Meredith Barrett

Feasibility of Deploying Inhaler Sensors to Identify the Impacts of Environmental Triggers and Built Environment Factors on Asthma Short-Acting Bronchodilator Use.

Background: Epidemiological asthma research has relied upon self-reported symptoms or healthcare utilization data, and used the residential address as the primary location for exposure. These data sources can be temporally limited, spatially aggregated, subjective, and burdensome for the patient to collect. Objectives: First, we aimed to test the feasibility of collecting rescue inhaler use data in space–time using electronic sensors. Second, we aimed to evaluate whether these data have the potential to identify environmental triggers and built environment factors associated with rescue inhaler use and to determine whether these findings would be consistent with the existing literature. Methods: We utilized zero-truncated negative binomial models to identify triggers associated with inhaler use, and implemented three sensitivity analyses to validate our findings. Results: Electronic sensors fitted on metered dose inhalers tracked 5,660 rescue inhaler use events in space and time for 140 participants from 13 June 2012 to 28 February 2014. We found that the inhaler sensors were feasible in passively collecting objective rescue inhaler use data. We identified several environmental triggers with a positive and significant association with inhaler use, including: AQI, PM10, weed pollen, and mold. Conversely, the spatial distribution of tree cover demonstrated a negative and significant association with inhaler use. Conclusions: Utilizing a sensor to capture the signal of rescue inhaler use in space–time offered a passive and objective signal of asthma activity. This approach enabled detailed analyses to identify environmental triggers and built environment factors that are associated with asthma symptoms beyond the residential address. The application of these new technologies has the potential to improve our surveillance and understanding of asthma. Citation: Su JG, Barrett MA, Henderson K, Humblet O, Smith T, Sublett JW, Nesbitt L, Hogg C, Van Sickle D, Sublett JL. 2017. Feasibility of deploying inhaler sensors to identify the impacts of environmental triggers and built environment factors on asthma short-acting bronchodilator use. Environ Health Perspect 125:254–261;u2002http://dx.doi.org/10.1289/EHP266

Effect of a mobile health, sensor-driven asthma management platform on asthma control

BACKGROUNDnAsthma inflicts a significant health and economic burden in the United States. Self-management approaches to monitoring and treatment can be burdensome for patients.nnnOBJECTIVEnTo assess the effect of a digital health management program on asthma outcomes.nnnMETHODSnResidents of Louisville, Kentucky, with asthma were enrolled in a single-arm pilot study. Participants received electronic inhaler sensors that tracked the time, frequency, and location of short-acting β-agonist (SABA) use. After a 30-day baseline period during which reference medication use was recorded by the sensors, participants received access to a digital health intervention designed to enhance self-management. Changes in outcomes, including mean daily SABA use, symptom-free days, and asthma control status, were compared among the initial 30-day baseline period and all subsequent months of the intervention using mixed-model logistic regressions and χ2 tests.nnnRESULTSnThe mean number of SABA events per participant per day was 0.44 during the control period and 0.27 after the first month of the intervention, a 39% reduction. The percentage of symptom-free days was 77% during the baseline period and 86% after the first month, a 12% improvement. Improvement was observed throughout the study; each intervention month demonstrated significantly lower SABA use and higher symptom-free days than the baseline month (P < .001). Sixty-nine percent had well-controlled asthma during the baseline period, 67% during the first month of the intervention. Each intervention month demonstrated significantly higher percentages than the baseline month (P < .001), except for month 1 (Pxa0= .80).nnnCONCLUSIONnA digital health asthma management intervention demonstrated significant reductions in SABA use, increased number of symptom-free days, and improvements in asthma control.nnnTRIAL REGISTRATIONnClinicalTrials.gov Identifier: NCT02162576.

AIR Louisville: Addressing Asthma With Technology, Crowdsourcing, Cross-Sector Collaboration, And Policy

Cross-sector partnerships benefit public health by leveraging ideas, resources, and expertise from a wide range of partners. In this study we documented the process and impact of AIR Louisville (a collaboration forged among the Louisville Metro Government, a nonprofit institute, and a technology company) in successfully tackling a complex public health challenge: asthma. We enrolled residents of Louisville, Kentucky, with asthma and used electronic inhaler sensors to monitor where and when they used medication. We found that the use of the digital health platform achieved positive clinical outcomes, including a 78xa0percent reduction in rescue inhaler use and a 48xa0percent improvement in symptom-free days. Moreover, the crowdsourced real-world data on inhaler use, combined with environmental data, led to policy recommendations including enhancing tree canopy, tree removal mitigation, zoning for air pollution emission buffers, recommended truck routes, and developing a community asthma notification system. AIR Louisville represents a model that can be replicated to address many public health challenges by simultaneously guiding individual, clinical, and policy decisions.

Impact of a digital health intervention on asthma resource utilization

Digital health interventions have been associated with reduced rescue inhaler use and improved controller medication adherence. This quality improvement project assessed the benefit of these interventions on asthma-related healthcare utilizations, including hospitalizations, emergency department (ED) utilization and outpatient visits. The intervention consisted of electronic medication monitors (EMMs) that tracked rescue and controller inhaler medication use, and a digital health platform that presented medication use information and asthma control status to patients and providers. In 224 study patients, the number of asthma-related ED visits and combined ED and hospitalization events 365xa0days pre- to 365xa0days post-enrollment to the intervention significantly decreased from 11.6 to 5.4 visits (pxa0<u20090.05) and 13.4 to 5.8 events (pu2009<u20090.05) per 100 patient-years, respectively. This digital health intervention was successfully incorporated into routine clinical practice and was associated with lower rates of asthma-related hospitalizations and ED visits.

Daily pattern of ß2-agonists: understanding real-life use of rescue medication

Background: The 2009 American Thoracic Society/European Respiratory Society report on asthma control states that s2-agonist use should be presented as “occasion” rather than “puffs” per day (AJRCCM 2009;180:59). Aim: To report the pattern of s2-agonist use after the initial “occasion” defined as the first 2 minutes and further use for the next 4 hours. Methods: s2-agonist use was determined with an electronic sensor recording date, time and number of puffs. Data were collected at the initial “occasion” and at 10, 60, 120 and 240 minutes after the initial “occasion.” Results: Data were recorded for 3,373 patients (mean age: 31) from 3/2015 to 2/2017. Patients used s2-agonists on 56,487 days. At the initial “occasion” 30%, 53%, 9%, 4% and 4% used 1, 2, 3, 4 or ≥ 5puffs, respectively, for a total of 117,450 puffs. The percent of puffs/time period following initial “occasion” stayed consistent over 4 hours as puffs subsequently increased by 21% to 141,586. Figure presents percent of puffs used by time. Conclusion: Analysis by “occasion” does not fully reveal the variability of s2-agonist use. Over the 5 time periods studied, 50% of subjects used 2 puffs, and the other 50% used 1 or ≥3 puffs. Differing patterns may reflect variable need, instruction or habit. Use of digital health tools show that puffs/day is a more reliable assessment of s2-agonist use compared to “occasion” to determine need for rescue or adherence to instructions.