Manchester-based digital health start-up Clin-e-cal has launched a free app to help people with respiratory diseases to monitor and improve their inhaler technique. The Clip-Tone Buddy app is the first digital solution which can provide real time feedback and effectively guide a user’s inhaler technique, as well as providing personalised tips for improving technique and monitoring regular inhaler usage.

Correct inhaler technique is recommended as a key way of improving management of respiratory conditions like asthma and COPD, including cutting the risk of symptomatic episodes of respiratory distress and reducing medication side effects[i]. Studies have also found that up to 90% of people are not using their inhaler correctly[ii]. On average, three people die from an asthma attack in the UK every day (Asthma UK). Many of these deaths would be preventable with improved management and correct inhaler use.

The Clip-Tone system consists of a small, moulded plastic attachment which clips to the top of an inhaler and generates a gentle whistling sound when the inhaler is used. Clin-e-cal’s Sound Response® technology then analyses the sound signal, and provides real-time visual feedback to patients on their inhalation technique, as well as tracking their adherence and sending medication reminders.

Professor Mark Everard, Emeritus McCusker Foundation Professor of Paediatric Respiratory Medicine at the University of Western Australia and Princess Margaret Hospital for Children, Perth, commented on the Clip-Tone Buddy app: “Clin-e-cal has developed an approach to a long-standing problem that is likely to be effective. Such an approach is a long, long overdue solution to a major therapeutic issue that people ignore because it seems too difficult to solve.”

The Clip-Tone attachment can be used with a range of inhalers, and the companion app only requires access to the smartphone’s microphone. The app creates an objective inhaler usage record for patients, which may be shared with healthcare professionals. Patients receive real-time feedback on their inhalation and co-ordination, and immediate analysis of their overall technique.

A study presented at the Primary Care Respiratory Society conference in September 2020 found that the Clip-Tone® smart inhaler technology is helpful for patients. 100% of patients who used the Clip-Tone® device found it useful, would choose to continue using it, and would recommend it to a friend. The Clip-Tone® app was found to routinely detect user inhalation efforts, guiding them towards improved technique.

A further study, published in the International Journal of Clinical Practice, assessed 200 inhaler naïve patients using the Clip-Tone Buddy app. It found that the Clip-Tone Buddy app’s visual feedback enabled patients to master and retain the optimal inhalation flow and duration more effectively than verbal counselling.

Clin-e-cal has also been working with asthma sufferers in the UK to develop and improve the Clip-Tone system. 63-year-old Tony Jankunas from Manchester has had asthma his whole life, and has been managing the condition for as long as he can remember.

He says, “Managing my asthma when I was a child was really tough; I had a lot of allergies, which exacerbated my asthma even more, and I had attacks which could last ten to twelve hours. I still have to think about avoiding places and environments which might trigger and attack, like dusty areas or going outside on a high pollen count day. People who don’t have asthma almost never have to think about breathing, but for people with asthma, we have to think about it on an almost constant basis. Asthma is a manageable condition, but that doesn’t mean that it is easy to live with.

Over the years, I must have tried just about every inhaler on the market, and even I have had trouble keeping track of the right technique for each one, and learning correct inhaler technique is now even more difficult with fewer in-person reviews due to the pandemic. I am very happy to be helping with the development of the Clip-Tone Buddy app, and I think it is really important that technology like this is made available to help people manage their respiratory conditions