medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-200medsovet-8320Research ArticleХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ЛЕГКИХCHRONIC PULMONARY DISEASESВозрастные особенности выбора ингаляторов у детей и подростков с бронхиальной астмой и другими заболеваниями органов дыханияAge-related features of the choice of inhalers in chilren and adolescents with bronchial asthma and other respiratory diseaseshttps://orcid.org/0000-0002-1751-5532ФурманЕ. Г.FurmanE. G.

Фурман Евгений Григорьевич - член-корр. РАН, д.м.н., профессор, заведующий кафедрой факультетской и госпитальной педиатрии.

614990, Пермь, ул. Петропавловская, д. 26

Evgeniy G. Furman - Corr. Member RAS, Dr. Sci. (Med.), Professor, Head of the Department of Faculty and Hospital Pediatrics, E.A. Vagner Perm State Medical University.

26, Petropavlovskaya St., Perm, 614990

furman1@yandex.ruhttps://orcid.org/0000-0003-0901-7944ХузинаЕ. А.KhuzinaE. A.

Хузина Екатерина Александровна - к.м.н., доцент кафедры факультетской и госпитальной педиатрии, ПГМУ им. ак. Е.А. Вагнера; врач-пульмонолог, Краевая ДКБ.

614990, Пермь, ул. Петропавловская, д. 26; 614066, Пермь, ул. Баумана, д. 22

Ekaterina A. Khuzina - Cand. Sci. (Med.), Associate Professor of the Department of Faculty and Hospital Pediatrics, E.A. Vagner Perm State Medical University; Pulmonologist, Regional Childrens Clinical Hospital.

26, Petropavlovskaya St., Perm, 614990; 22, Bauman St., Perm, 614066

eka-khuzina@yandex.ruПермский государственный медицинский университет имени академика Е.А. ВагнераРоссияVagner Perm State Medical UniversityRussian FederationПермский государственный медицинский университет имени академика Е.А. Вагнера; Краевая детская клиническая больницаРоссияVagner Perm State Medical University; Regional Children’ s Clinical HospitalRussian Federation202405062024099299Copyright © Фурман Е.Г., Хузина Е.А., 20242024Фурман Е.Г., Хузина Е.А.Furman E.G., Khuzina E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8320

Ингаляционный путь доставки лекарственных препаратов представляется наиболее логичным при заболеваниях органов дыхания. Однако важнейшим условием эффективности ингаляционной терапии у детей и подростков наряду с правильным выбором действующего вещества, является подбор оптимального устройства и адекватное выполнение инспираторного маневра. При назначении терапии следует уделять внимание технике ингаляции конкретного больного, а также учитывать вероятность развития побочных эффектов при применении тех или иных устройств. В статье приводятся данные о факторах, влияющих на легочную депозицию препарата, в том числе о внутреннем сопротивлении различных ингаляторов, которое наряду с оценкой инспираторного потока, развиваемого пациентом, имеет наибольшую информативность при выборе устройства. Разбираются наиболее проблемные аспекты доставки препаратов в дыхательные пути у детей младше 5 лет и у пациентов с неадекватной скоростью вдоха. Обсуждаются принципы правильного выполнения ингаляции, необходимые для получения оптимальной респирабельной фракции. Известно, что проблема синхронизации вдоха с моментом поступления лекарственного препарата является самой важной при использовании дозированных аэрозольных ингаляторов, у детей она может быть решена применением спейсера или использованием небулайзеров, преобразующих жидкую форму препарата в аэрозоль с помощью сжатого воздуха. Индивидуальный подбор ингалятора в зависимости от способностей и предпочтений пациента у некоторых категорий больных может значительно повысить эффективность терапии без увеличения дозы лекарственных препаратов. В статье также представлены современные данные по цифровым ингаляторным системам и возможностям применения электронных устройств контроля и использования ингалятора.

