The effect of Clip-tone® and its smartphone application on optimization of metered-dose inhaler inhalation technique

Abstract

Background: While pMDI are extensively prescribed, its use frequently results in repetitive inhalation-techniques mistakes.

One of the most repetitive errors is inhaling too fast through the pMDI.

Aims and Objectives: The aim of the present study was to assess the effect of Clip-tone® with linked smartphone application on the inhalation-flow of subjects.

Methods: 200 subjects were involved in the study. They were randomized into 4 groups. Group 1 received only verbal pMDI counseling; group 2 received verbal counseling plus resistance (a modified Clip-tone® with no whistle); group 3 received verbal counseling with whistle as audio feedback from normal Clip tone® and group 4 received verbal counseling with whistle from Clip-tone® and visual feedback (smartphone application). Inhalation time through the pMDI for each subject was recorded three times and inter and intra-subject variations were calculated.

Results: Group 4 showed 37 subjects with correct inhaling flow (5 seconds) with the lowest variation between subjects (inter-subject variability) and lowest intra-personal variability. While group 3 showed 45 subject having correct flow (5 seconds); their’ inter and intra-subject variations were lower when compared with groups 1 and 2 which had 28 and 20 subjects respectively with inhalation-time about 5-seconds.

Conclusions: Providing visual and audio-feedbacks by the Clip-tone® with smartphone application preserved the deep and slow inhalation over the pMDI much better compared to verbal counseling alone. We recommend the patients to take all their inhaled doses using pMDI add-on devices e.g. Clip-tone® with smartphone application.