Digital Inhalers Improve Asthma Control, May Lower Risk of Severe Exacerbations: Study Shows

Digital inhalers have sensors that provide real-time feedback to patients regarding their medication usage and inhalation technique. These tools aim to address the long-standing issue of poor adherence, estimated to affect around 43% of asthma patients globally.

To better understand their clinical utility, Leonardo Ologundudu, from McMaster University in Ontario, Canada, and colleagues conducted a systematic review of 12 randomized controlled trials involving 2,483 children (ages 4–17) and adults. This work was undertaken in the context of developing new clinical guidelines for severe and difficult-to-control asthma by the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma, and Immunology Joint Task Force.

Based on the study, the researchers reported the following findings:

• Digital inhalers likely improve asthma symptom control, with 44.3% of users achieving at least a three-point increase in Asthma Control Test scores, compared to 39.8% in the control group.
• The study suggests that digital inhalers may reduce the incidence of severe asthma exacerbations, particularly in patients at high risk, with an 11% relative reduction, though the certainty of this finding is low.
• On average, digital inhalers may result in 45 fewer severe exacerbations per 1,000 patients.
• The review found minimal harm associated with digital inhalers, with a median device failure rate of about 12%.
• Technical issues, such as sensor synchronization with smartphones, were the primary cause of failure.
• One trial reported a case of protected health information exposure, but overall, adverse outcomes were rare.

The authors emphasize considering the benefits of digital inhalers within a broader clinical context. Patients already demonstrating consistent adherence and proper technique may derive limited additional benefit, whereas those requiring ongoing support might find digital inhalers especially helpful.

However, limitations exist. Many studies lacked blinded outcome assessors, and few enrolled older adults above 60. Moreover, the combined effect of digital inhalers and remote clinician monitoring was commonly studied, making it difficult to isolate its standalone impact.

Still, the findings are expected to influence future clinical practice. “These results support the incorporation of digital inhalers into asthma management, particularly for select patient subgroups. Updated guidelines should reflect this evolving landscape,” the researchers concluded.

Reference:

Ologundudu L, Rayner DG, Oppenheimer J, Sumino K, Hoyte F, RiveraSpoljaric K, Perry TT, Nyenhuis SM, Chipps B, Israel E, Shade LE, Press VG, Rangel S, Guyatt GH, McCabe E, O’Byrne PM, Hall L, Orr H, Sue-Wah-Sing D, Melendez A, Winders T, Przywara K, Gardner DD, Rank MA, Bacharier LB, Mosnaim G, Chu DK, Patient-facing digital inhalers for asthma: a systematic review and meta-analysis, The Journal of Allergy and Clinical Immunology: In Practice (2025), doi: https://doi.org/10.1016/j.jaip.2025.04.039.