• Asthma
  • Wearables to predict and prevent asthma attacks

    Wearables are already quite good and measuring vital signs. A team at North Carolina State University has developed Health and Environmental Tracker (HET) to help people with asthma. It incorporates several novel sensing devices in a wristband and a patch that adheres to each patient’s chest.

    Research by a team at Edinburgh University, and published in Pub Med, found “An increasing prevalence of asthma in Africa over the past two decades. Due to the paucity of data, we believe that the true prevalence of asthma may still be under-estimated.” There was an estimated 74.4m asthma patients in Africa in 1990. By 2010, there were over 119m, an increase of about 60% in 20 years. The prevalence’s geographically skewed, being higher in urban areas than rural communities. The new wearable can have a valuable role in Africa.

    The patch includes sensors that track patients’ movements, heart rates, respiratory rates, oxygen in their bloods, skin impedances and wheezing in their lungs HET’s wristband focuses mainly on environmental factors. It monitors volatile organic compounds and ozone levels in patients’ surrounding environment and ambient humidity and temperature. It also has sensors to monitor motion, heart rate and oxygen in the blood. There’s a non-wearable spirometer that patients can breathe into several times a day to measure their lung function. This data’s transferred into HET’s data analysis system.

    HET users can track their wellness, and the correlated data can give patients notice to take corrective and avoiding action if it’s needed. This could simple changes such as going indoors or breaking exercise.

    HET’s still being tested, so won’t be available in Africa for a while. Its approach to correlating data in wearables can offer Africa’s mHealth developers a more sophisticated development model.

  • Connected inhaler technology helps reduce inhaler use

    Today, asthma may affect as many as 334 million people globally, and its prevalence is rising, says the Global Asthma Report. Low- and middle-income countries suffer the most severe cases. While there’s no cure for asthma, it can be managed with proper prevention and treatment. 

    A recent study of 495 asthma patients conducted at Dignity Health found that Propeller Health’s connected inhaler technology helped to reduce the use of a rescue inhaler, says an article in mobihealthnews. “The research demonstrates that the benefits of telehealth go beyond monitoring medication adherence, but can also identify patterns of risk and impairment. This additional information may allow more timely interventions and enhanced asthma management,” Dr. Rajan Merchant, the principal study investigator and physician at Dignity Health’s Woodland Clinic Medical Group said in a statement. “Although additional study efforts are needed, digital health is promising to help improve care and asthma control.”

    Patients were split into a routine care group and an experimental group. Both had Propeller sensors fixed to their Short-Acting Beta Antagonist (SABA) inhalers, a rescue inhaler used only when the patient’s asthma becomes exacerbated. Patients in the routine care group didn’t have access to data from the sensor. T the intervention did. It had feedback about where and when they were using the inhaler. The study lasted a year, to include seasonal variations in symptoms. 

    At the end of the study period, both groups had decreased their SABA use and increased their number of SABA-free days, but the intervention group had done it a significantly larger margin. The study also looked at asthma control measured by the asthma control test. Patients whose asthma was well controlled at the start of the study showed no difference between the two groups. Those who began the study uncontrolled were more likely to improve with access to the Propeller data. In an exit survey, 59% of the intervention group said they had learned about a new asthma trigger as a result of using the technology.  

    Researchers noted that more participants dropped from the study than expected, possibly due to syncing and battery life issues with the technology. These have been corrected. They also noted the existence of the Hawthorne Effect. Participant in formal studies who know they’re being observed are sometimes modify or improve their behavior or performance.

    Asthma has quickly become a common and costly disease for many countries. More research’s needed to help support people living with this life-long disease. mHealth and eHealth have a big role to play.

  • mHealth helps an asthma patient

    The European Lung white book page on adult asthma says that the UK has some of the highest rates of asthma in the world. It’s not surprising that it’s an important condition where mHealth can help. A patient is using her smartphone records to ask for medication that prevents attacks, so she doesn’t need to visit her GP.

