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Potential benefits for and possible concerns of patients, healthcare providers, pharmacies, pharmaceutical manufacturers and payers are discussed. 10 OctOber 2018 Inhalation Connected inhalers: Stakeholders' potential benefits and possible concerns Napoleon Monroe New Directions Technology Consulting inhaler-specific operational errors so incorrect opera- tional techniques need to be "unlearned." Connectiv- ity can help patients cope with complexity and change so they can use their inhalers to improve or maintain their health. Techniques of administration, including coordination of breathing, can impact deposition of medication. Exhalation prior to inhalation, baseline pulmonary function, positioning of the head and the inhaler, and breath hold between puffs can affect depth of medica- tion delivery and effectiveness of a given dose. 1, 2 In addi- tion, other activities, such as inhaler priming and shak- ing and use of a spacer, may be required to achieve appropriate dose delivery. Connectivity can provide reminders to patients about proper procedures for inhaler use. Beyond medical conditions such as asthma or COPD, even if a patient is not seriously or obviously debilitated, their ability and inclination to adhere to a treatment regimen can be impacted by many factors. For example, patients exhibit variations in cognitive function, lan- guage skill, hand/eye coordination, tolerance for instruction, physical strength, emotional state, vision, hearing and comorbidities. Even for those who are unimpaired in these areas, their health literacy may be insufficient to understand the meaning of inhaler label- ing language, a practitioner's hurried or overly technical explanation, or direct-to-consumer communications. Again, connectivity can offer patients educational information during inhaler administration. is article provides an overview of the potential benefits that connected inhalers may offer various stakeholder groups. It also discusses some possible concerns. While wide-ranging, this article is not all-inclusive. Potential benefits For patients ere are compelling situations that argue for the bene- fits that connected inhalers may provide patients, the primary benefit being better patient outcomes. Patients with asthma and chronic obstructive pulmo- nary disease (COPD) can be subject to critical, even life-threatening, exacerbations, which are best treated immediately. ere may be little time to seek profes- sional assistance. Connectivity can provide near real- time support for self-treatment, which may include initiating appropriate emergency response, if and when required. Connectivity can also provide opportunities for dia- logue to encourage adherence. Such dialogue may include reminders to use or replace inhalers. In addi- tion, connectivity can give a patient tools to help ensure that they have their inhaler with them wherever they go. e complexity of using inhalers correctly makes edu- cation and instruction essential. Coordination of multi- ple steps is key to proper administration. Having under- standable information at time of dosing can provide patients with meaningful assistance to help ensure self-dosing is effective. For some patients, administra- tion may be infrequent, making recall of the necessary steps more difficult. Connectivity can provide refresher training to reinforce initial training. Connected inhalers can also aid patients who may use multiple types or competing brands of inhalers contain- ing various types and doses of medication. It is also sometimes necessary for a patient to change from one brand of inhaler to another, for instance to improve treatment or maintain insurance coverage, or due to an adverse reaction. New inhalers are periodically introduced and some are not intuitive in their methods of use. In addition, studies 1 have shown there is a high incidence of serious

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