Real-World Outcomes from use of Enerzair Inhalers with Propeller Monitor Connected Inhaler System in A Regional Severe Asthma Adherence Clinic

Abstract

Background Adherence to inhaled corticosteroids is a major issue requiring assessment prior to decision on initiating biologics in patients with severe asthma. Use of FeNO suppression testing with a digital connected inhaler system is increasingly viewed as gold-standard for assessing adherence. Some digital connected inhaler systems come with patient smartphone App and clinician dashboard, and others with only patient App through which to review inhaler usage. As poor medication adherence and poor appointment attendance are associated, there are potential advantages to review through a clinician dashboard. Aim To review adherence assessment outcomes at a regional severe asthma service for patients using an Enerzair inhaler with Propeller monitor connected inhaler system, reviewable only through the patient's smartphone. Methods Outcomes for all patients commenced on the Enerzair connected inhaler system for adherence monitoring from Nov'22- Feb'24 were reviewed. Baseline medication possession ratio (MPR) for their preventer inhaler, attendance at adherence follow-up clinics, results of FeNO suppression testing, and systemic assessment decisions at end of adherence monitoring were assessed. Positive FeNO suppression was defined as a baseline FeNO >=45ppb that decreased by >=42% with monitored inhaler usage. Results Over this time-period 37 patients agreed to adherence monitoring and FeNO suppression tests with the Enerzair connected inhaler system (figure 1). 28 patients (average baseline MPR 65%) attended their first follow-up adherence clinic visit at 1-3 months after baseline visit, 5 (average MPR 57%) did not attend first follow-up adherence clinic but attended a re-scheduled appointment. 4 (MPR 50%) patients did not attend any adherence follow-up. Of 9 patients whose FeNO did not suppress with adherence monitoring, 3 (33%) started on a biologic, 4 started active monitoring and 2 required other assessments before final decision. Of the 8 patients whose FeNO did suppress with adherence monitoring only 1 (13%) started on a biologic. Discussion In patients who agree to FeNO suppression testing, attendance at follow-up visits was high and lack of a clinician dashboard to remotely review adherence was not a major limitation to the service. Adherence remains only one aspect of multi-disciplinary assessment in severe asthma prior to initiating biologics. (Table Presented).