A Review on Smart Inhalers: A Smart Approach to COPD and Asthma

Zalak Prajapati, Sifa Meman, Mona Gupta, Nisha Patel , Sandhya Bodhe, C. Patel,

doi:10.5281/zenodo.15351341

Review Paper | Open Access
Volume 03 | Issue 05 | Article Id IJPS/250304579

A Review on Smart Inhalers: A Smart Approach to COPD and Asthma
Zalak Prajapati* Sifa Meman Mona Gupta Nisha Patel Sandhya Bodhe C. Patel
Shri Sarvajanik Pharmacy College, Near Arvind Baug, Mehsana- 384001, Gujarat, India.

Abstract

The development of smart inhalers represents a significant advancement in the management of asthma and chronic obstructive pulmonary disease (COPD). These devices integrate digital technology with traditional inhalation systems to monitor medication usage, track adherence, and provide real-time feedback to patients and healthcare providers. Smart inhalers are equipped with sensors that collect data on inhalation patterns, dosage, and environmental factors, enabling personalized treatment strategies and early detection of exacerbations. Digital devices that record inspiratory flows with inhaler use can guide proper inhaler technique and may prove to be a clinically useful lung function measure. Adoption of digital inhalers into practice is still early, and additional research is needed to determine patient and clinician acceptability, the appropriate place of these devices in the therapeutic regimen, and their cost effectiveness.

Keywords

COPD, Alveoli, Asthma, Bronchitis, Fibrosis, Dyspnoea, Smart Inhalers.

Introduction

Chronic Obstructive Pulmonary Disease (COPD)

“Chronic obstructive pulmonary disease” (COPD) is a term for certain types of irreversible lung and airway damage that block (obstruct) patients’ airways and make it hard to breathe. If a patient diagnosed with either emphysema or chronic bronchitis, he/she might have COPD.

Changes in patient’s lungs and airways in COPD include:

Loss of elasticity in patients’ airways and air sacs in the lungs (alveoli).
Inflammation, scarring (fibrosis) and narrowing of the airways.
Thick mucus in the airways.
Destruction of the walls between the alveoli. This enlarges them and traps air.

People with COPD often get exacerbations, or worsening of symptoms, like severe difficulty breathing, thicker mucus, wheezing and cough. Patients might need to go to the hospital for severe exacerbations.

COPD gets progressively worse over time. Flare-ups get more severe and happen more often. This usually takes years or decades, though some people get worse faster.

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Figure 1: Different stages of COPD

Pathophysiology OF COPD

The pathophysiology of COPD is complex and involves several mechanisms:

Inflammation: Chronic exposure to harmful particles (like cigarette smoke) triggers an inflammatory response in the lungs. This inflammation leads to recruitment of neutrophils, macrophages, and T lymphocytes, which contribute to airway remodelling and destruction of lung tissue.
Oxidative Stress: Increased oxidative stress, particularly in smokers, plays a major role in lung damage by activating inflammatory cells and increasing the production of proteases that degrade lung tissue.
Airway Remodelling and Emphysema: Over time, the airways undergo structural changes, including smooth muscle hypertrophy, mucous gland hyperplasia, and fibrosis. Emphysema, a condition of alveolar destruction, leads to reduced lung elasticity and the collapse of small airways.
Airflow Limitation: The combination of airway narrowing due to inflammation, mucus production, and loss of alveolar support leads to irreversible airflow obstruction.

Clinical Features

COPD presents with a variety of symptoms, the most common being:

Chronic cough and sputum production: Often an early sign, especially in smokers.
Dyspnoea (shortness of breath): This symptom worsens over time, limiting the patient's ability to perform daily activities.
Wheezing and chest tightness: Common in more advanced stages of COPD.
Frequent exacerbations: COPD patients are prone to acute exacerbations, which can further deteriorate lung function.

Types Of Chronic Obstructive Pulmonary Disease

COPD includes both emphysema and chronic bronchitis. People with COPD often have features of both.

Emphysema is when patient’s alveoli become damaged and enlarged. The most common symptom is shortness of breath (dyspnoea).
Chronic bronchitis is inflammation in patient’s large airways. This narrows patient’s airways and makes lots of mucus. Cough is the most common symptom.

