped from 3.4 visits to the hospital in the prior year to 2.2 visits in the year covered by the study.

The Cleveland Clinic’s Umur Hatipoğlu, M.D., a study co-author, said electronic monitoring allows for more accurate assessment of inhaler use.

“We prescribe inhaled medications for patients with COPD all the time,” he said in a press release. “It’s really the cornerstone of their therapy, and when they return to the clinic, we do ask them whether they’re using their medications, but the reality is we never know how adherent patients are objectively.”

Richard Rice, RRT, M.Ed., another Cleveland Clinic co-author, told Inside Digital Health that the Propeller platform sent alerts when it determined that increased rescue inhaler use suggested the patient was at high risk of COPD exacerbation.

“A common scenario would be: They were more active than usual or did not have access to their nebulizer, necessitating increased use,” he said. “There were also scenarios where we scheduled same- or next-day appointments, and they were examined and prescribed prednisone for the early exacerbation onset. There were also instances where this was assessed and prescribed via a phone conversation.”

Alerts also came for other reasons, such as a patient not using their controller medication for four days. Such alerts could be followed up with a phone call to determine and fix the problem.

The decrease in hospitalizations noted in the study not only suggests an opportunity to improve the health of patients with COPD. It also lays out a potentially significant path to cut healthcare spending in a high-cost clinical area.

According to the Centers for Disease Control and Prevention, the U.S. spent $32.1 billion on COPD treatment in 2010, and that number was expected to climb to $49 billion by 2020. Private insurers pay for only 18% of that spending. Medicare and Medicaid cover the rest, the agency said.

The study was published last month in The Journal of Telemedicine and Telecare.

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