Identifying subgroups of asthma patients for potential intervention using electronic medication monitors (EMM)

Abstract

Background: EMMs monitoring individual-level patterns of rescue and controller inhaler use in patients with asthma can help identify subgroups for potential intervention. Methods: Patients with self-reported asthma ≥18 years of age enrolled in a digital health program (1/2018-7/2019) that passively collected inhaler use data via EMMs and provided a mobile app to share medication use trends and related educational content. Patients with ≥90 days of EMM use were categorized into groups according to controller medication adherence (0-24, 25-49, 50-74, and 75-100%) and rescue use (1-3, 4-14, 15-28, ≥28 puffs/week). Multivariable logistic regressions identified whether age, gender, Asthma Control Test (ACT) score (5-15, 16-19, ≥20), daily app opens and census tract-level demographics were associated with adherence and rescue use groups (α=0.05). Results: The percentage of study patients (n=1263, mean age: 39 years, 79% female) with 75-100% adherence, ≥28 rescue puffs/week and both was 18%, 6% and 1.5%, respectively (Table). Models identified that older age, ACT ≥20 and higher app opens were associated with having 75-100% adherence, while ACT 5-15 and higher app opens were associated with having ≥28 rescue puffs/week. Conclusion: Patients with lower adherence and higher rescue use may warrant additional training on inhaler technique and consideration for change or step up in therapy. EMMs can be used to objectively identify candidates for potential intervention. Table: Percent of patients in rescue use subgroups