Rafi-Tone – A free NHS App for young inhaler users


Non sponsored post, Rafi-Tone

I was recently sent an email about Rafi-Tone, a gamification app developed in the UK that helps children overcome the distress associated with asthma treatment. The registered medical device can be downloaded for free, the app supports good inhaler technique which is especially crucial during the Covid-19 outbreak.

A newly validated app called Rafi-Tone, makes using an inhaler with a spacer easier and more fun for young children with wheeze or asthma symptoms. By motivating positive inhaler technique, medication is likely to be more effective.

Good inhaler technique is even more crucial at the moment, as those with asthma are advised to be particularly vigilant about taking their medication as prescribed, to ensure optimum control.

The Rafi-Tone app is designed for young inhaler users, enabling parents to overcome the distress often associated with treatment and allowing them to log and monitor use. Rafi Robot, the star of the app, helps to engage the child whilst promoting effective inhaler technique through a series of fun games.

The app was originally developed by a University academic to help his son, Rafi, by using specially designed games and cartoons to encourage and monitor correct inhaler technique. After impressive results in hospital studies, it was further developed by University of Manchester through a spin-out company, Clin-e-cal to produce the current app, which is now available on the NHS Apps Library.


Respiratory infections, often leading to symptoms requiring inhaler treatment, are one of the most common childhood diseases in the world. Asthma UK advises parents that using the correct inhaler and spacer technique reduces their child’s risk of asthma symptoms and potentially life-threatening asthma attacks. However, correct inhaler use can be difficult, particularly with younger children and often results in distress for both the parent and child. This can result in poor adherence and ineffective drug delivery.

Many parents report problems getting their children to take their asthma medication, especially when using a spacer and mask which goes over the child’s nose and mouth. In order to properly inhale the medication, there must be a firm seal between the mask and the child’s face, and the child must breathe in steadily. Regular medication is necessary to reduce the incidence of symptomatic episodes of respiratory distress.

Problems using a spacer can not only lead to poor adherence and ineffective drug delivery, but also cause significant distress for both parents and children. Many parents report missing doses as a result of their child’s distress.

The Rafi-Tone app was developed using gamification principles to make the process as fun and engaging as possible. In large studies, 51% of children reported becoming upset when using their standard spacer, but this reduced to only 22% by switching to the Rafi-tone system. Similarly, the number of parents confident that the spacer had delivered the right dose more than doubled from 42% to 89%. The study also saw improvements in children’s own perceptions, and strong endorsement from independent specialist nurses who took part in the study.

The Rafi-Tone app is a registered medical device and can be downloaded for free from the Apple App Store (iOS) or Google Play Store (Android) for patients using the Able spacer.  

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