“Medical adherence, inhaler technique, and underlying comorbidities are practical challenges in the assessment of patients with asthma,” stated Prof. Richard Costello (Bon Secours Hospital Dublin, Ireland)1. Objective measures are needed to separate patients with difficult-to-treat asthma from those with severe asthma. The INCA-SUN trial (NCT02307669) randomised 216 patients with severe, uncontrolled asthma to the experimental arm, in which patients received personalised biofeedback on inhaler adherence, technique, and peak expiratory flow, with treatment decisions being informed by digital data, or to usual care.
At week 32, 11% of participants in the experimental group and 21% of the participants in the usual care arm required add-on biologic therapy (OR 0.42; P=0.038). In addition, participants in the usual care arm more often received added high doses of inhaled corticosteroids (ICS) compared with the experimental arm (OR 0.26; P=0.049). A reduction in high dose ICS was more frequently reported in the digital arm than in the usual care arm (OR 2.11; P=0.047).
The authors showed that adherence was approximately 10% higher in the digital arm than in the control arm. Importantly, asthma control rates, lung function, T2 inflammation, and exacerbation rates were comparable for the 2 study arms, indicating that the digital approach achieves asthma control more frequently by improving the current therapy instead of escalating therapy.
Finally, Prof. Costello said that the direct medical costs for 1 individual were €3,000 less in the digital arm than in the usual arm.