Novel insights gained from an integrated electronic inhaler in patients with severe asthma treated with biologics

SESSION TITLE: Late Breaking Obstructive Lung Disease PostersSESSION TYPE: Original Investigation PostersPRESENTED ON: 10/18/2022 01:30 pm - 02:30 pmPURPOSE: Evidence suggests that electronic inhaler monitoring decreases reliever use, exacerbations and improves adherence. A novel digital system featuring an integrated electronic inhaler captures medication use timing, amount, and inhalation parameters. In this ongoing feasibility study, we evaluated inhaler use differences between patients with controlled and uncontrolled severe asthma.METHODS: Patients were enrolled into a single center, open label, prospective, observational, real-world Asthma Predictive Analytics Study (NCT04997304). In this study, patients were provided with FDA approved electronic inhalers to passively track medication use. We enrolled seventy-one severe asthma patients aged ≥18 years, who were receiving or initiating a biologic and willing to switch their maintenance and reliever to fluticasone/salmeterol and albuterol digital inhalers, respectively. We excluded those with significant non-asthma pulmonary disease. Patients were divided based on poor control (ACT <19). We performed descriptive analyses of demographics, clinical characteristics, inhaler timestamps and inhalation parameters.RESULTS: Our cohort had predominantly female, obese, never smokers with uncontrolled asthma but preserved lung function. Baseline exacerbation rate was 1.14±1.98 per year with a total of 81 exacerbation events. Overall adherence with maintenance inhaler therapy was suboptimal (61.8%) with a mean of 1.30 puffs per day with no differences between controlled (n=52) and uncontrolled asthma groups (n=16) (63.4% vs 61.6%, p=0.086). When using their maintenance inhaler, patients with uncontrolled asthma demonstrated lower inspiratory duration (1555 vs 1796 msec, p<0.001) and volume (1830 vs 2045 mL, p<0.001), but slightly higher peak inspiratory flow (97.6 vs 95.4 LPM, p<0.001). The overall mean number of reliever puffs per day was 1.05 with uncontrolled patients utilizing more reliever doses (1.22 vs 0.22 puffs/day, p<0.001). When using their reliever inhaler, patients with uncontrolled asthma demonstrated similar inspiratory duration (1734 vs 1746 msec, p=0.608), but lower inspiratory volume (1544 vs 1818 mL, p<0.001) and peak inspiratory flow (74.3 vs 83.0 LMP, p<0.001).CONCLUSIONS: In this severe asthma cohort, we have identified differences in inhalation parameters that may impact outcomes in patients on biologics. Maintenance inhaler adherence is low overall. Uncontrolled asthma in this population may be secondary to suboptimal technique, such as the observed lower inspiratory volume. This is reflected by not only by their low ACT scores but also by increased rescue inhaler use.CLINICAL IMPLICATIONS: Attention should be paid to inhaler adherence and technique in severe asthma patients on biologics, particularly when control is an issue. Digital inhaler technology is a potentially under-utilized tool that can aid in remote monitoring and identification of at-risk individuals.DISCLOSURES:Employee relationship with Teva Pharmaceuticals Please note: 08-10-15 to current Added 06/06/2022 by Amanda Boe, value=SalaryNo relevant relationships by Brian DerstineNo relevant relationships by Hannah HarwoodEmployee relationship with Teva Pharmaceuticals Please note: >$100000 by Tanisha Hill, value=SalaryAdvisory Committee Member relationship with AstraZeneca, Genentech, GSK, Novartis, Regeneron, Sanofi, Teva and Amgen Please note: >24 months Added 03/30/2022 by Njira Lugogo, value=Consulting feeClinical trial funding for institution relationship with AstraZeneca, Genentech, GSK, Regeneron, Sanofi, TEVA, Gossamer and Avillion Please note: >24 months Added 03/30/2022 by Njira Lugogo, value=Grant/Research SupportConsultant relationship with AstraZeneca, TEVA Please note: >24 months Added 03/30/2022 by Njira Lugogo, value=Consulting feeFunds for developing CME presentations relationship with AKH, Medscape and NACE Please note: >24 months by Njira Lugogo, value=Grant/Research SupportResearch money received by institution relationship with Janssen Please note: 08/2020 - Present Added 03/30/2022 by Njira Lugogo, value=Grant/ResearchNo relevant relationships by Emily MerchenNo relevant relationships by Arjun MohanNo relevant relationships by Rachel RomanekNo relevant relationships by Elaina ShoemakerNo relevant relationships by June