Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Faculty of Medical and Health Sciences, University of Auckland, USA.
Respir Med. 2022 Dec;205:107038. doi: 10.1016/j.rmed.2022.107038. Epub 2022 Nov 7.
Modernizing inhaled medications through digital technology can help address persistent problems of non-adherence and poor inhaler technique in patients with obstructive lung diseases. With a growing body of supportive clinical studies, advances in digital inhaler sensors and platforms, greater support from payers and healthcare organizations, significant growth with these technologies is expected. While all digital (smart) inhalers record adherence, these are distinguished by their compatibility with commercial inhalers, capabilities to guide inhaler technique, use of patient-reported outcomes, and user-friendliness for both the healthcare professional (HCP) and patient. Due to the complexity and novelty of employing digital inhalers, collaboration with multiple entities within health systems is necessary and a well-planned integration is needed. For HCPs and patients, cybersecurity and privacy are critical, it will require review by each healthcare organization. In the US, some payers reimburse for remote monitoring using digital inhalers, but reimbursement is currently unavailable in other countries. There are several models for remote patient care, as employing an active, ongoing digital interface between the HCP and patient or they may choose to only review data at clinical encounters. Personalization of therapies and feedback are key to success. While digital inhaler malfunction uncommonly occurs, patient attrition over a year is significant. Some patients will be challenged to use digital platforms or have the necessary technology. Additional research is needed to address cost-effectiveness, in vivo accuracy of inspiratory measurement capable devices, ability to teach inhaler technique, their application for monitoring lung function, and lastly real-world adoption and implementation in routine clinical practice.
通过数字技术使吸入药物现代化，可以帮助解决阻塞性肺部疾病患者持续存在的不遵医嘱和吸入器使用技术不佳的问题。随着越来越多的临床研究支持，数字吸入器传感器和平台的进步，以及支付方和医疗保健组织的更大支持，这些技术预计将显著增长。虽然所有数字（智能）吸入器都记录用药依从性，但它们的区别在于与商业吸入器的兼容性、指导吸入器使用技术的能力、使用患者报告的结果以及对医疗保健专业人员（HCP）和患者的易用性。由于使用数字吸入器的复杂性和新颖性，需要与医疗系统内的多个实体合作，并需要进行精心规划的整合。对于 HCP 和患者而言，网络安全和隐私至关重要，需要每个医疗保健组织进行审查。在美国，一些支付方会报销使用数字吸入器进行远程监测的费用，但在其他国家目前无法报销。远程患者护理有几种模式，既可以选择在 HCP 和患者之间建立主动的、持续的数字接口，也可以选择仅在临床就诊时查看数据。个性化治疗和反馈是成功的关键。虽然数字吸入器故障很少发生，但患者在一年内的流失率很高。有些患者可能会在使用数字平台或拥有必要的技术方面遇到挑战。需要进一步研究来解决成本效益、吸气测量设备的体内准确性、教授吸入器使用技术的能力、其在监测肺功能方面的应用，以及最后在常规临床实践中的实际采用和实施。
