Digital strategies to support adherence to medication in asthma and COPD

The first part of this dissertation describes the global variation in the prevalence of asthma and the associated direct and indirect costs. Indirect costs of asthma and COPD were then further examined. It was found that asthma and COPD patients have a much higher absenteeism rate than people without these diseases.
Since (lack of) adherence is one of the factors that can be influenced and affects the health and well-being of asthma and COPD patients, an overview of interventions to improve adherence was made and a practical adherence toolkit was designed: the "TAI Toolkit."
The TAI Toolkit was then applied in combination with a new digital attachment chamber. This "smart" spacer can measure both the time and quality of drug inhalation. The "OUTERSPACE" proof-of-concept study in COPD patients demonstrated a significant reduction in inhalation errors of more than 30%. Digital intake data correlated well with drug exposure in head hair.
A protocol for the second OUTERSPACE study was then formulated, this time in "real-world" asthma patients in primary care. In the protocol-based randomized controlled trial, inhalation errors decreased by 26.2% in the intervention group, while in the usual care group they increased by 14.6%, a significant difference.
The discussion elaborates on the different types of therapy non-adherence and the concept of patient empowerment". It is postulated that medication use should be more conditional and that digital tools, if properly implemented, can support the optimization of asthma/COPD care.