Late Breaking Abstract - Assessment of an electronic system on the impact on inhaler skills and technique – ASSIST study

<bold>Background:</bold> Inhaler therapy is the mainstay of treatment for airway disease and is highly effective if taken correctly. It is estimated that ~ 90% of pressurised metered dose inhaler (pMDI) users have poor inhaler technique. Inhaler flow rate and duration of inhalation are common mistakes. We hypothesised that the Clip-Tone system (CTS; Clement Clarke, Clin-e-Cal), a combined acoustic flow rate guidance signal and smartphone App giving real-time inhaler technique feedback, would lead to better and maintained pMDI technique compared with usual care (UC). <bold>Methods:</bold> Asthmatic patients (>16yrs), on daily pMDI treatment were recruited from primary care. Inhaler technique was scored using validated UK inhaler technique checklist (0-10) and then randomised to CTS or UC for the next 6 months. Repeated inhaler technique assessment was carried out at 1-, 3- and 6-months post randomisation. Assessment was videoed at baseline and 6 months to allow duration of inhalation to be measured and for scoring by a blinded assessor. <bold>Results:</bold> 126 participants (mean age 44.2yrs; 29 male) consented to the study and were randomised (65 CTS, 61 UC). Mean[95%CI] baseline inhaler score was similar in both groups (CTS: 5.06[4.60,5.52]; UC: 5.10[4.64,5.56]; p=0.82). Inhaler scores improved significantly from 1 month, and was maintained to month 6, in CTS group (7.68 (7.33, 8.02) compared with UC group 5.59(5.17, 6.00); p<0.001). Duration of inhalation increased significantly in the CTS group by median 1.84s, compared with 0.0s in the UC group (p<0.001). <bold>Conclusion:</bold> The use of CTS may be a useful approach not only for initial training of pMDI users but for ongoing daily medication, to maintain improved inhaler technique.