PC1027: Tracking Asthma Medication Use in Children After an Emergency Department Visit with a Smart Inhaler and Connected Mobile Application

Background: Asthma is the most common chronic childhood illness and the third leading cause of hospitalization among pediatric patients in the US. It is responsible for more than 1.8 million emergency department (ED) visits per year and represents significant health care burden and costs.1
The primary objective of this study is to determine the feasibility of employing a “smart” inhaler connected to a mobile application to track asthma inhaler use after an ED visit. Future goals are to determine if regular daily use of a steroid inhaler results in less rescue medication use, and to connect this usage with real time environmental data to build a risk profile to alert patients of conditions that increase risk of asthma exacerbation.

Methods: A cross-sectional cohort study was conducted at a single urban academic hospital pediatric ED between November 2021 and January 2022. Eligibility criteria included age 5-18 years, ED presentation with an asthma-related complaint, access to a blue tooth enabled mobile device, and discharge from the ED with a prescription for albuterol and/or an inhaled steroid. Each study participant was provided an electronic sensor device fitted to the asthma medication inhaler and connected to a mobile application on the patient or caregiver’s phone. The “smart” sensor registered an event each time the patient pressed on the inhaler to deliver a puff of medication. Each patient also had a phone follow up within 30 days, and a chart review was conducted to determine if an ED visit occurred within 7 days of the initial ED visit with a related complaint.

Results: Of the 19 patients eligible for the study, 16/19 (84.2%) agreed to participate. Mean age of participants was 9.1 years (95% CI 6.65 to 11.6) and 6/16 (37.5%) were females. 13/16 (81.3%) of patients were English speaking and 3/16 (18.3%) were Spanish speaking. Albuterol was prescribed to all patients while Fluticasone was prescribed to 5/16 (31.2%) of the participants. Successful sensor synchronization was achieved in 4/16 (25%), while the remaining 12/16 (75%) never synchronized their sensor to the mobile app. On a 30-day phone follow up and chart review, 1/16 (6%) patients had an ER return within 7 days of enrollment, and 3/16 (18.8%) were not successfully contacted on follow up. Overall, the system successfully registered 31 medication dose events and sent email notification to the clinician in every instance.

Conclusion: Our study is a successful proof of concept, demonstrating moderate feasibility of real-time tracking of pediatric inhaled asthma medication using a “smart” inhaler device after an ED visit. Further studies are in development to construct an asthma risk profile by connecting medication use events and environmental data as a predictive tool to prevent future asthma exacerbations.