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Comment & Response
August 20, 2019

Monitoring Adherence to Inhaled Medications

Author Affiliations
  • 1Department of Clinical Sciences, Drake University College of Pharmacy and Health Sciences, Des Moines, Iowa
JAMA. 2019;322(7):692-693. doi:10.1001/jama.2019.8643

To the Editor Drs Hew and Reddel1 highlighted the importance of adherence to inhaled controller medications in the treatment of chronic respiratory conditions. Some of their claims regarding adherence monitoring systems for inhalers lacked a balanced perspective.

The authors encouraged clinicians to select inhalers with adherence monitoring systems and charged the pharmaceutical industry with providing compatible data platforms that integrate into electronic medical records, while also decreasing cost of the devices.1 They noted that add-on monitors may improve adherence and facilitate patient-clinician discussions, and they cited limitations of their use, including clinician time, patient education, and patient refusal.1 They proposed that integrated monitors may overcome these limitations; however, these issues may arise even with integrated devices. Additionally, while inhaler nonadherence rates are high,1,2 not all patients fit this classification. Manufacturers must consider the need to continue to market inhalers without adherence monitors, as a subset of the population will not benefit from adherence monitors. Including monitors on all inhalers would drive up medication costs, which may be a barrier to adherence.2