The Inhaler Compliance Assessment (INCA) device uses time-stamped audio recordings of inhaler use to assess not only inhaler adherence but also inhaler technique (http://www.tueohealth.com/). Specifically, it can assess proper inhaler technique by measuring a failure to prime the inhaler, inadequate inspiratory flow, and dose dumping. This information can be used to determine if medication was not properly delivered due to inhaler technique errors (attempted adherence) or missed/late medication doses. In one study of 184 people with chronic obstructive pulmonary disease, the INCA device was used to assess controller inhaler adherence [40]. The mean rate of attempted adherence was 58.7%, whereas actual adherence (proper timing and technique) was only 23%. Only 7% of participants had actual adherence above 80%, underscoring the importance of addressing proper inhaler technique. Currently, there is no mobile app for the INCA tool and the data must be downloaded onto a computer for analysis. Additional studies are currently being conducted using an INCA App to assess its ability to improve asthma outcomes.