    She’s among the first NHS patients to link health information on her iPhone and her GP medical records. Data includes results of regular peak flow lung tests in her EMIS Health Group Personal Health Record (PHR) accessed with the Patient Access app. With her authorisation, her GP can view her PHR alongside her GP’s medical records, who can then make informed decisions about the strength of medication she needs, then issue an appropriate prescription.

    EMIS Health sees this as step towards GPs making better-informed decisions for a range of problems, including high blood pressure, diabetes and weight. EMIS Health’s’ PHR integrated with Apple HealthKit can enable users to manage their own health in partnership with their GP and other health professionals. In the UK, more than 6,500 users have logged 1.1 million pieces of information since the PHR was launched earlier in 2014.

    As an example of integrated eHealth, it shows a direction for African healthcare’s mHealth programmes and the value of long-term relationships between health systems and eHealth vendors. It also emphasises the challenge in selecting an appropriate eHealth vendor from the outset. EMIS Health began life as Egton Medical Information Systems in the 1980s, founded by two GPs so they could see patients in locations away from their paper notes.

  • Asthma apps are about breathing

    For most of us, breathing isn’t difficult. I certainly don’t spend much time thinking about it, except for the occasional scary sea-swimming moment, caught clutching the sand after diving beneath an unexpectedly large wave. For asthmatics though, breathing can become impossible and the signs of deterioration are often small and subtle and only noticed by patients and their families once the patient is already in trouble, ‘trapped below the surface’ of a tight chest, needing urgent rescue through medical care, and often hospitalization, to avoid death. Keeping these patients out of the dangerously deep water of a serious attack is about helping them to identify danger signs long before they are serious, to take action, or to identify and avoid triggers that accelerate a plunge into the abyss.

    Open mHealth says that mHealth is about making “health data as useful and actionable” for patients and clinicians. The growing industry around mHealth is equally interested in reducing costs and the burden of care faced by health workers by reducing hospital visits. For asthmatics, both will sound like good news and they are no doubt pleased that innovators are not sitting idle.

    A number of companies now offer Apps and sensors to monitor breathing and help manage Asthma. Three quite different examples, sharing the same aim, are AsthmaMD that offers a Peak Flow Meter to measure lung function, iSonea that gauges adherence by monitoring wheezing, and Propeller Health’sapp and sensor, which attaches to a standard inhaler. All focus on helping asthmatics manage their condition and reduce the number of visits to healthcare providers. Ephraim Schwartz provides more detail in his June piece in mHealth News.

    AsthmaMD uses a Peak Flow Meter, a device that measures the force with which the patient breathes out, a key aspect of breathing particularly reduced in asthmatics. The meter syncs with an App via Bluetooth. When patients blow into the meter, a value is transmitted to the App, which then explains to the patient what the value means. The App will also track lung function over time and produces easy-to-read, color-coded peak flow charts, which provide healthcare providers with information to use to tailor treatment plans. They’ve reported a 10% improvement in lung function for active users, compared to a control group, and reduction in hospitalization and readmissions. It’s available over the counter in the US for $20.

    AsthmaMD apparently has 100,000 users and its developers have begun thinking about how to use their growing data source to answer questions about how to improve asthma care.

    iSonea’s device is called iSoneaAir. It records wheezes, a characteristic sound associated with obstructed airways. By measuring the wheeze rate, health workers are able to monitor patients’ progress outside of the clinical environment and assess how effective medications are before and after inhaling. “Doctors as well as insurers are looking at our application because it gives them a disease management focus,” said Ross Wilson, senior clinical manager at iSonea.

    The solution consists of an iPhone or Android App and the wheeze monitor, which is placed against the throat. The device syncs with the App via Bluetooth and wheeze recordings can be sent to health workers or stored in the cloud.

    The Propeller Health App, along with its sensor, tracks exact location, time and frequency of medication taken.

    Africa’s health challenges need solutions of their own, and the mHealth community in Africa is expanding its capacity to deliver. There’ll be lessons to learn from projects that gain traction elsewhere. Though probably none that will help me avoid the next big wave, or hold my breath longer when I get it wrong.