The inhalation way of drug delivery seems to be the most logical for respiratory diseases. However, the most important condition for the effectiveness of inhalation therapy in children and adolescents along with the correct choice of the active substance is the selection of the optimal device and adequate execution of the inspiratory maneuver. When prescribing therapy attention should be paid to the inhalation technique of a particular patient and also take into account the likelihood of side effects when using certain devices. The article provides data on factors affecting the pulmonary deposit of the drug, the internal resistance of various inhalers which have the greatest informativeness for choosing a device along with the assessment of the inspiratory flow rate developed by the patient. The most problematic aspects of drug delivery to the respiratory tract in children under 5 years of age and in patients with inadequate inhalation rate are analyzed. The principles of correct inhalation are discussed which are necessary to obtain an optimal respiratory fraction. It is known that the problem of synchronizing inhalation with the moment of receipt of the drug is the most important when using metered – dose aerosol inhalers. In children this problem can be solved by using a spacer or using nebulizers that convert the liquid form of the drug into an aerosol using compressor air. Individual selection of an inhaler depending on the abilities and preferences of the patient in some groups of patients can significantly increase the effectiveness of therapy without increasing the dose of medications. The article presents up-to-date data on digital inhaler systems and the possibilities of using electronic devices for monitoring and using the inhaler.