Symptoms Of COPD

COPD symptoms often don't appear until a lot of lung damage has occurred. Symptoms usually worsen over time, especially if smoking or other irritating exposure continues.

Symptoms of COPD may include:

Trouble in catching breath, especially during physical activities.
Wheezing or whistling sounds when breathing.
Ongoing cough that may bring up a lot of mucus. The mucus may be clear, white, yellow or greenish.
Chest tightness or heaviness.
Lack of energy or feeling very tired.
Frequent lung infections.
Losing weight without meaning to. This may happen as the condition worsens.
Swelling in ankles, feet or legs.
Chest tightness.
Coughing more often.
More mucus or changes in mucus colour or thickness.
Fever.

People with COPD also are likely to have times when their symptoms become worse than the usual day-to-day variation. This time of worsening symptoms is called an exacerbation. It can last for several days to weeks. They can be caused by triggers such as smells, cold air, air pollution, colds or infections.

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Figure 2: Comparison of Normal and COPD-Affected Alveoli Structure

Diagnosis Of COPD

1. Clinical Assessment

Symptoms: Chronic cough, sputum production, dyspnoea (shortness of breath), and wheezing.
Risk Factors: Smoking history, occupational exposure to pollutants, family history of lung disease, and recurrent respiratory infections.

2. Spirometry (Pulmonary Function Tests)

Spirometry is the gold standard for COPD diagnosis.

Forced Expiratory Volume in 1 second (FEV?)/Forced Vital Capacity (FVC) ratio < 0.70 post-bronchodilator confirms persistent airflow limitation.
Disease severity is classified based on FEV? percentage predicted:
- Mild (GOLD 1): FEV? ≥ 80%
- Moderate (GOLD 2): FEV? 50-79%
- Severe (GOLD 3): FEV? 30-49%
- Very severe (GOLD 4): FEV? < 30%

3. Imaging Studies

Chest X-ray: May show hyperinflation, flattened diaphragm, or increased lung radiolucency.
High-Resolution CT (HRCT) Scan: Helps detect emphysema and rule out other lung diseases.

4. Arterial Blood Gas (ABG) Analysis

Used in advanced COPD to assess oxygenation (hypoxemia) and carbon dioxide retention (hypercapnia).

5. Biomarkers and Additional Tests

Alpha-1 Antitrypsin (AAT) Level: Checked in young patients or those with a family history of COPD to rule out AAT deficiency.
Pulse Oximetry: Measures oxygen saturation in chronic cases.

Treatment Of COPD

Although there is currently no cure for COPD, there are treatments available to relieve its symptoms and slow down its long-term development.

Recommended treatments may include:

Quitting smoking: If patient is a smoker, the most essential part in preventing the COPD from progressing any further is to quit smoking.
Medications: These include various inhalers, steroids and antibiotics as needed to help to manage the symptoms, and reduce the frequency and severity of flare ups (also known as acute exacerbations).
Pulmonary rehabilitation: A program combining exercise with education about the disease will also help to cope with symptoms, and better manage the COPD.
Nutritional changes: For some people with COPD, dietary changes can help patients feel better.
Oxygen therapy: For patients with inadequate levels of oxygen saturation in their blood (a condition known as hypoxia), oxygen therapy can help.
Non-invasive ventilation: Adding non-invasive ventilatory support to conventional therapy can reduce breathlessness, and improve respiratory rate and blood gas exchange.

Because COPD affects the ability to breathe properly (inhaling enough oxygen and exhaling enough carbon dioxide), one can end up with 2 problems:

1. Not enough oxygen in the bloodstream (Hypoxia)
2. Too much carbon dioxide in the bloodstream (Hypercapnia)

With increasing evidence supporting the use of non-invasive ventilation, it is becoming a more widely used therapy alongside standard treatments for certain patients. Some of these observed benefits of non-invasive ventilation include shorter hospital stays and readmission rates, reduced need for invasive intubation, and improved survival and quality of life.

Asthma

Asthma is a prevalent chronic inflammatory respiratory condition affecting millions of people worldwide and present substantial challenges in both diagnosis and management. This respiratory condition is characterized by inflammation of the airways, causing intermittent airflow obstruction and bronchial hyper responsiveness. The asthma symptoms include coughing, wheezing, and shortness of breath, which can be frequently exacerbated by triggers ranging from allergens to viral infections. The prevalence and severity of asthma are determined by a complex interplay between genetic and environmental factors. Despite treatment advancements, disparities persist in asthma care, with variation in access to diagnosis, treatment, and patient education across different demographics.

