: We theorize that an electronic medication monitor (EMM) attached to a dry powder inhaler (DPI) that communicates wirelessly with a device that provides desirable rewards for appropriate use, can improve the adherence of adolescents to inhaled steroids prescribed for asthma. The objective of the proposed Phase 1 SBIR project is to test the feasibility of this approach. We propose a research plan with the following specific aims: 1. Demonstrate the technical feasibility of an EMM with wireless communication capability by building a proof-of-concept inhaler monitor for the Advair Diskus DPI, 2. Create software that integrates the wireless inhaler monitor into SixtySeven Kilohertz's previously developed Adolescents' Disease Empowerment and Persistence Technology (ADEPT) for Asthma System, 3. Outline an approach to using Contingency Management (CM) theory in ADEPT to reinforce medication adherence. Asthma is the leading serious chronic disease of childhood and its treatment requires proper adherence to prescribed medication. Unfortunately, adolescents' adherence to their prescribed regimen of inhaled steroids is unacceptably low. CM is a theory-based approach that has proven to be effective in changing behavior and improving adherence to prescribed medication. A CM based adherence intervention with adolescents can be successful without needing to answer the difficult question of why their adherence is poor. This project is significant because: 1. It proposes a unique intervention to a serious medical problem that has been frequently studied but for which few systematic solutions have been proposed and tested, 2. It represents an approach to improving adherence that is applicable to a number of chronic diseases of childhood, 3. It is directed at issues of recognized importance in nursing research. The proof-of-concept inhaler monitor to be developed will: 1. Record each actuation of the inhaler with a time and date stamp, 2. Sense that the device is placed near the face during inhalation, 3. Detect multiple dosing and dumping, and 4. Wirelessly transmit data to a recording device, which is capable of sending this data to a server database over the cellular telephone network. This technology has commercial value to healthcare payers and pharmaceutical companies, both of which have financial interests in improving medication adherence.