ингаляционная терапияинспираторное сопротивлениетехника ингаляциидети младше 5 летэлектронные устройства контроляinhalation therapyinspiratory resistanceinhalation techniquechildren under 5 years oldelectronic control devicesReferencesКолосова НГ, Геппе НА. Ингаляционная терапия в педиатрии: от фундаментальной науки к практическому использованию. Педиатрия. Consilium Medicum. 2018;(3):66–68. Режим доступа: https://www.elibrary.ru/ymcqtj.Kolosova NG, Geppe NA. Inhalation therapy in pediatrics: from basic science to practical use. Pediatrics. Consilium Medicum. 2018;(3):66–68. (In Russ.) Available at: https://www.elibrary.ru/ymcqtj.Геппе НА, Колосова НГ, Кондюрина ЕГ, Малахов АБ, Мизерницкий ЮЛ, Ревякина ВА (ред.) Национальная программа «Бронхиальная астма у детей. Стратегия лечения и профилактика». М.: Оригинал-макет; 2017. 160 с. Режим доступа: https://astgmu.ru/wp-content/uploads/2018/10/Natsionalnaya-programma-BA-u-detej.-Strategiya-lecheniya-i-profilaktika.pdf.Геппе НА, Колосова НГ, Кондюрина ЕГ, Малахов АБ, Мизерницкий ЮЛ, Ревякина ВА (ред.) Национальная программа «Бронхиальная астма у детей. Стратегия лечения и профилактика». М.: Оригинал-макет; 2017. 160 с. Режим доступа: https://astgmu.ru/wp-content/uploads/2018/10/ Natsionalnaya-programma-BA-u-detej.-Strategiya-lecheniya-i-profilaktika.pdf.Virchow JC. Guidelines versus clinical practice – which therapy and which device? Respir Med. 2004;98(Suppl B):S28–S34. https://doi.org/10.1016/j.rmed.2004.07.012.Virchow JC. Guidelines versus clinical practice – which therapy and which device? Respir Med. 2004;98(Suppl B):S28–S34. https://doi.org/10.1016/j.rmed.2004.07.012.Bisgaard H, O’Callaghan C, Smaldone GC (eds). Drug Delivery to Lung. Boca Raton: CRC Ress; 1999. 536 с. https://doi.org/10.1201/b14022.Bisgaard H, O’Callaghan C, Smaldone GC (eds). Drug Delivery to Lung. Boca Raton: CRC Ress; 1999. 536 с. https://doi.org/10.1201/b14022.Capstick TG, Clifton IJ. Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma. Expert Rev Respir Med. 2012;6(1):91–103. https://doi.org/10.1586/ers.11.89.Capstick TG, Clifton IJ. Inhaler technique and training in people with chronic obstructive pulmonary disease and asthma. Expert Rev Respir Med. 2012;6(1):91–103. https://doi.org/10.1586/ers.11.89.Häussermann S, Sommerer K, Scheuch G. Regional Lung Deposition: In Vivo Data. J Aerosol Med Pulm Drug Deliv. 2020;33(6):291–299. https://doi.org/10.1089/jamp.2020.29032.sh.Häussermann S, Sommerer K, Scheuch G. Regional Lung Deposition: In Vivo Data. J Aerosol Med Pulm Drug Deliv. 2020;33(6):291–299. https://doi.org/10.1089/jamp.2020.29032.sh.Lavorini F. The challenge of delivering therapeutic aerosols to asthma patients. ISRN Allergy. 2013;2013:102418. https://doi.org/10.1155/2013/102418.Lavorini F. The challenge of delivering therapeutic aerosols to asthma patients. ISRN Allergy. 2013;2013:102418. https://doi.org/10.1155/2013/102418.Newman SP, Millar AB, Lennard-Jones TR, Moren F, Clarke SW. Improvement of pressured aerosol deposition with Nebuhaler spacer device. Thorax. 1984;39(12):935–941. https://doi.org/10.1136/thx.39.12.935.Newman SP, Millar AB, Lennard-Jones TR, Moren F, Clarke SW. Improvement of pressured aerosol deposition with Nebuhaler spacer device. Thorax. 1984;39(12):935–941. https://doi.org/10.1136/thx.39.12.935.Hirst PH, Pitcairn GR, Weers JG, Tarara TE, Clark AR, Dellamary LA et al. In vivo lung deposition of hollow porous particles from a pressurized metered dose inhaler. Pharm Res. 2002;(19):258–264. https://doi.org/10.1023/a:1014482615914.Hirst PH, Pitcairn GR, Weers JG, Tarara TE, Clark AR, Dellamary LA et al. In vivo lung deposition of hollow porous particles from a pressurized metered dose inhaler. Pharm Res. 2002;(19):258–264. https://doi.org/10.1023/a:1014482615914.Cochrane MG, Bala MV, Downs KE, Mauskopf J, Ben-Joseph RH. Inhaled corticosteroid for asthma therapy: patient compliance, devices, and inhalation technique. Chest. 