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Figure 3: Comparison of Normal and Asthmatic Bronchial Tubes

What Is an Asthma Attack?

When the breath normally, muscles around the airways are relaxed, letting air move easily and quietly. During an asthma attack, three things can happen:

Bronchospasm: The muscles around the airways constrict (tighten). When they tighten, it makes the airways narrow. Air cannot flow freely through constricted airways.
Inflammation: The lining of the airways becomes swollen. Swollen airways don’t let as much air in or out of the lungs.
Mucus production: During the attack, the body creates more mucus. This thick mucus clogs airways.

Pathophysiology Of Asthma

Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen (e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an increase in mucus production. This leads to a significant increase in airway resistance, which is most pronounced on expiration.

Airway obstruction occurs due to the combination of:

Inflammatory cell infiltration.
Mucus hypersecretion with mucus plug formation.
Smooth muscle contraction.

These reversible changes may become irreversible over time due to,

Basement membrane thickening, collagen deposition, and epithelial desquamation.
Airway remodelling occurs in chronic disease with smooth muscle hypertrophy and hyperplasia.

If not corrected rapidly, asthma may become more difficult to treat, as the mucus production prevents the inhaled medication from reaching the mucosa. The inflammation also becomes more edematou. This process is resolved (in theory complete resolution is required in asthma, but in practice, this is not checked or tested) with beta-2 agonists (e.g., salbutamol, salmeterol, albuterol) and can be aided by muscarinic receptor antagonists (e.g., ipratropium bromide), which act to reduce the inflammation and relax the bronchial musculature, as well as reducing mucus production.

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Figure 4: Pathology of asthma

Types Of Asthma:

• Episodic asthma

• Chronic asthma

• Severe acute asthma

• Occupational asthma

• Exercise induced asthma

• Nocturnal asthma

Symptoms Of Asthma

Symptoms of asthma can vary from person to person. Symptoms sometimes get significantly worse. This knows as an asthma attack. Symptoms are often worse at night or during exercise. Common symptoms of asthma include:

Figure 5: Symptoms Of Asthma

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Smart Inhalers

A Smart inhaler is an inhaler that technology has enhanced. A smart inhaler is an example of a digital medicine. These medical devices use technology to help collect health information. Smart inhalers, which incorporate sensors and artificial intelligence (AI) algorithms, are an innovative development in COPD management. These devices can help patients manage their respiratory conditions more effectively by tracking usage patterns, reminding patients when it's time for their next dose, and providing feedback on inhaler technique. Smart inhaler can also send reminders. This can be helpful if one have trouble remembering the doses. The apps for each also log use of a rescus inhaler separately from use of a maintenance inhaler.

Figure 6: Smart Inhaler

Smart inhalers networking features are essential for facilitating the smooth transfer of death to centralized platform or the system healthcare providers. These gadgets provide a connection between the patient and their care team using Bluetooth or other wireless communication protocols. This connection allows for timely interventions in addition to real-time data monitoring. Automated alerts can be sent off to provide instructions or reminder, for example, when a patient forget a dosage or use improper inhaler technique. Smart inhalers increase patient accountability and empowerment by providing real-time feedback, reminder, and personalized insights. It offers several advantages over traditional inhalers, including improved adherence to medication regimens and better symptom control. Studies have shown that smart inhalers can improve medication adherence by up to 59%, reduce the risk of exacerbations, and improve quality of life for patients with COPD. People with chronic lung condition that affect their breathing, like asthma or chronic obstructive pulmonary disorder (COPD), most commonly use inhalers.

Which Conditions Do Inhalers Treat?

Inhaled medication most commonly treats asthma and COPD. Providers sometimes prescribe them to treat respiratory infections like bronchitis.

Providers also use them to treat:

Cystic fibrosis
Diabetes
Flu
Parkinson's disease
Schizophrenia

How Smart Inhalers Helps to Manage COPD:

Tracking usage patterns: Smart inhalers use sensors to track when patients use their inhalers, which can help to ensure that patients are taking their medications as prescribed. This information can be used by healthcare providers to assess treatment effectiveness and make any necessary adjustments.

