title: Adherence monitoring and e-health: how clinicians and researchers can use technology to promote inhaler adherence for asthma.
abstract: In the past decade, rapid technological developments have advanced electronic monitoring devices (EMD) for asthma inhalers beyond simple recording of actuations to providing adherence promotion features and detailed information about patterns of medication use. This article describes currently available EMDs, discusses their utility and limitations in assessing adherence, and describes the potential for EMD-based adherence promotion interventions in clinical settings. To date, the main use of EMDs has been in clinical research. In selected populations, simple EMD-based adherence interventions, delivered either through clinician-to-patient feedback about medication use or by direct-to-patient reminders for missed doses, can significantly improve adherence. Further work is now needed to determine the impact of EMDs on clinical outcomes and their cost-effectiveness and feasibility for different clinical settings, including in disadvantaged populations. If this evidence can be provided, then the use of EMDs could expand into the management of asthma in populations with high health care costs, eg, severe asthma. In the future, medication monitoring could help distinguish poor treatment response from poor adherence, guide prescribing decisions, and prompt providers to discuss barriers to adherence; electronic health records may provide the gateway for integrating medication-use monitoring into digital chronic care management.
authors.affiliation: School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Amy Hai Yan
authors.initials: AH
authors.lastname: Chan
authors.affiliation: Woolcock Institute of Medical Research, Clinical Management Group, University of Sydney, Sydney, Australia.
authors.forename: Helen Kathryn
authors.initials: HK
authors.lastname: Reddel
authors.affiliation: Division of Pulmonary, Allergy, Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Andrea
authors.initials: A
authors.lastname: Apter
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Md.
authors.forename: Michelle
authors.initials: M
authors.lastname: Eakin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Md.
authors.forename: Kristin
authors.initials: K
authors.lastname: Riekert
authors.affiliation: Woolcock Institute of Medical Research, Clinical Management Group, University of Sydney, Sydney, Australia. Electronic address: j.m.foster@woolcock.org.au.
authors.forename: Juliet Michelle
authors.initials: JM
authors.lastname: Foster
mesh_terms: D001249:Asthma / Q000188:drug therapy*; D006801:Humans; D055118:Medication Adherence; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data*; D010820:Physicians; D012108:Research Personnel; D017216:Telemedicine
keywords: Adherence; Asthma; Electronic medication monitoring; Materials testing