2000;117(2):542–550. https://doi.org/10.1378/chest.117.2.542.Cochrane MG, Bala MV, Downs KE, Mauskopf J, Ben-Joseph RH. Inhaled corticosteroid for asthma therapy: patient compliance, devices, and inhalation technique. Chest. 2000;117(2):542–550. https://doi.org/10.1378/chest.117.2.542.Newman SP. Aerosol generation and delivery systems. Respir Care. 1991;36(9):939–951. Available at: https://pubmed.ncbi.nlm.nih.gov/10145539/.Newman SP. Aerosol generation and delivery systems. Respir Care. 1991;36(9):939–951. Available at: https://pubmed.ncbi.nlm.nih.gov/10145539/.Hamm GR, Backstrom E, Brulls M, Nilsson A, Strittmatter N, Andren PE et al. Revealing the regional localization and differential lung retention of inhaled compounds by mass spectrometry imaging. J Aerosol Med Pulm Drug Deliv. 2020;33(1):43–53. Available at: https://pubmed.ncbi.nlm.nih.gov/31364961/.Hamm GR, Backstrom E, Brulls M, Nilsson A, Strittmatter N, Andren PE et al. Revealing the regional localization and differential lung retention of inhaled compounds by mass spectrometry imaging. J Aerosol Med Pulm Drug Deliv. 2020;33(1):43–53. Available at: https://pubmed.ncbi.nlm.nih.gov/31364961/.Crowder TM, Donovan MJ. Science and technology of dry powder inhalers. In: Smyth HDC, Hickey AJ. (eds). Controlled Pulmonary Drug Delivery. New York, NY: Springer; 2011, pp. 203–222. https://doi:10.1007/978-1-4419-9745-6_9.Crowder TM, Donovan MJ. Science and technology of dry powder inhalers. In: Smyth HDC, Hickey AJ. (eds). Controlled Pulmonary Drug Delivery. New York, NY: Springer; 2011, pp. 203–222. https://doi:10.1007/978-1-4419-9745-6_9.De Boer AH, Hagedoorn P, Hoopentocht M, Buttini F, Grasmeijer F, Frijlink HW. Dry powder inhalation: past, present and future. Expert Opin Drug Deliv. 2017;14(4):499–512. Available at: https://pubmed.ncbi.nlm.nih.gov/27534768/.De Boer AH, Hagedoorn P, Hoopentocht M, Buttini F, Grasmeijer F, Frijlink HW. Dry powder inhalation: past, present and future. Expert Opin Drug Deliv. 2017;14(4):499–512. Available at: https://pubmed.ncbi.nlm.nih.gov/27534768/.Richter K. Successful use of DPI systems in asthmatic patients – key parameters. Respir Med. 2004;98 Suppl B:S22-S27. https://doi.org/10.1016/j.rmed.2004.07.013.Richter K. Successful use of DPI systems in asthmatic patients – key parameters. Respir Med. 2004;98 Suppl B:S22-S27. https://doi.org/10.1016/j.rmed.2004.07.013.Horvath A, Balashazy I, Tomisa G, Farkas A. Significance of breath – hold time in dry powder aerosol drug therapy of COPD patients. Eur J Pharm Sci. 2017;104:145–149. https://doi.org/10.1016/j.ejps.2017.03.047.Horvath A, Balashazy I, Tomisa G, Farkas A. Significance of breath – hold time in dry powder aerosol drug therapy of COPD patients. Eur J Pharm Sci. 2017;104:145–149. https://doi.org/10.1016/j.ejps.2017.03.047.Авдеев СН, Айсанов ЗР. Новые перспективы ингаляционной терапии бронхиальной астмы. Пульмонология. 2020;30(4):473–484. https://doi.org/10.18093/0869-0189-2020-30-4-473-484.Avdeev SN, Aisanov ZR. The new prospects of the inhalation therapy for bronchial asthma. Pulmonologiya. 2020;30(4):473–484. (In Russ.) https://doi.org/10.18093/0869-0189-2020-30-4-473-484.Laube BL, Janssens HM, de Jongh FHC, Devadason SG, Dhand R, Diot P et al. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37(6):1308–1331. Available at: https://pubmed.ncbi.nlm.nih.gov/21310878/.Laube BL, Janssens HM, de Jongh FHC, Devadason SG, Dhand R, Diot P et al. What the pulmonary specialist should know about the new inhalation therapies. Eur Respir J. 2011;37(6):1308–1331. Available at: https://pubmed.ncbi.nlm.nih.gov/21310878/.Brand P, Meyer T, Weuthen T, Timmer W, Berkel E, Wallenstein G et al. Lung deposition of radiolabeled tiotropium in healthy subjects and patients with chronic obstructive pulmonary disease. J Clin Pharmacol. 