title: Three-month validation of a turbuhaler electronic monitoring device: implications for asthma clinical trial use.
abstract: BACKGROUND
  Electronic monitoring of inhaled asthma therapy is suggested as the 'gold standard' for measuring patterns of medication use in clinical trials. The SmartTurbo (Adherium (NZ) Ltd, Auckland, New Zealand) is an electronic monitor for use with a turbuhaler device (AstraZeneca, UK). The aim of this study was to determine the accuracy of the SmartTurbo in recording Symbicort actuations over a 12-week period of use.
  
  
  METHODS
  Twenty SmartTurbo monitors were attached to the base of 20 Symbicort turbuhalers. Bench testing in a research facility was undertaken on days 0, 5, 6, 7, 8, 9, 14, 21, 28, 56 and 84. Patterns of 'low-use' (2 sets of 2 actuations on the same day) and 'high-use' (2 sets of 8 actuations on the same day) were performed. The date and time of actuations were recorded in a paper diary and compared with data uploaded from the SmartTurbo monitors.
  
  
  RESULTS
  2800 actuations were performed. Monitor sensitivity was 99.9% with a lower 97.5% confidence bound of 99.6%. The positive predictive value was 99.9% with a 97.5% lower confidence bound of 99.7%. Accuracy was not affected by whether the pattern of inhaler use was low or high, or whether there was a delay in uploading the actuation data.
  
  
  CONCLUSIONS
  The SmartTurbo monitor is highly accurate in recording and retaining electronic data in this 12-week bench study. It can be recommended for use in clinical trial settings, in which quality control systems are incorporated into study protocols to ensure accurate data acquisition.
authors.affiliation: Capital and Coast District Health Board , Wellington , New Zealand ; Medical Research Institute of New Zealand , Wellington , New Zealand.
authors.forename: Janine
authors.initials: J
authors.lastname: Pilcher
authors.affiliation: Capital and Coast District Health Board , Wellington , New Zealand ; Medical Research Institute of New Zealand , Wellington , New Zealand.
authors.forename: Philippa
authors.initials: P
authors.lastname: Shirtcliffe
authors.affiliation: Medical Research Institute of New Zealand , Wellington , New Zealand ; Nottingham Respiratory Research Unit , The University of Nottingham , Nottingham , UK.
authors.forename: Mitesh
authors.initials: M
authors.lastname: Patel
authors.affiliation: Medical Research Institute of New Zealand , Wellington , New Zealand.
authors.forename: Steve
authors.initials: S
authors.lastname: McKinstry
authors.affiliation: Capital and Coast District Health Board , Wellington , New Zealand ; Medical Research Institute of New Zealand , Wellington , New Zealand.
authors.forename: Terrianne
authors.initials: T
authors.lastname: Cripps
authors.affiliation: Capital and Coast District Health Board , Wellington , New Zealand ; Wellington School of Medicine & Health Sciences, University of Otago Wellington , Wellington , New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
authors.affiliation: Capital and Coast District Health Board , Wellington , New Zealand ; Medical Research Institute of New Zealand , Wellington , New Zealand.
authors.forename: Richard
authors.initials: R
authors.lastname: Beasley
keywords: Asthma