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

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.

SUBMITTER: D'Arcy S

PROVIDER: S-EPMC4048229 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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

D'Arcy Shona S MacHale Elaine E Seheult Jansen J Holmes Martin S MS Hughes Cian C Sulaiman Imran I Hyland Deirdre D O'Reilly Conor C Glynn Senan S Al-Zaabi Thekra T McCourt John J Taylor Terence T Keane Frank F Killane Isabelle I Reilly Richard B RB Costello Richard W RW

PloS one 20140606 6

<h4>Rationale</h4>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.<h4>Objectives</h4>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 ...[more]

PMID: 24905012

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Project description:Asthma and chronic obstructive pulmonary disease (COPD) patients are required to inhale forcefully and deeply to receive medication when using a dry powder inhaler (DPI). There is a clinical need to objectively monitor the inhalation flow profile of DPIs in order to remotely monitor patient inhalation technique. Audio-based methods have been previously employed to accurately estimate flow parameters such as the peak inspiratory flow rate of inhalations, however, these methods required multiple calibration inhalation audio recordings. In this study, an audio-based method is presented that accurately estimates inhalation flow profile using only one calibration inhalation audio recording. Twenty healthy participants were asked to perform 15 inhalations through a placebo Ellipta™ DPI at a range of inspiratory flow rates. Inhalation flow signals were recorded using a pneumotachograph spirometer while inhalation audio signals were recorded simultaneously using the Inhaler Compliance Assessment device attached to the inhaler. The acoustic (amplitude) envelope was estimated from each inhalation audio signal. Using only one recording, linear and power law regression models were employed to determine which model best described the relationship between the inhalation acoustic envelope and flow signal. Each model was then employed to estimate the flow signals of the remaining 14 inhalation audio recordings. This process repeated until each of the 15 recordings were employed to calibrate single models while testing on the remaining 14 recordings. It was observed that power law models generated the highest average flow estimation accuracy across all participants (90.89±0.9% for power law models and 76.63±2.38% for linear models). The method also generated sufficient accuracy in estimating inhalation parameters such as peak inspiratory flow rate and inspiratory capacity within the presence of noise. Estimating inhaler inhalation flow profiles using audio based methods may be clinically beneficial for inhaler technique training and the remote monitoring of patient adherence.

Dataset Information

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

Publications

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

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