The effect of Clip-tone^® and its smartphone application on optimisation of metered-dose inhalers inhalation technique

Although metered-dose inhalers (pMDI) therapy is convenient and widely prescribed, its use usually results in repetitive inhalation technique errors. One of the most repetitive errors is inhaling too fast through the pMDI. The present study aimed to evaluate the effect of Clip-tone^® along with smartphone visual feedback application on the subject's inhalation time.

Two hundred subjects were included in the study. They were randomised into four groups. Group 1 received only verbal counselling; group 2 received verbal counselling with resistance (a modified Clip-tone^® that does not produce whistle attached to their pMDI); group 3 received verbal counselling plus whistle (as audio feedback) from ordinary Clip-tone^® and group 4 received verbal counselling plus audio feedback (whistle) from Clip-tone^® and visual feedback (smartphone application). Inhalation time through the pMDI for each subject was recorded three times and inter and intra-subjects variations were calculated.

Verbal counselling plus audio feedback and verbal counselling plus audio and visual feedbacks groups had 45/50 (90%) and 37/50 (74%) subjects respectively, having correct inhalation flow (inhaling at between 3 to 7 seconds). Verbal counselling plus audio feedback and verbal counselling plus audio and visual feedbacks groups' inter and intra-subjects variations were lower than that of verbal counselling and verbal counselling with resistance groups which had 28/50 (52%) and 20/50 (40%) subjects respectively, with inhalation time between 3 and 7 seconds.

Providing audio feedback by the Clip-tone^® along with smartphone visual feedback application maintained the deep and slow inhalation through pMDI much better compared to verbal counselling only. We recommend the patients to take all their inhaled doses using pMDI attached to a training device like Clip-tone^® along with a smartphone visual feedback application for optimisation of the aerosol delivery from the pMDI.