2007;47(10):1335–1341. Available at: https://pubmed.ncbi.nlm.nih.gov/17625157/.Brand P, Meyer T, Weuthen T, Timmer W, Berkel E, Wallenstein G et al. Lung deposition of radiolabeled tiotropium in healthy subjects and patients with chronic obstructive pulmonary disease. J Clin Pharmacol. 2007;47(10):1335–1341. Available at: https://pubmed.ncbi.nlm.nih.gov/17625157/.Lavorini F, Levy ML, Corrigan C, Crompton G. The ADMIT series – issues in inhalation therapy. 6) Training tools for inhalation devices. Prim Care Respir J. 2010;19(4):335–341. Available at: https://pubmed.ncbi.nlm.nih.gov/21049263/.Lavorini F, Levy ML, Corrigan C, Crompton G. The ADMIT series – issues in inhalation therapy. 6) Training tools for inhalation devices. Prim Care Respir J. 2010;19(4):335–341. Available at: https://pubmed.ncbi.nlm.nih.gov/21049263/.Brocklebank D, Wright J, Cates C. Systematic review of clinical effectiveness of pressurised metered dose inhalers versus other hand held inhaler devices for delivering corticosteroids in asthma. BMJ 2001; 323:896. Available at: https://doi.org/10.1136/bmj.323.7318.896.Brocklebank D, Wright J, Cates C. Systematic review of clinical effectiveness of pressurised metered dose inhalers versus other hand held inhaler devices for delivering corticosteroids in asthma. BMJ 2001; 323:896. Available at: https://doi.org/10.1136/bmj.323.7318.896.Mahler DA. Peak Inspiratory Flow Rate as a Criterion for Dry Powder Inhaler Use in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. 2017;14(7):1103–1107. Available at: https://pubmed.ncbi.nlm.nih.gov/28481631/.Mahler DA. Peak Inspiratory Flow Rate as a Criterion for Dry Powder Inhaler Use in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. 2017;14(7):1103–1107. Available at: https://pubmed.ncbi.nlm.nih.gov/28481631/.Sanders MJ. Guiding Inspiratory Flow: Development of the in-check DIAL G16, a tool for improving inhaler technique. Pulm Med. 2017;2017:1495867. https://doi.org/10.1155/2017/1495867.Sanders MJ. Guiding Inspiratory Flow: Development of the in-check DIAL G16, a tool for improving inhaler technique. Pulm Med. 2017;2017:1495867. https://doi.org/10.1155/2017/1495867.Pedersen S, Dubus J.C, Crompton G. Inhaler selection in children with asthma. Prim Care Pespir J. 2010;(19):209–216. https://doi.org/10.4104/pcrj.2010.00043.Pedersen S, Dubus J.C, Crompton G. Inhaler selection in children with asthma. Prim Care Pespir J. 2010;(19):209–216. https://doi.org/10.4104/pcrj.2010.00043.Laube BL, Janssens HM, de Jongh FHC, Devadason SG, Dhand R, Diot P et al. ERS/ISAM task force consensus statement. Eur Respir J. 2011:erj01664-2010. Available at: https://erj.ersjournals.com/content/early/2011/02/11/09031936.00166410.Laube BL, Janssens HM, de Jongh FHC, Devadason SG, Dhand R, Diot P et al. ERS/ISAM task force consensus statement. Eur Respir J. 2011:erj01664-2010. Available at: https://erj.ersjournals.com/content/early/2011/02/11/09031936.00166410.Фурман ЕГ, Хузина ЕА, Репецкая МН. Бронхиальная астма у детей в условиях новой коронавирусной инфекции. Доктор.Ру. 2020;19(10):42–47. https://doi.org/10.31550/1727-2378-2020-19-10-42-47.Furman EG, Khuzina EA, Repetskaya MN. Bronchial asthma in children amidst the novel coronavirus infection. Doctor.Ru. 2020;19(10):42–47. (In Russ.) https://doi.org/10.31550/1727-2378-2020-19-10-42-47.Геппе НА, Колосова НГ, Зайцева ОВ, Захарова ИН, Заплатников АЛ, Мизерницкий ЮЛ и др. Диагностика и терапия бронхиальной астмы у детей дошкольного возраста. Место небулизированных ингаляционных глюкокортикостероидов в терапии бронхиальной астмы и крупа (Консенсус по результатам совета экспертов педиатрического респираторного общества). Российский вестник перинатологии и педиатрии. 