Digital Smart Inhaler monitoring in children and young people with high-risk asthma in UK primary care

Background: Children and young people (CYP) with asthma in the UK have the highest rate of severe asthma attacks of any high-income country in Europe. A major obstacle to good asthma outcomes is poor adherence to preventer medication (ICS) and over-reliance on short-acting beta-2 agonists (SABA). We aimed to discover whether a smart inhaler-enabled care pathway in high-risk CYP with asthma is acceptable to CYP/parents and feasible within primary care. Methods: Prospective cohort study (Nov-23-Dec-24) in Leicestershire primary care. CYP (5-16yrs) on the practice asthma register with high-risk asthma (attack in previous year and/or high SABA prescriptions) were invited to attend an asthma review at their practice. Spirometry, FeNO and asthma control were assessed at baseline. CYPs were given a digital smart inhaler (Hailie, Adherium (NZ) Limited) linked via Blue-tooth to the app on their/their parent’s smart phone. Telephone follow-up at 3-months was conducted and face-to-face follow-up at 6-months is in progress. Results: 72 children were recruited; mean age 9.0 (SD 3.1) years, 43 (60%) boys. 58 (81%) were from White ethnic backgrounds, and 45% from the most deprived areas of Leicester/Leicestershire. 68 (94%) were prescribed an ICS inhaler at baseline. FeNO at baseline was available for 40 (55%) CYP, median 39.5ppb (range 5-130ppb). Baseline spirometry was available for 62 (86%), median FEV1%predicted 82% (range 68-123%). The mean asthma control score increased from 19.6 (SD 3.6) at baseline to 23.5 (SD 3.1) at 3 months follow up. Conclusions: Digital smart inhaler monitoring of high-risk children with asthma in primary care is feasible and acceptable to CYP and their carers. Digital smart inhaler monitoring was associated with a substantial improvement in asthma control at 3-months follow-up.