Michael J. Thomas
CEO, iSonea Limited
The Center for Disease Control (CDC) measured a 12 percent increase from 2001-9 to 25 million Americans in 2009 – including nearly 10 percent of American children. Yet, only about one-third of those diagnosed with asthma were using long-term control medications and a similarly scant number reported that they had a written asthma action plan.
A recent survey published in the Annals of Allergy, Asthma and Immunology confirmed this worrying trend: while 8-in-10 respondents admitted they have persistent asthma, only half were using controller medications. Environmental contributors to the asthma epidemic may be beyond the power of individuals, but other factors are not–under-utilization of effective medications, lack of consumer education, and vigilance when it comes to symptoms, triggers and risks.
New technology has profoundly altered the way we communicate with one another and entertain ourselves. We believe the same technology can be harnessed to change the way we take care of ourselves, enabling people to easily monitor their breathing, objectively quantify symptoms in different real-life settings and provide timely patient education.
iSonea Ltd (ASX:ISN; OTCQX:ISOAY) is developing innovative, non-invasive devices and mobile health applications using Acoustic Respiratory Monitoring (ARM™), to improve the management of costly, chronic respiratory disorders such as asthma and Chronic Obstructive Pulmonary Disease (COPD). Unlike other lung-function tests, this method relies on passive application of proprietary sensors and does not require patient effort or cooperation, making it more suitable for use in infants, small children and elderly or infirm.
By combining this proprietary technology with its AsthmaSense™ mobile apps and universally available smartphones, iSonea enables anyone, anywhere, at any time to monitor breathing distress symptoms, take action and improve personal outcomes. iSonea’s core ARM technology has produced three devices for use in hospital and clinic settings, or in the home, school, and work environments, that have received clearance from the U.S. FDA, the European Union CE, and the Australian TGA.
iSonea Ltd was formed from the merger of two proprietary acoustic respiratory diagnostic technology companies: KarmelSonix, which developed passive technology to record and analyze the lung acoustics generated during the respiratory cycle, and Pulmosonix, which had developed active technology to inject sounds into the thorax and detect the changed signal at various locations, deriving diagnostic conclusions from the sound propagation data.
The synergy between the technologies has allowed iSonea to develop unique solutions for better monitoring and management of asthma.
The idea behind ARM is simple – using both analog and digital technology to record and assess the sound of air moving in and out of the lungs in order to recognize and describe wheezing. This air movement produces characteristic sounds under different circumstances.
With asthmatics, a trained ear and a stethoscope can distinguish between normal breathing and varying degrees of wheezing. ARM automates and objectively quantifies this process. A sensor captures the sounds and a computer compares the sounds to known patterns of breathing programmed into the algorithm. Sounds are matched and a wheeze rate score is assigned, based on the percentage of breathing time the person is wheezing. The wheeze rate will show 0% if the patient is not wheezing, or will display higher numbers that correlate with the persistence of wheezing. Think of this as a “thermometer” for wheeze.
The ARM device allows a patient or parent to establish an individual baseline for normal, quiet breathing in different real-life settings and activities. Regular monitoring allows them to know when symptoms are stable, increasing, or decreasing. It also provides an objective way to measure and quantify the effect of exposure to triggers or response to medication.
The process does not require forced breathing, as with peak-flow meters or on patient technique. We think that for many parents and patients this will be an attractive option since stethoscopes and trained set of ears are not available at home.
It also automates the bookkeeping. Instead of peak flow measurements and recording the results by hand, the iSonea ARM devices do these things in real time, and store the results for review with their physician, similar to the home glucose monitors used by diabetics.
Where do smartphones fit in?
The smartphone is a natural fit for integration with ARM technology. Five-hundred million were sold in 2011 with projected sales of 1 billion annually by 2015, a platform for near-universal, cost-effective access to ARM technology.
Initially, our AsthmaSense apps will provide a comprehensive self-management tool with testing reminders and risk alerts – a “remote asthma security system.” Within a year, this app will be integrated with wheeze probe sensors to automatically input breathing function data.
Small, portable sensors will be easy to carry and can be plugged into, or wirelessly communicate with, an iPhone or ‘Droid phone. Our AsthmaSense app will harness the computer in the phone to recognize the breath sounds, provide a reading, and transmit the results to a cloud-based trending database. The phone will utilize personal trigger and medication data, GPS location information, time and date stamps, and local environmental factors to inform the patient about risks and if action steps are recommended. Text messages can also be sent to parent, family caregiver or healthcare professional. A dashboard view on a HIPAA-protected website will provide asthma management trends to the physician, for adjustment of the patient’s asthma action plan.
Thus ARM, coupled with AsthmaSense mobile health applications, will provide a convenient monitoring companion, and a valuable repository for aggregate compliance and outcomes data for therapy companies, insurers, physicians and consumers.
How can we change patient behavior?
We know that asthma outcomes are improved when patients and parents are engaged in the care process. This includes use of asthma medications as prescribed, avoidance of asthma triggers and monitoring regularly with objective methods.
The rationale for objective monitoring is that it gives the patient or parent a definite number or quantitative measure of how things are going. This allows for an earlier warning that the asthma might not be well controlled.
Different patients have trouble with self-monitoring. Children may find it too difficult, while adults think they can understand their degree of asthma control based on their symptoms. It is well documented in peer-reviewed medical journals that such patients are often wrong.
Why does it matter?
The bottom line is that asthma experts agree that patients should monitor regularly, but most do not. We believe that Acoustic Respiratory Monitoring coupled with the AsthmaSense mHealth app will provide a solution that builds on the new smartphone behavior they have readily adopted.
With healthcare accounting for almost 20 percent of the U.S. economy, and with 75 percent of healthcare costs in the U.S. linked to chronic conditions, better physician-demonstrated outcomes are imperative. This can only be accomplished if patients change from passive recipients of physician care to collaborators.
In the case of asthma, the goals are to A) help patients adhere to medication plans, B) increase their awareness of environmental or activity triggers, C) monitor their breathing symptoms regularly, and D) work with providers in adjusting asthma action plans. At last we have the technology to lift these challenges out of the realm of drudgery and integrate them with everyday life.
You may contact Mr. Thomas at: mthomas@iSoneaMed.com
This new app has now been launched. Read more about it here. To download the app, click here.