By Henry Ehrlich
November 2, 2010 we featured an article by David Van Sickle, PhD called “Rural Asthma in the Midwest.” He had developed a technology that would among other things allow rural residents to track the state of their asthma.
“To identify when and where participants were experiencing asthma symptoms, we provided each one with a device to track the time and location where they use their rescue inhaler. This small, battery powered device, is attached to their regular medication. It uses a global positioning system (GPS) receiver to determine where and when the inhaler is used and then sends that information to a remote database, This device takes advantage of the fact that nearly everyone with asthma is prescribed a medication (albuterol) that they carry around with them and use to relieve symptoms as and when they occur. We also asked participants to complete monthly surveys throughout the study period, which we used to track their exposures, and their asthma control and management and health care utilization.”
The gadget was called Asthmapolis. Given the life span of many innovations, and the competition in this space enabled by smart phone technology, we were very pleased to see Dr. Van Sickle pop up in the pages of his hometown Wisconsin State Journal talking about his product, which now is known as Propeller and his company is PropellerHealth.com.
Among the tidbits of information, Van Sickle’s eureka moment when he was a “disease detective” at the CDC. He came across the case of an epidemic in Barcelona, Spain. “Between 1981 and 1987, emergency rooms in Barcelona experienced more than two dozen days when visits for asthma increased significantly. In total, the events sent more than 1,100 people to the hospital and, tragically, resulted in 20 deaths.
“It took eight years for experts to identify the culprit: massive clouds of soybean dust caused by a lack of proper filters on harbor silos. Until then, soybean dust had never been identified as an allergen. People had no idea it could cause asthma attacks, so they weren’t looking for it.” That was the impetus for Propeller. For more click here.
The other technology is NIOX MINO, which measures fractional exhaled nitrous oxide (FeNO), a marker for asthmatic inflammation. Dr. Chiramonte wrote on September 17, 2011, “[These devices] are particularly useful when patients tell me they have been taking their medication conscientiously and can’t understand why they still ended up in the emergency room. The numbers don’t lie, although I’m afraid patients do, and we can get the numbers on the spot. This is why some people call the NIOX MINO the “naughty or nice machine.” The company Aerocrine [now Circassia], which makes them, has compiled a particularly powerful case history, which we repeat in our book. It tells of a teenager from a very troubled home who swore up and down that he had been taking his meds, the pharmacist’s records showed that his prescriptions had been filled regularly, and yet his asthma became so bad that the final specialist who saw him was on the verge of reporting him to the state as in danger of imminent death. This specialist gave him the FEno test, which showed that inflammation was raging. FEno was at 70 parts per billion. The new guidelines define the threshold for uncontrolled asthma at 25 ppb. Faced with this evidence, the boy confessed that he had been stashing his medication under his bed. He had done this because his sister was confined to a wheelchair and his asthma helped him compete for the attention of the single mother. After taking the medication regularly (and a program of family therapy) his FEno levels came down below 20 ppb.
The news is that XIOX MINO is now available to 22-million Aetna customers: “Aetna’s updated policy is excellent news for people with asthma and parents of children who live with asthma,” said David Acheson, senior vice president, US Commercial, Circassia. “The update includes data from a recent US Agency for Healthcare Research and Quality report that highlights the use of FeNO testing as a valuable part of comprehensive asthma diagnosis and management. We are pleased to see Aetna update its Clinical Policy Bulletin to include FeNO and provide expanded coverage to its members who have this serious condition.”
The surprise is that this excellent machine took seven years to be accepted by an insurance company. I have no idea how many others also offer it. There are many unnecessary tests in the allergy field. This one really works, quickly and definitively.