SMART INHALERS IN PEDIATRIC ASTHMA: ADHERENCE MONITORING, EXACERBATION PREVENTION, AND PUBLIC HEALTH IMPLEMENTATION - A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.1(49).2026.5353Keywords:
Pediatric Asthma, Smart Inhalers, Medication Adherence, Digital Health, Exacerbation Prevention, Implementation ScienceAbstract
Background: Pediatric asthma remains one of the most important chronic conditions of childhood, yet outcomes are still undermined by poor adherence to inhaled corticosteroids, incorrect inhaler technique, delayed recognition of deterioration, and uneven access to follow-up care. Smart inhalers and related connected inhaler platforms have emerged as digital tools intended to address these gaps by objectively measuring use, delivering reminders, supporting self-management, and enabling remote clinical review.
Objective: This narrative review synthesizes the pediatric literature on smart inhalers with emphasis on three linked questions: their value for adherence monitoring, their potential to prevent exacerbations, and the practical requirements for public health implementation.
Methodology: A narrative review was undertaken using PubMed/MEDLINE and PubMed Central as primary scientific sources, complemented by major guideline and policy documents. Literature published mainly between 2010 and March 2026 was reviewed, with priority given to pediatric trials, systematic reviews, qualitative studies, and implementation analyses.
Results: Pediatric studies consistently show that smart inhalers improve measured adherence, especially when electronic monitoring is coupled with reminders and feedback. Evidence for improved asthma control and reduced exacerbations is promising but heterogeneous, with effects varying by device type, population risk, duration of follow-up, and degree of clinical integration. Actuation-only devices may overestimate true use because they do not confirm correct inhalation. Implementation studies indicate that technical usability, multiple-caregiver workflows, data integration, privacy, reimbursement, and digital inequities are central determinants of success.
Conclusions: Smart inhalers should be understood not as stand-alone gadgets but as socio-technical interventions. Their strongest near-term role in pediatric asthma is targeted deployment in children with poor adherence, recent attacks, or suspected severe disease, supported by structured onboarding, technique education, and integration into routine primary and specialist care.
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Copyright (c) 2026 Paweł Żurek, Daria Danielczyk, Natalia Malatyńska, Oliwer Muller, Jagoda Pałubska, Katarzyna Rosa, Agata Słoma, Anna Szot, Dominik Szydełko, Martyna Szymczyk
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