Asthma is a very common disease. In Europe, at least one in ten children has asthma symptoms. Globally, an estimated 300 million people are living with the condition.
For people with asthma, their inhaler plays a central role in managing the condition. These simple drug delivery devices have been used for decades to deliver medication to the lungs. Regular treatment with inhaled controller medication helps to keep asthma under control and, for some patients, ‘rescue’ or relief medication can limit the impact of an exacerbation (or ‘asthma attack’).
The inhaler remains state-of-the art in drug delivery for asthma sufferers and will continue to be a companion for patients around the world. However, in the decades since it was first designed, we are now seeing important advances in technology: sensors allowing physiological and environmental information to be collected quickly, and digital communication facilitates real-time connectivity between devices, patients and clinics.
Asthma inhalers 2.0
The myAirCoach consortium, funded through the EU Horizon 2020 research programme, has been working to extend the utility of inhalers by developing adaptors to make inhalers smarter that we hope can use technology to improve outcomes for patients. Companies, hospitals and universities – in collaboration with patients – have been working to improve inhalers so that we can get as much information as possible about how the patient uses their device and information about the state of the lungs and the immediate environment.
One potential benefit is in improving how inhalers are used. While most patients can swallow a pill, using an inhaler correctly can be tricky. Patients have to trigger the metered-dose inhaler at the same time as taking a deep breath, for example, and this is not easy – especially for children and elderly patients. Crucially, patients and their doctors often do not know whether the inhaler has been used correctly: they don’t know if it was used at the right time and if the right dose was administered. In some cases, it is also impossible to tell whether the inhaler has been used at all.
We want a device that tells us when and how it was used. Advances in sensor technology allow lots of tiny gadgets to be added to the inhaler through an adaptor. These can measure breathing rate, cough, breath sounds, and activity that will tell us about the health of the lungs; detect nitric oxide levels in the breath to indicate inflammation in the airways; and monitor environmental factors such as temperature, humidity and pollution.
We are already making progress on several of these fronts and have developed a prototype for an adapter to attach to a conventional inhaler to study in asthmatics. This work, which includes close interactions with the European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) and Asthma UK, will tell us whether the prototype is user-friendly and whether it benefits the patient in the long term.
And that’s just the hardware. Equally exciting is the information side. The sensing units in the adaptor are linked to an App in the mobile phone via Bluetooth connectivity and such information can be transmitted to the clinic where it can be analysed. The App itself will include standard asthma questionnaires, a patient action pan and asthma diaries.
Furthermore, using modelling tools, there will be prediction of clinical state and a feedback plan for optimal asthma treatment for the patient.
Asthma management – ‘there’s an app for that’
By providing patients with feedback on their condition, the smartphone app could prompt them to take certain actions as necessary, may advise them to make an appointment with their doctor or if indicated may advise them to seek prompt attention such as a visit to an emergency room. Health professionals can use the data to identify patients who need training in inhaler use and to adjust personalised management plans to improve asthma treatment.
Today, doctors routinely ask patients to recall times where they had exacerbations or other breathing difficulties. We believe adding real-world data on key indicators – such as airway inflammation, lung health and the use of inhalers – will allow for more responsive patient management.
The next step for the my AirCoach project will be to test whether the new device will help the patient in better controlling his/her asthma.
Big data, big opportunities
Looking at the bigger picture, there may be further research benefits to collecting large volumes of data from inhalers. Providing it could be done in a manner that was compliant with patient privacy and data protection, unprecedented real-world insights on the asthma patient population could be unlocked.
For example, we might learn how well certain medicines work for particular sub-populations; identify environmental triggers of exacerbations; and compare outcomes for patients in different environments such as rural vs urban settings.
The implications may go beyond asthma care. Exacerbations are often triggered by respiratory viruses, including flu outbreaks. Rather than relying on GPs and hospitals to report flu cases after they occur, we may get an early warning sign if our asthma patient population records a spike in inhaler use, or if the smart-inhaler sensors detect changes in airway inflammation.
All of that is a little further down the road but offer a glimpse of what may be possible in the near future. For the moment, we will continue to work together on extending the usefulness of the inhaler for the digital era.