2018;63(3):125–132. https://doi.org/10.21508/1027-4065-2018-63-3-124-132.Geppe NA, Kolosova NG, Zaytseva OV, Zakharova IN, Zaplatnikov AL, Mizernitsky YuL et al. Diagnostic and treatment of bronchial asthma in children of preschool age. Place of nebulized inhaled glucocorticosteroids in treatment of bronchial asthma and croup (Consensus on the results of the Council of experts of the Pediatric respiratory society). Russian Bulletin of Perinatology and Pediatrics. 2018;63(3):125–132. (In Russ.) https://doi.org/10.21508/1027-4065-2018-63-3-124-132.Papadopoulos NG, Arakawa H, Carlsen KH, Custovic A, Gern G, Lemanske R et al. International consensus on (ICON) pediatric asthma. Allergy. 2012;67(8):976–997. https://doi.org/10.1111/j.1398-9995.2012.02865.x.Papadopoulos NG, Arakawa H, Carlsen KH, Custovic A, Gern G, Lemanske R et al. International consensus on (ICON) pediatric asthma. Allergy. 2012;67(8):976–997. https://doi.org/10.1111/j.1398-9995.2012.02865.x.Weinmayr G, Forastiere F, Büchele G, Jaensch A, Strachan DP, Nagel G. Overweight/obesity and respiratory and allergic disease in children: international study of asthma and allergies in childhood (ISAAC) phase two. PLoS ONE. 2014;9(12):е113996. https://doi.org/10.1371/journal.pone.0113996.Weinmayr G, Forastiere F, Büchele G, Jaensch A, Strachan DP, Nagel G. Overweight/obesity and respiratory and allergic disease in children: international study of asthma and allergies in childhood (ISAAC) phase two. PLoS ONE. 2014;9(12):е113996. https://doi.org/10.1371/journal.pone.0113996.Durbin C, Egan R, Gervasi K, Nadeau N, Neal E, Reich S, Gregory T. The effects of obesity on pulmonary function in children. JAAPA. 2017;30(9):30–33. https://doi.org/10.1097/01.JAA.0000522135.76069.ce.Durbin C, Egan R, Gervasi K, Nadeau N, Neal E, Reich S, Gregory T. The effects of obesity on pulmonary function in children. JAAPA. 2017;30(9):30–33. https://doi.org/10.1097/01.JAA.0000522135.76069.ce.Jubber AS. Respiratory complications of obesity. Int J Clin Pract. 2004;58(6):573–580. Available at: https://pubmed.ncbi.nlm.nih.gov/15311557/.Jubber AS. Respiratory complications of obesity. Int J Clin Pract. 2004;58(6):573–580. Available at: https://pubmed.ncbi.nlm.nih.gov/15311557/.Robinson PD. Obesity and its impact on the respiratory system. Paediatr Respir Rev. 2014;15(3):219–226. https://doi.org/10.1016/j.prrv.2014.06.003.Robinson PD. Obesity and its impact on the respiratory system. Paediatr Respir Rev. 2014;15(3):219–226. https://doi.org/10.1016/j.prrv.2014.06.003.Фурман ЕГ, Ярулина АМ, Софронова ЛВ. Состояние функции внешнего дыхания и дыхательной мускулатуры у детей с ожирением. Педиатрическая фармакология. 2015;12(2):143–147. https://doi.org/10.15690/pf.v12i2/1276.Furman EG, Yarulina AM, Sofronova LV. Lung function and respiratory muscle strength in obese in children. Pediatric Pharmacology. 2015;12(2):143–147. (In Russ.) https://doi.org/10.15690/pf.v12i2/1276.Авдеев СН. Оценка силы дыхательных мышц в клинической практике. Пульмонология и аллергология. 2008;(4):12–17. Режим доступа: https://cyberleninka.ru/article/n/otsenka-sily-dyhatelnyh-myshts-v-klinicheskoy-praktike/viewer.Avdeev SN. Assessment of respiratory muscle strength in clinical practice. Pulmonologia i Allergologia. 2008;(4):12–17. (In Russ.) Available at: https://cyberleninka.ru/article/n/otsenka-sily-dyhatelnyh-myshts-v-klinicheskoy-praktike/viewer.Овсянников ДЮ. Трудности и ошибки диагностики и терапии бронхиальной астмы у детей. Медицинский совет. 2017;(1):100–106. https://doi.org/10.21518/2079-701X-2017-1-100-106.Ovsyannikov DYu. Challenges and errors in the diagnosis and treatment of asthma in children. Meditsinskiy Sovet. 2017;(1):100–106. (In Russ.) https://doi.org/10.21518/2079-701X-2017-1-100-106.Калинина НМ, Фурман ЕГ, Соколовский ВЛ. Использование портативного детектора свистящих хрипов у детей для диагностики синдрома бронхиальной обструкции. Пермский медицинский журнал. 2022;39(2):86–92. https://doi.org/10.17816/pmj39286-92.Kalinina NM, Furman EG, Sokolovskiy BL. Diagnostics of bronchial obstruction syndrome with portal wheezing detector in children. Perm Medical Journal. 