Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies
Authors: Jácome Cristina , Almeida Rute , Pereira Ana Margarida , Amaral Rita , Vieira-Marques Pedro , Mendes Sandra , Alves-Correia Magna , Ferreira José Alberto , Lopes Inês , Gomes Joana , Araújo Luís , Couto Mariana , Chaves Loureiro Cláudia , Santos Lilia Maia , Arrobas Ana , Valério Margarida , Todo Bom Ana , Azevedo João , Teixeira Maria Fernanda , Ferreira-Magalhães Manuel , Pinto Paula Leiria , Pinto Nicole , Neves Ana Castro , Morête Ana , Bom Filipa Todo , Costa Alberto , Silva Diana , Vasconcelos Maria João , Falcão Helena , Marques Maria Luís , Mendes Ana , Cardoso João , Cidrais Rodrigues José Carlos , Oliveira Georgeta , Carvalho Joana , Lozoya Carlos , Santos Natacha , Menezes Fernando , Gomes Ricardo , Câmara Rita , Alves Rodrigo Rodrigues , Moreira Ana Sofia , Abreu Carmo , Silva Rui , Bordalo Diana , Alves Carlos , Lopes Cristina , Taborda-Barata Luís , Fernandes Ricardo M. , Ferreira Rosário , Chaves-Loureiro Carla , Cálix Maria José , Alves Adelaide , Fonseca João Almeida 
Published: July 2021

Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support.Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use.Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use.Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25–P75) 16–36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3–45] days, translated on a median use rate of 15 [3–38]%. Median inhaler adherence assessed through the app was 34 [4–73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6–83]% and 43 [3–73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p &lt; 0.001), but no differences between patients interacting with the app for 30 days or less were seen.Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.