Providing reminders: Smart inhalers can remind patients when it's time for their next dose, which can help to prevent missed doses and ensure that patients are taking their medications on schedule.

Offering feedback on inhaler technique: Smart inhalers can provide feedback to patients on their inhaler technique, which can help to ensure that patients are using their inhalers correctly and getting the full benefit of their medications. Correct inhaler technique is important for optimal medication delivery to the lungs.

Improving adherence: Studies have shown that smart inhalers can improve adherence to medication regimens in patients with COPD. Improved adherence can lead to better symptom control, reduced exacerbations, and improved quality of life.

Facilitating patient-provider communication: Smart inhalers can help patients and healthcare providers to track medication use and treatment effectiveness. This information can be used to facilitate communication and shared decision-making between patients and healthcare providers.

HOW DO SMART INHALER WORK?

Working with smart inhaler is simple

Smart inhaler add-ons are medical devices that gather comprehensive data about every usage of inhalers. They use Bluetooth to send information to the application on the phone, which in return provides doctor or researchers with insights about asthma & COPD for better treatment.

STEP 1: ATTACH - Put smart device on your inhaler

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STEP 2: CONNECT - Link device with app on your phone

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STEP 3: COLLECT - Use inhaler like before and collect data

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STEP 4: SHARE - Get accurate treatment based on precise data

What Kind of Data Do Smart Inhaler Collect?

Smart inhalers collect comprehensive data about every medication usage. among others, it includes:

medication usages
asthma attacks occurrence
weather conditions on inhaler use
medication adherence
exacerbation periods
long term trend and statistics

How Can Data from Smart Inhalers Be Used?

Data from smart inhalers improves various aspects of traditional asthma & COPD care and provide opportunities for new innovation solutions;

Remote patient monitoring
Real-time patient screening
Asthma exacerbations predictions
Modification of asthma & COPD therapy
Remote treatment adjustments
Automated asthma & COPD research
Comprehensive patient asthma & COPD history

Smart inhalers, which incorporate sensors and artificial intelligence (AI) algorithms, are an innovative development in COPD management. These devices can help patients manage their respiratory conditions more effectively by tracking usage patterns, reminding patients when it's time for their next dose, and providing feedback on inhaler technique. Smart inhalers offer several advantages over traditional inhalers, including improved adherence to medication regimens and better symptom control. Studies have shown that smart inhalers can improve medication adherence by up to 59%, reduce the risk of exacerbations, and improve quality of life for patients with COPD.

Benefits Of Smart Inhalers

Integration of remote monitoring and telemedicine: smart inhalers make it possible to remotely monitor patient' asthma management, which it possible especially useful in circumstances when face-to-face visits are difficult. Through linked platform, healthcare clinicians may view patient inhaler usage information and symptom trends. With the use of this capacity, doctors may conduct virtual consultations without the need for in-person meeting in order to monitor patient' progress, modify treatment plans, and offer timely advice. Smart inhalers alert patient to missed or repeat doses and remind patients to take their doses on time, conveniently and automatically, depending on the time of the dose. these reminders can arrive wherever the patient is. These devices can relieve the stress of having to remember to take medication on time, especially when there are many drugs to be remembered. They can help optimize inhalation technique and efficacy and finally, they track symptoms for both patient and doctors to understand how, where and when symptoms become worse, and to monitor the use of the rescue inhaler for immediate short-term relief.

CONCLUSION:

Smart inhalers offer a transformative approach to the management of asthma and chronic obstructive pulmonary disease (COPD), bridging the gap between traditional inhalation therapy and digital health. By providing real-time data on medication adherence, inhalation technique, and environmental triggers, these devices empower patients and healthcare providers with actionable insights. The integration of smart technology enhances treatment efficacy, supports personalized care, and has the potential to significantly reduce disease-related complications and healthcare costs. While challenges such as cost, accessibility, and data security must be addressed, the continued advancement and adoption of smart inhalers mark a promising step toward more proactive and effective respiratory care. The patient profile (e.g., presence of comorbidities, smoking status, socioeconomic factors), the dosing regimen, the complexity of the device and patient’s perception of the disease are the main factors that influence the adherence to treatment.

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