Aung Hnin, Tan Ronnie, Flynn Cara, Divall Pip, Wright Adam, Murphy Anna, Shaw Dominick, Ward Tom J C, Greening Neil J
Department of Respiratory Sciences, University of Leicester, Leicester, UK.
Institute for Lung Health, NIHR Respiratory Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK.
Eur Respir Rev. 2024 Dec 4;33(174). doi: 10.1183/16000617.0136-2024. Print 2024 Oct.
Sub-optimal inhaler adherence undermines the efficacy of pharmacotherapy in COPD. Digitalised care pathways are increasingly used to improve inhaler-use behaviour remotely. This review investigated the feasibility and impact of remote electronic inhaler adherence monitoring (EIM) and intervention platforms on clinical outcomes in COPD.
A literature search was conducted and studies investigating maintenance inhaler use among people with COPD using digital technology were selected. Pairwise and proportional meta-analyses were employed with heterogeneity assessed using I statistics. When meta-analysis was not feasible, a narrative synthesis of outcomes was conducted.
We included 10 studies including 1432 people with COPD whose maintenance inhaler usage was supported by digital inhalers and apps featuring audiovisual reminders and educational content with or without engagement with healthcare providers (HCPs). Inhaler adherence rate (AR) varied with calculation methods, but an overall suboptimal adherence was observed among people with COPD. HCP-led adherence interventions alongside EIM improved mean AR by 18% (95% CI 9-27) passive EIM only. Enhanced AR may reduce COPD-related healthcare utilisation with little impact on health-related quality of life and exacerbation rate. Despite encountering technical issues among 14% (95% CI 5-23%) of participants, 85% (95% CI 76-94%) found digital platforms convenient to use, while 91% (95% CI 79-100%) perceived inhaler reminders as helpful.
Digitalised interventions can enhance maintenance inhaler adherence in COPD but their overall effect on clinical outcomes remains uncertain. Further work is required to tailor interventions to individuals' adherence behaviour and investigate their longer-term impact.
吸入器依从性欠佳会削弱慢性阻塞性肺疾病（COPD）药物治疗的疗效。数字化护理路径越来越多地用于远程改善吸入器使用行为。本综述调查了远程电子吸入器依从性监测（EIM）和干预平台对COPD临床结局的可行性和影响。
进行文献检索，选择使用数字技术调查COPD患者维持吸入器使用情况的研究。采用成对和比例荟萃分析，并使用I统计量评估异质性。当荟萃分析不可行时，对结果进行叙述性综合分析。
我们纳入了10项研究，包括1432名COPD患者，他们的维持吸入器使用得到数字吸入器和应用程序的支持，这些应用程序具有视听提醒和教育内容，有或没有与医疗保健提供者（HCPs）互动。吸入器依从率（AR）因计算方法而异，但COPD患者总体依从性欠佳。HCP主导的依从性干预与EIM一起，仅被动EIM就能使平均AR提高18%（95%CI 9-27）。提高AR可能会减少与COPD相关的医疗保健利用，对与健康相关的生活质量和急性加重率影响不大。尽管14%（95%CI 5-23%）的参与者遇到技术问题，但85%（95%CI 76-94%）的人认为数字平台使用方便，而91%（95%CI 79-100%）的人认为吸入器提醒有帮助。
数字化干预可以提高COPD患者维持吸入器的依从性，但其对临床结局的总体影响仍不确定。需要进一步开展工作，根据个体的依从行为调整干预措施，并调查其长期影响。