2022;39(2):86–92. (In Russ.) https://doi.org/10.17816/pmj39286-92.Chrystyn H, Audibert R, Keller M, Quaglia B, Vecellio L, Roche N. Real-life inhaler adherence and technique: Time to get smarter! Respir Med. 2019;158:24–32. https://doi.org/10.1016/j.rmed.2019.09.008.Chrystyn H, Audibert R, Keller M, Quaglia B, Vecellio L, Roche N. Real-life inhaler adherence and technique: Time to get smarter! Respir Med. 2019;158:24–32. https://doi.org/10.1016/j.rmed.2019.09.008.Greene G, Costello RW. Personalizing medicine – could the smart inhaler revolutionize treatment for COPD and asthma patients? Expert Opin Drug Deliv. 2019;16(7):675–677. Available at: https://pubmed.ncbi.nlm.nih.gov/31177857/.Greene G, Costello RW. Personalizing medicine – could the smart inhaler revolutionize treatment for COPD and asthma patients? Expert Opin Drug Deliv. 2019;16(7):675–677. Available at: https://pubmed.ncbi.nlm.nih.gov/31177857/.Blakey JD, Bender BG, Dima AL, Weinman J, Safioti G, Costello RW. Digital technologies and adherence in respiratory diseases: the road ahead. Eur Respir J. 2018;52:1801147. https://doi.org/10.1183/13993003.01147-2018.Blakey JD, Bender BG, Dima AL, Weinman J, Safioti G, Costello RW. Digital technologies and adherence in respiratory diseases: the road ahead. Eur Respir J. 2018;52:1801147. https://doi.org/10.1183/13993003.01147-2018.Hew M, Reddel HK. Integrated adherence monitoring for inhaler medications. JAMA. 2019;321:1045–1046. https://doi.org/10.1001/jama.2019.1289.Hew M, Reddel HK. Integrated adherence monitoring for inhaler medications. JAMA. 2019;321:1045–1046. https://doi.org/10.1001/jama.2019.1289.Safioti G, Granovsky L, Li T, Reich M, Cohen S, Hadar Y et al. A predictive model for clinical asthma exacerbations using albuterol eMDPI (ProAir Digihaler): a twelve-week, open-label study. Iproc. 2019;5(1):e15173. Available at: https://www.iproc.org/2019/1/e15173.Safioti G, Granovsky L, Li T, Reich M, Cohen S, Hadar Y et al. A predictive model for clinical asthma exacerbations using albuterol eMDPI (ProAir Digihaler): a twelve-week, open-label study. Iproc. 2019;5(1):e15173. Available at: https://www.iproc.org/2019/1/e15173.Merchant RK, Inamdar R, Quade RC. Effectiveness of population health management using the propeller health asthma platform: a randomized clinical trial. J Allergy Clin Immunol Pract. 2016;4(3):455–463. https://doi.org/10.1016/j.jaip.2015.11.022.Merchant RK, Inamdar R, Quade RC. Effectiveness of population health management using the propeller health asthma platform: a randomized clinical trial. J Allergy Clin Immunol Pract. 2016;4(3):455–463. https://doi.org/10.1016/j.jaip.2015.11.022.Charles T, Quinn D, Weatherall M, Aldington S, Beasley R, Holt S. An audio-visual reminder function improves adherence with inhaled corticosteroid therapy in asthma. J Allergy Clin Immunol. 2007;119(4):811–816. https://doi.org/10.1016/j.jaci.2006.11.700.Charles T, Quinn D, Weatherall M, Aldington S, Beasley R, Holt S. An audio-visual reminder function improves adherence with inhaled corticosteroid therapy in asthma. J Allergy Clin Immunol. 2007;119(4):811–816. https://doi.org/10.1016/j.jaci.2006.11.700.Foster JM, Smith L, Usherwood T, Sawyer SM, Rand CS, Reddel HK. The reliability and patient acceptability of the SmartTrack device: a new electronic monitor and reminder device for metered dose inhalers. J Asthma. 2012;49(6):657–662. https://doi.org/10.3109/02770903.2012.684253.Foster JM, Smith L, Usherwood T, Sawyer SM, Rand CS, Reddel HK. The reliability and patient acceptability of the SmartTrack device: a new electronic monitor and reminder device for metered dose inhalers. J Asthma. 2012;49(6):657–662. https://doi.org/10.3109/02770903.2012.684253.

The authors declare that there are no conflicts of interest present.