Background: Smart inhalers are electronic monitoring devices which are promising in increasing medication adherence and maintaining asthma control. A multi-stakeholder needs and capacity assessment is recommended prior to implementation in healthcare systems.

Aims and objectives: This study aimed to explore perceptions of stakeholders and to identify anticipated facilitators and barriers associated with the implementation of smart inhalers in the Dutch healthcare system.

Methods: Data were collected in the Netherlands through online focus group discussions with patients with asthma (n=9) and healthcare professionals (n=7) and through online individual semi-structured interviews with policy makers (n=4) and smart inhaler developers (n=4). Data were analysed using the Framework method.

Results: Five themes were identified: i) perceived benefits, ii) usability, iii) feasibility, iv) payment and reimbursement, and v) data safety and ownership. In total, 14 barriers including lack of reimbursement, lack of integration of smart inhaler data in electronic health records and uncertainty regarding data access, and 32 facilitators including the need for evidence, the willingness to change workflows by healthcare organisations and the involvement of all stakeholders in the development process were identified among all stakeholders.

Conclusions: The results of this study could inform the design of a tailored implementation strategy and may help developers in improving the design of the current devices, which together could increase the chance of successful implementation of smart inhalers in daily clinical practice.