Nijira Lucia Lugogo, MD: Effectively Monitoring SABA Use with Digital Inhaler Technology

A new investigation suggests that elevated short-acting β-agonist (SABA) use among patients with sub-optimally controlled asthma was much more common than previously believed, including in patients with levels experts believe to be associated with exacerbations and asthma-related death.

The data was presented today at the American Thoracic Society 2022 International Conference in San Francisco during the late breaking-session, “Application of Modified Delphi Expert Consensus Thresholds on SABA Reliever Use in Asthma to Data Obtained from a 12-Week Study of a Digital Inhaler in Suboptimally Controlled Asthma Patients”.

In an interview with HCPLive, primary investigator Nijira Lucia Lugogo, MD, from the University of Michigan, spoke of the genesis of the study as well as how she and her colleagues collected data on SABA overuse in patients with asthma.

“We started out by polling 100 clinicians around the country to ask them what their thoughts were about what a safe SABA threshold is,” Lugogo said. “Because we know from the guidelines, we're supposed to minimize SABA use as much as possible. But we wanted to know from clinicians (was) do you feel that the guidelines have been clear enough on what an unsafe threshold is?”

Lugogo and colleagues received over 80 responses before convening a panel of experts who concluded that the threshold for harm was roughly 3 inhalers per 12-month period, or 138 inhalations.

These thresholds were retroactively applied to an open-label study that featured 359 patients with ≥1 asthma exacerbation/prior year and suboptimal asthma control, all of whom monitored their SABA use through a digital inhaler called the ProAir Digihaler.

Lugogo and colleagues found that approximately 30% of the study population were using their medication above the suggested threshold, and that 5 patients had to be treated in order to identify 1 potential patient that would be at risk for poor outcomes including asthma exacerbations from SABA overreliance.

At times, patient reports on SABA use can be inaccurate, as can pharmacy fill records. As such, clinicians do not always know if their patients are using their medication appropriately.

With this study, Lugogo believed that the data collected with the Digihaler offers clinicians “a clear line of sight” into how patients are using their medications, giving patients and clinicians better insight into SABA use, which can be utilized to make healthier and appropriate changes to treatment.

“What we were trying to do is really use what the experts believed was important information, apply it to a data set of patients that had been using the digital inhaler with the rescue medication, and then tried to identify how many patients would we need to treat with this device and for how long in order to identify patients that were potentially at risk," Lugogo said.

Hear the full interview with Dr. Lugogo above, and click here for more news from ATS 2022.