By Henry Ehrlich
Part of our mission at Asthma Allergies Children world headquarters is to help leverage the knowledge of specialists like Dr. Chiaramonte and Dr. Ehrlich to make treatment more effective. As both of them have written, and we have continued to highlight in our news and journals pages, lack of compliance with asthma control strategies is an immense burden on individual and public health. Simply put, doctors can’t hover over patients to make them fill their prescriptions and then take their medication. And mothers can only do so much. Five or six years ago, Paul and I tried to interest companies in some cellphone-based reminder capability—it didn’t come naturally to us but we saw our children texting and thought that was the ticket. No one bit.
Now, however, the time seems to have come. One way to spot technology developments is to follow the money. We found Asthmapolis (a smartphone app that allows remote monitoring of inhaler use) in an investor bulletin, and more recently we spotted iSonea, which analyses breathing sounds to indicate the extent of asthma control. I got in touch with Michael Thomas, CEO of iSonea. Mr. Thomas is a microbiologist by training who prior to iSonea spent years in Big Pharma before landing in a company devoted to sleep medicine, which is where he became familiar with the science of airflow, breathing patterns being a key indicator of sleep obstructive breathing, or sleep apnea.
This is what I learned from our conversation:
The key to iSonea’s technology is research by an emergency room doctor in Israel who became interested in sound and sound analysis. He and his colleagues established the correlation between airflow (as indicated by sound), spirometry and asthma symptoms. An impressive bibliography of peer-reviewed research in reputable journals has shown that breathing sounds can accurately represent the state of asthma control. However, developing a good technology and bringing it to market are different things. As we have seen from the experience of things like the Betamax video format (look it up, those of you too young to remember the VCR wars of the early 1980s), good technology doesn’t guarantee success. iSonea acquired their portfolio of patents and it just happens that they did it at the right time, when the explosion in mobile technology allows them to circumvent the old way of developing proprietary devices and data processing. “Even five years ago,” says Thomas, “the potential for widespread adoption of this technology would have been limited.” Suddenly, however, “There was a tsunami. You don’t have to build the hardware or the data capabilities. You can rent them when you need them.”
The real challenge is getting people to modify their behavior and do the things that are proven to achieve control—taking medication and avoiding triggers. But, as we have written repeatedly on this site, easier said than done. Taking your medication can be influenced by everything from higher co-payments to just plain annoyance, leading to the ER. While some patients conscientiously measure their peak flows, others do not. (With the smallest patients, of course, parents must rely on visual and behavior clues to ascertain asthma control.) The result: worse performance at school and at work, and higher costs measured in hospital treatment.
Thomas explains, “Managing asthma is frustrating because we’re all human beings. We have idiosyncrasies. We all do things we shouldn’t do. But technology can make it cheap, easy, and—very important to younger patients–cool to change.” The first step was the Wheezometer, a device that is held against the throat just under the chin. It records the information on the spot and indicates the level of asthma activity on a display.
With smartphones becoming ubiquitous, however, the transformative instrument is at hand in the form of an app called AsthmaSense™. Initially AsthmaSense™ will allow highly convenient record keeping for all information pertinent to an asthma action plan, but a second version will offer an attachment a la the Wheezometer™, to hold under your chin, with the same analytic function and recording function performed “in the cloud.” Limitless access to functionality can turn a mobile device into a custom personal asthma manager, which can warn a patient about pollen counts, or in concert with GPS, can advise that he might be entering a city experiencing an ozone alert.
Thomas says, “Using a cloud database we can compile snapshots for patients that doctors can share, too. The value is trend data—no one is going to measure themselves hour by hour, and no doctor is going to follow a patient in real time. But a couple of times a month, a health care provider—it doesn’t have to be a doctor–or a patient can look at it and see what’s going on. The cloud makes it easy to get data, compile a longitudinal record, and also a global comparison—how a patient is doing relative to others under the same environmental conditions.”
It will also give the provider insight into compliance issues for individual patients. For example, “I see you still have your dog.”
Pricing is still a work in progress, but Thomas says, “The subscriber fee will surely be less than the insurer’s cost for a single spirometry. The cost of information is negligible.”
This is good news for health care costs. “Payers need good data to get their coding, and this will supply impeccable data,” Thomas told me, “But it wouldn’t even have to be billable in the standard sense. Costs drop dramatically when people do the right thing—stop smoking, get more exercise, and take their asthma meds. Doctors can use this, but also nurse practitioners, asthma educators, mothers and patients-even quite young ones. It could be offered by a plan as an inducement for enrollment—sign up with us and get the latest technology to help manage your asthma.”
We plan to keep our eye on this technology. In coming weeks and months we will feature a guest editorial written by iSonea explaining the technology. Dr. Ehrlich has been sent the peer-reviewed articles listed below for comment, and perhaps his own analysis will be forthcoming. And finally, our own Certified Asthma Educator, Harriet Spitzer Picker has agreed to be a beta-tester for AsthmaSense using her own iPhone.
For more information, visit www.isoneamed.com.