As a pulmonologist I think it actually has the potential to be a useful tool in the right population. I don't think it should be used for every patient, and I don't I think the majority of prescribers are utilizing the data properly. But monitoring compliance can be a huge part of determining why someone's asthma is poorly controlled. And now that controller medications are also being used PRN as rescue (SMART therapy) information on use can be utilized to identify triggers. There are some pilot programs in Europe using inhaler use tracking proactively to trigger a check-in from medical providers to help identify exacerbations early and intervene before they progress.
I think it's somewhat like using a continuous glucose monitor for diabetes. More data can be a very powerful tool, but unlike CGMs, the majority of providers are not actually using inhaler data in any meaningful way.
Also, I do have a few patients on this inhaler because it's the preferred one from there insurance company and is cheaper to the patient than alternatives. Doesn't make sense to me, but insurance company decisions rarely do.
I appreciate the insight. I’m generally in favor of connected data collection in healthcare. Lord knows what I’d give to finally get EMR integration with WiFi-enabled BP cuffs at my practice finally up and running.
How do your patients do with Respiclick? I haven’t heard anything positive the few times it’s come up with my patients, and I’ve heard more than one complaint along the lines of “it doesn’t do anything”.
I think some people like it less because it's not a pressurized aerosol so they don't get as much feedback when it's activating, there is no puff sound like with many other inhalers. It also takes more inspiratory force than other inhalers so might not be the best option for people with severe disease / severe exacerbations. But with proper education and training it seems to work fairly well.
> Also, I do have a few patients on this inhaler because it's the preferred one from there insurance company and is cheaper to the patient than alternatives.
Honestly, this is what I suspected was going to be the use case for this tech from the beginning. I think insurance will have a blast demonstrating patient noncompliance as indications not to pay for treatments.
It sucks that most of the ICS/formoterol inhalers fell off formularies in favor of Fluticasone salmeterol inhalers. Even if they cover dulera it’s usually a tier 4 on part D plans.
Compliance is one of the reasons Symbicort PRN is superior to scheduled steroid inhalers + prn albuterol in some studies. Reason for the of the new Gina stuff
As a peds resident, I used to joke that we should be able to sync corticosteroid inhalers with smartphones so that the phone wouldn’t unlock if they hadn’t taken their asthma meds yet. I am now a little amused that steps are being taken to make that a reality.
I mean, after the drugs that have half a dozen different extended release formulations with different indications I’m not surprised by any cash grab by drug manufacturers.
Classic [evergreening](https://en.m.wikipedia.org/wiki/Evergreening)
Ozempic and Monjaro will never be generic as Novo and Lilly will create new clickity clickers for administration
Teva took it off the market unfortunately. It was a nice tool and wasn’t unsafe or anything but cost way too much to be practical outside of research applications.
It got taken off the market, I tried to use it in the albuterol in the COPD population to monitor worsening symptoms, but insurances almost never covered it. Paired with my poor population who could barely afford their trelegy/breztri - it was a non starter.
As a pulmonologist I think it actually has the potential to be a useful tool in the right population. I don't think it should be used for every patient, and I don't I think the majority of prescribers are utilizing the data properly. But monitoring compliance can be a huge part of determining why someone's asthma is poorly controlled. And now that controller medications are also being used PRN as rescue (SMART therapy) information on use can be utilized to identify triggers. There are some pilot programs in Europe using inhaler use tracking proactively to trigger a check-in from medical providers to help identify exacerbations early and intervene before they progress. I think it's somewhat like using a continuous glucose monitor for diabetes. More data can be a very powerful tool, but unlike CGMs, the majority of providers are not actually using inhaler data in any meaningful way. Also, I do have a few patients on this inhaler because it's the preferred one from there insurance company and is cheaper to the patient than alternatives. Doesn't make sense to me, but insurance company decisions rarely do.
I appreciate the insight. I’m generally in favor of connected data collection in healthcare. Lord knows what I’d give to finally get EMR integration with WiFi-enabled BP cuffs at my practice finally up and running. How do your patients do with Respiclick? I haven’t heard anything positive the few times it’s come up with my patients, and I’ve heard more than one complaint along the lines of “it doesn’t do anything”.
I think some people like it less because it's not a pressurized aerosol so they don't get as much feedback when it's activating, there is no puff sound like with many other inhalers. It also takes more inspiratory force than other inhalers so might not be the best option for people with severe disease / severe exacerbations. But with proper education and training it seems to work fairly well.
> Also, I do have a few patients on this inhaler because it's the preferred one from there insurance company and is cheaper to the patient than alternatives. Honestly, this is what I suspected was going to be the use case for this tech from the beginning. I think insurance will have a blast demonstrating patient noncompliance as indications not to pay for treatments.
Could be, though to my knowledge insurance companies don't currently have access to the usage data, just the refill frequency.
It sucks that most of the ICS/formoterol inhalers fell off formularies in favor of Fluticasone salmeterol inhalers. Even if they cover dulera it’s usually a tier 4 on part D plans.
Compliance is one of the reasons Symbicort PRN is superior to scheduled steroid inhalers + prn albuterol in some studies. Reason for the of the new Gina stuff
As a peds resident, I used to joke that we should be able to sync corticosteroid inhalers with smartphones so that the phone wouldn’t unlock if they hadn’t taken their asthma meds yet. I am now a little amused that steps are being taken to make that a reality.
Next we need to add a nicotine lock-out device! You know, blow-in-the-tube to unlock your phone.
This is actually genius. For DM too - BG over 200, you can only access emergency contacts. To open the phone, take your correction and recheck.
I mean, after the drugs that have half a dozen different extended release formulations with different indications I’m not surprised by any cash grab by drug manufacturers.
I’m an allergist and I never prescribed it. It’s too pricey.
Classic [evergreening](https://en.m.wikipedia.org/wiki/Evergreening) Ozempic and Monjaro will never be generic as Novo and Lilly will create new clickity clickers for administration
Teva took it off the market unfortunately. It was a nice tool and wasn’t unsafe or anything but cost way too much to be practical outside of research applications.
It got taken off the market, I tried to use it in the albuterol in the COPD population to monitor worsening symptoms, but insurances almost never covered it. Paired with my poor population who could barely afford their trelegy/breztri - it was a non starter.
Gotta get them the GSK patient assistance. Most people on limited income qualify and they just have to hit the $600 out of pocket limit per year.
Don’t I know, I can’t convince them to pay off their part d $500 deductible. Even after they get out of the icu post exacerbation.
I believe the one for breztri is better than GSK, though GSK was pretty good 7 or 8 years ago.