Background

Asthma is a chronic condition characterised by wheezing, shortness of breath and cough. It affects roughly 5.5 million people in the UK today and is mainly treated through inhaled medication; with short-term reliever medication available to quickly relieve symptoms and asthma attacks and long-term controller medication capable of controlling the condition and leaving the patient relatively symptom free over time.

A robust finding in asthma research is that patients often do not use their controller medication as prescribed and over-rely on their rescue inhaler. This leaves them susceptible to symptoms, asthma attacks and ultimately hospitalisation and even death.

There is a need to accurately monitor how adherent patients are to their inhaled medication, in order to detect when patients are at risk, identify when patients require intervention, and to accurately assess the impact of different interventions in clinical trials to understand how adherence can best be improved.

Electronic Monitoring Devices (EMDs) offer the most accurate method for recording inhaler use and have also been shown to improve adherence when they contain a reminder function or adherence data is fed-back to the patient.

However, there has been little to no research to date investigating how EMDs can be designed and developed to ensure they meet the needs of both patients and healthcare providers.

Study 1

Seven adolescents with severe asthma used an EMD with their normal controller medication for one month. Over this time, they completed three questionnaires and interviews on their attitudes towards the device with particular focus on having their medication taking behaviour monitored.

Study 2

A three-round Delphi survey with 39 healthcare professionals and stakeholders in Asthma care including physicians, GPs, nurses, pharmacists and Clinical Commissioning Group members. Participants were asked for their views on the key benefits and barriers associated with the introduction of EMDs in asthma care and were subsequently asked to rate a list of the issues raised by all participants for their relative importance.

Study 3

Two workshops and a tech-trial with 17 healthy adolescents aged 16-17 at Long Eaton School Sixth Form. Participants had their location and daily activity levels monitored used a smartphone and Fitbit Zip. This data was then presented back to them and they completed a series of activities surrounding the potential uses for this data – such as it’s potential use in asthma care to monitor the locations where people are using their inhalers and look at other data such as pollen counts and pollution levels to gain an in-depth understanding of that asthma patient’s triggers.

Outcomes

This research will help inform the future development of EMDs through identifying important issues for both patients and healthcare professionals. It will also act as a trigger for future user-focused research in asthma care as the attitudes of other patient groups such as the elderly, or patients from different economic and social backgrounds must also be considered going forward.