Opportunities and Challenges in the Implementation of Smart Inhalers to Improve Asthma Outcomes

Asthma remains a leading cause of preventable morbidity and healthcare use worldwide, despite the availability of effective preventative inhaled therapies. A major contributor to this persistent gap between expected and observed outcomes is suboptimal adherence to inhaler treatment and failure to act appropriately when symptom control is lost. Inhalers with integrated or attached electronic components that record medication use and related information are promising technologies to address these challenges. Evidence from adult and paediatric studies indicates that smart inhalers can improve adherence. They may also improve self-management; for example, through integration with a digital personalised asthma action plan. Advances in digital connectivity and data integration also open opportunities for predicting exacerbations, as well as optimising and tailoring treatment decisions. Despite their promise and increasing evidence, there has not been a widespread adoption of this technology. Barriers to adoption include patient acceptability, data privacy, interoperability of digital platforms, clinician workload, and environmental sustainability related to electronic waste. While economic modelling and early implementation studies suggest potential cost-effectiveness, the key question of ‘who pays’ remains unresolved. Overall, smart inhalers offer a promising avenue to reduce preventable harm in asthma, but their integration into guidelines and practice requires ongoing coordinated progress in technological design, healthcare system readiness, and sustainability planning.