SullivanNo relevant relationships by Stewart WangNo relevant relationships by Peng Zhang SESSION TITLE: Late Breaking Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Evidence suggests that electronic inhaler monitoring decreases reliever use, exacerbations and improves adherence. A novel digital system featuring an integrated electronic inhaler captures medication use timing, amount, and inhalation parameters. In this ongoing feasibility study, we evaluated inhaler use differences between patients with controlled and uncontrolled severe asthma. METHODS: Patients were enrolled into a single center, open label, prospective, observational, real-world Asthma Predictive Analytics Study (NCT04997304). In this study, patients were provided with FDA approved electronic inhalers to passively track medication use. We enrolled seventy-one severe asthma patients aged ≥18 years, who were receiving or initiating a biologic and willing to switch their maintenance and reliever to fluticasone/salmeterol and albuterol digital inhalers, respectively. We excluded those with significant non-asthma pulmonary disease. Patients were divided based on poor control (ACT <19). We performed descriptive analyses of demographics, clinical characteristics, inhaler timestamps and inhalation parameters. RESULTS: Our cohort had predominantly female, obese, never smokers with uncontrolled asthma but preserved lung function. Baseline exacerbation rate was 1.14±1.98 per year with a total of 81 exacerbation events. Overall adherence with maintenance inhaler therapy was suboptimal (61.8%) with a mean of 1.30 puffs per day with no differences between controlled (n=52) and uncontrolled asthma groups (n=16) (63.4% vs 61.6%, p=0.086). When using their maintenance inhaler, patients with uncontrolled asthma demonstrated lower inspiratory duration (1555 vs 1796 msec, p<0.001) and volume (1830 vs 2045 mL, p<0.001), but slightly higher peak inspiratory flow (97.6 vs 95.4 LPM, p<0.001). The overall mean number of reliever puffs per day was 1.05 with uncontrolled patients utilizing more reliever doses (1.22 vs 0.22 puffs/day, p<0.001). When using their reliever inhaler, patients with uncontrolled asthma demonstrated similar inspiratory duration (1734 vs 1746 msec, p=0.608), but lower inspiratory volume (1544 vs 1818 mL, p<0.001) and peak inspiratory flow (74.3 vs 83.0 LMP, p<0.001). CONCLUSIONS: In this severe asthma cohort, we have identified differences in inhalation parameters that may impact outcomes in patients on biologics. Maintenance inhaler adherence is low overall. Uncontrolled asthma in this population may be secondary to suboptimal technique, such as the observed lower inspiratory volume. This is reflected by not only by their low ACT scores but also by increased rescue inhaler use. CLINICAL IMPLICATIONS: Attention should be paid to inhaler adherence and technique in severe asthma patients on biologics, particularly when control is an issue. Digital inhaler technology is a potentially under-utilized tool that can aid in remote monitoring and identification of at-risk individuals. DISCLOSURES: Employee relationship with Teva Pharmaceuticals Please note: 08-10-15 to current Added 06/06/2022 by Amanda Boe, value=Salary No relevant relationships by Brian Derstine No relevant relationships by Hannah Harwood Employee relationship with Teva Pharmaceuticals Please note: >$100000 by Tanisha Hill, value=Salary Advisory Committee Member relationship with AstraZeneca, Genentech, GSK, Novartis, Regeneron, Sanofi, Teva and Amgen Please note: >24 months Added 03/30/2022 by Njira Lugogo, value=Consulting fee Clinical trial funding for institution relationship with AstraZeneca, Genentech, GSK, Regeneron, Sanofi, TEVA, Gossamer and Avillion Please note: >24 months Added 03/30/2022 by Njira Lugogo, value=Grant/Research Support Consultant relationship with AstraZeneca, TEVA Please note: >24 months Added 03/30/2022 by Njira Lugogo, value=Consulting fee Funds for developing CME presentations relationship with AKH, Medscape and NACE Please note: >24 months by Njira Lugogo, value=Grant/Research Support Research money received by institution relationship with Janssen Please note: 08/2020 - Present Added 03/30/2022 by Njira Lugogo, value=Grant/Research No relevant relationships by Emily Merchen No relevant relationships by Arjun Mohan No relevant relationships by Rachel Romanek No relevant relationships by Elaina Shoemaker No relevant relationships by June Sullivan No relevant relationships by Stewart Wang No relevant relationships by Peng Zhang