Digital health and tele-monitoring.

Living with asthma for over 30 years I have experienced a lot of different medication, types (and colours) of inhaler and ways of managing my asthma.

The types of inhaler have gone varied from a metered dose inhaler with a nebuhaler (similar to the volumetric but longer and thinner), to the spin haler and rotahaler where you put capsules in the device which is then cracked and the dry powder inhaled, then there was the dischaler similar to the accuhaler but it only have 4 or 8 doses per disc before it needed changing. Then now I have a ellipta device, a metered dose inhaler with aero chamber, an accuhaler and then a respimat device. No longer are you taking a brown and blue inhaler but any colour of the rainbow.

30 years ago…

When taking your inhaler you just had to remember to take it and work it into your routine. The number of doses and how often you had to take your preventer would be written down in your personal action plan and that was it. For your reliever inhaler you just had to sort of keep track of when you were taking it and how often. It was a mental game of remembering.

Then the management of your asthma was done via peak flow results which you wrote down in your peak flow diary (when you remembered) and you personal action plan was written down by the GP or asthma nurse which told you when you needed to increase or decrease your preventer inhaler and what to do in case of an asthma attack.

Fast forward to modern day…

There are so many devices and apps out there to help you manage your asthma and remind you when to take your inhaler which is great (although not perfect). At first I was very hesitant about using smart devices or even apps. I thought that I have managed my asthma myself all my life so far and have never needed prompts to take my inhalers and medication really (except maybe when I was in my teens when I was a little more rogue with medication). I have it built into my daily routine so could not see the added benefit of these devices to my asthma management and control. However I was wrong. I have experienced so many benefits of smart devices and enhanced management of my asthma through using apps.

Over the years I have been very fortunate to have been given various smart inhalers, smart peak flow meters and have the chance to both design and test run some apps.

Smart Peak Flow Meters

I have had the opportunity to try a few different smart peak flow meters. I have been doing my peak flow for years and years. Before using a smart peak flow meter and with everything going paper light it is not as easy to get your hands on a paper peak flow diary so I became quite lax at recording my peak flow. I still did it 3 times twice a day but would just take a mental note of it and would be able to tell if my peak flow was lower or higher than the previous and if it was in the right range. This was fine but not ideal.

The first transition from the mini wright peak flow (manual go standard peak flow) was to a digital peak flow metre which gave you an electronic reading and stored readings for 30 days. You could plug it into your computer and transfer the data to your computer to look at but I don’t think I ever did that mainly because I am bad at losing cables.

The current smart peak flow meters all tend to be devices that are either plugged into your phone or bluetooth to your phone via an app. The device sends the results to your phone and stores it in the app. You can then access all your data without having to write anything down, input anything literally all you need to do is open the app and blow 3 times it does the rest for you. They do have the option to input more data if you want such as how you were feeling etc and they also have the facility to preset your peak flow zones so the result will be highlighted in red, amber or green for you. It is easy to upload the data or print it out which ever you prefer. It has been helpful to compare different years data and see if there are any trends that repeat each year which is helpful in the overall management of my asthma.

Smart Inhaler Devices 

To begin with I thought smart inhalers were a bit of a gimmick and to be honest was not sure how they would really help. The early smart inhalers and even some of the ones around today you can tell they have not had patient input when it comes to the design. For most asthmatics our inhalers live in our pockets so if there is a smart device it needs to fit on the inhaler and still fit in our pockets (without having to change what we wear to accommodate this as one Dr/researcher said to me once). Now having had experience of different smart inhalers I can see their value as part of your asthma management plan. As someone who is good at taking their preventer inhaler I didnt really see the value for me from using it but I guess for someone who is not using their it might be helpful to identify when they take it more and when they don’t but also it might help them to take their preventer especially if their care provider would be able to access the data from the device.

The smart device for a reliever inhaler is what I have benefitted from. The device is small and my inhaler still fits in my pocket. Being a fairly severe asthmatic who does all they can to try and control their asthma but still requires to use a lot of their reliever inhaler I don’t always register when I am taking it and find it hard to recall how many times in a day do I need to use it and when in the day am I using it. (I know some people will not be able to understand this but my consultant knows I require this much and we are doing what we can to optimise treatment and get more control to reduce my reliever use). Since using the smart device on my reliever I have found it fascinating to look at the data and see how much of my reliever I am using but more interestingly when in the day I am using it. I have found there are some really prominent trends which have highlighted that I use my reliever consistently between 4-5am most mornings and then again between 5-7pm at night. I take it at other times in the day but during these times is where I am most consistent in my requirements which I would never have been able to identify had I not had the use of the smart device.

Mobile Apps

My first foray into tech for asthma would be in the app world. I was approached by someone in the states who has CF and they designed an app for managing  CF but wanted to do similar for asthma. I helped with the needs for asthma patients. It is an app I still use today but there are some tweaks I would want to make. This app was developed a number of years ago so was relevant for the time as smart inhalers were very much in their infancy. Below is the main menu of the app “My Fight Against Asthma”

Over the years I have used a number of different apps as I have come across them on the app store but none have totally suited my needs. No app combines every aspect of care in one. Just now I use a total of 5 different apps to monitor and control my asthma. They are:

• MIR Smart One App which records my peak flow via my bluetooth electronic peak flow meter which enables me to track symptoms too.
• My Fight Against Asthma which has my asthma action plan (but without action alerts), triggers, emergency contact details, my history, it also has a  bit for reminders.
• Propellor Health which is the app for the smart device on my deliver.
• My Therapy to track my medication and give me reminders for medication particularly the medication I take weekly and 3 monthly as this is easier to forget.
• Pollen which I have found to be the best for keeping up to date with the pollen counts and what pollen is about too.

My dream app/device

My dream app would combine all of the above apps in one. Despite using all these apps there is one fundamental thing that is missing and it is something asthmatics all over the world want. It is an asthma action plan that is interactive. Just now you can input your data particularly peak flow and it will tell you what zone you are in but it won’t then go on to tell you what action to take automatically which is something we all really want.

If I could have an app function wish list it would have:

• asthma action plan which tells you the action you need to take depending on peak flow via a pop up or something similar (this is the tricky part as for this function to happen it requires the app to become a medical device which is why none of the apps just now have this function)
• accepts peak flow and smart inhaler data from external devices
• will identify trends eg low peak flow and high reliever use and notify me
• Medication tracker so you can input when you start an inhaler and give prompts for when to order more medication
• Daily diary which shows all smart data as well as having free text box for personal input
• Various functions that can be activated according to your type of asthma. For me it would allergies and food diary as I often cant work out if an allergy has triggered my asthma.

This would be my dream so if anyone reading this thinks they can fulfil my dream message me and we can work on something but as I am not the most tech savvy person and have no idea about how to design or develop an app it will never happen. Equally if anyone knows of an app that does any of my dream functions please also let me know.

This has just been my experience of digital health in asthma. I have gone from being slightly negative and not particularly interested in it to being an active promoter of it as the value is amazing. during lockdown for COVID-19 it has been so useful as I have been able to send the data in to my asthma specialist and while he cant listen to my chest he can get a feel for how my asthma is from all the data I have been able to send him. He has been able to have both objective and subjective information to help tailoring my asthma treatment and management plan.