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A method to assess adherence in inhaler use through analysis of acoustic recordings of inhaler events.

D'Arcy S, MacHale E, Seheult J, Holmes MS, Hughes C, Sulaiman I, Hyland D, O'Reilly C, Glynn S, Al-Zaabi T, McCourt J, Taylor T, Keane F, Killane I, Reilly RB, Costello RW - PLoS ONE (2014)

Bottom Line: The correlation between clinical outcomes and adherence, as determined by this device, was compared for temporal adherence alone and combined temporal and technique adherence.Repeated training reduced this to 7% of participants (p = 0.03).EudraCT 2011-004149-42.

View Article: PubMed Central - PubMed

Affiliation: Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland.

ABSTRACT

Rationale: Poor adherence to inhaler use can be due to poor temporal and/or technique adherence. Up until now there has been no way of reliably tracking both these factors in everyday inhaler use.

Objectives: This paper introduces a device developed to create time stamped acoustic recordings of an individual's inhaler use, in which empirical evidence of temporal and technique adherence in inhaler use can be monitored over time. The correlation between clinical outcomes and adherence, as determined by this device, was compared for temporal adherence alone and combined temporal and technique adherence.

Findings: The technology was validated by showing that the doses taken matched the number of audio recordings (r2 = 0.94, p<0.01). To demonstrate that audio analysis of inhaler use gives objective information, in vitro studies were performed. These showed that acoustic profiles of inhalations correlated with the peak inspiratory flow rate (r2 = 0.97, p<0.01), and that the acoustic energy of exhalations into the inhaler was related to the amount of drug removed. Despite training, 16% of participants exhaled into the mouthpiece after priming, in >20% of their inhaler events. Repeated training reduced this to 7% of participants (p = 0.03). When time of use was considered, there was no evidence of a relationship between adherence and changes in AQLQ (r2 = 0.2) or PEFR (r2 = 0.2). Combining time and technique the rate of adherence was related to changes in AQLQ (r2 = 0.53, p = 0.01) and PEFR (r2 = 0.29, p = 0.01).

Conclusions: This study presents a novel method to objectively assess how errors in both time and technique of inhaler use impact on clinical outcomes.

Trial registration: EudraCT 2011-004149-42.

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Related in: MedlinePlus

The decision algorithm, outlining the steps taken to analyse each recording, is shown in (A).In (B) and (C) the data from two individuals over 90 days are shown on the X-axis, and the time of use on the Y-axis. If the sequence of events required for correct inhaler use is performed, with sufficient energy of inhalation, then the event is displayed with a green spot. If there is a critical error, then the event is displayed with an orange spot. In (D) and (E) the weekly rate of adherence incorporating the time and technique are shown. It should be noted that while both users took their inhalers very regularly, the individual in (E) had poor technique in the first month, which impacted the true rate of inhaler use.
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pone-0098701-g005: The decision algorithm, outlining the steps taken to analyse each recording, is shown in (A).In (B) and (C) the data from two individuals over 90 days are shown on the X-axis, and the time of use on the Y-axis. If the sequence of events required for correct inhaler use is performed, with sufficient energy of inhalation, then the event is displayed with a green spot. If there is a critical error, then the event is displayed with an orange spot. In (D) and (E) the weekly rate of adherence incorporating the time and technique are shown. It should be noted that while both users took their inhalers very regularly, the individual in (E) had poor technique in the first month, which impacted the true rate of inhaler use.

Mentions: The package instructions accompanying a Diskus inhaler describe the steps required for its correct use. Table 1 and Figure 1B demonstrate how each of these phases can be identified visually from a display of an acoustic recording created by the INCA device. Visual and audio analysis was carried out using the audio processing software Audacity, (http://audacity.sourceforge.net).


A method to assess adherence in inhaler use through analysis of acoustic recordings of inhaler events.

D'Arcy S, MacHale E, Seheult J, Holmes MS, Hughes C, Sulaiman I, Hyland D, O'Reilly C, Glynn S, Al-Zaabi T, McCourt J, Taylor T, Keane F, Killane I, Reilly RB, Costello RW - PLoS ONE (2014)

The decision algorithm, outlining the steps taken to analyse each recording, is shown in (A).In (B) and (C) the data from two individuals over 90 days are shown on the X-axis, and the time of use on the Y-axis. If the sequence of events required for correct inhaler use is performed, with sufficient energy of inhalation, then the event is displayed with a green spot. If there is a critical error, then the event is displayed with an orange spot. In (D) and (E) the weekly rate of adherence incorporating the time and technique are shown. It should be noted that while both users took their inhalers very regularly, the individual in (E) had poor technique in the first month, which impacted the true rate of inhaler use.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4048229&req=5

pone-0098701-g005: The decision algorithm, outlining the steps taken to analyse each recording, is shown in (A).In (B) and (C) the data from two individuals over 90 days are shown on the X-axis, and the time of use on the Y-axis. If the sequence of events required for correct inhaler use is performed, with sufficient energy of inhalation, then the event is displayed with a green spot. If there is a critical error, then the event is displayed with an orange spot. In (D) and (E) the weekly rate of adherence incorporating the time and technique are shown. It should be noted that while both users took their inhalers very regularly, the individual in (E) had poor technique in the first month, which impacted the true rate of inhaler use.
Mentions: The package instructions accompanying a Diskus inhaler describe the steps required for its correct use. Table 1 and Figure 1B demonstrate how each of these phases can be identified visually from a display of an acoustic recording created by the INCA device. Visual and audio analysis was carried out using the audio processing software Audacity, (http://audacity.sourceforge.net).

Bottom Line: The correlation between clinical outcomes and adherence, as determined by this device, was compared for temporal adherence alone and combined temporal and technique adherence.Repeated training reduced this to 7% of participants (p = 0.03).EudraCT 2011-004149-42.

View Article: PubMed Central - PubMed

Affiliation: Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland.

ABSTRACT

Rationale: Poor adherence to inhaler use can be due to poor temporal and/or technique adherence. Up until now there has been no way of reliably tracking both these factors in everyday inhaler use.

Objectives: This paper introduces a device developed to create time stamped acoustic recordings of an individual's inhaler use, in which empirical evidence of temporal and technique adherence in inhaler use can be monitored over time. The correlation between clinical outcomes and adherence, as determined by this device, was compared for temporal adherence alone and combined temporal and technique adherence.

Findings: The technology was validated by showing that the doses taken matched the number of audio recordings (r2 = 0.94, p<0.01). To demonstrate that audio analysis of inhaler use gives objective information, in vitro studies were performed. These showed that acoustic profiles of inhalations correlated with the peak inspiratory flow rate (r2 = 0.97, p<0.01), and that the acoustic energy of exhalations into the inhaler was related to the amount of drug removed. Despite training, 16% of participants exhaled into the mouthpiece after priming, in >20% of their inhaler events. Repeated training reduced this to 7% of participants (p = 0.03). When time of use was considered, there was no evidence of a relationship between adherence and changes in AQLQ (r2 = 0.2) or PEFR (r2 = 0.2). Combining time and technique the rate of adherence was related to changes in AQLQ (r2 = 0.53, p = 0.01) and PEFR (r2 = 0.29, p = 0.01).

Conclusions: This study presents a novel method to objectively assess how errors in both time and technique of inhaler use impact on clinical outcomes.

Trial registration: EudraCT 2011-004149-42.

Show MeSH
Related in: MedlinePlus