Using technology to improve asthma and respiratory management

By Dr Amy Chan PhD, BPharm(Hons), MPS, RegPharmNZ Senior Clinical Research Fellow (University of Auckland) and Lead Pharmacist – Clinical Research (Auckland DHB)

‘Beep beep beep’. The familiar yet annoying sound of my phone alarm going off in the morning for work cuts through my sleep. Bleary-eyed, I sleepily click it off as I get ready for another day at work.

Rain – low 17 degrees, high 26, windy conditions expected from 14:00 – 20:00. High pollen counts expected, likely to trigger asthma. High risk of asthma worsening. Click to review plan.

A push notification pops up on my phone. I click to review my plan on my asthma management app, which has helpfully checked the weather and my triggers for me for today. It reminds me to take my preventer before I head out to work, and asks if I want to book an appointment for my asthma review with my GP in two weeks. I push yes to send off the appointment request and throw in a request for a repeat prescription of my inhalers – something I had been meaning to do for weeks but had been slipping down my to-do list. Thank you phone, what would I do without you?

Digital technology use – the current landscape

This seamless integration of digital health apps and technologies into our daily lives may have seemed impossible in the past – yet now, in 2022, it is very much a tangible reality. I still recall the first mobile phone I had in high school – a phone the size of a cordless phone complete with antennae. Other than playing ‘snake’ and using it for the odd text or two (due to the extortionate costs of SMS messages back then), it served very little purpose even for telecommunications, let alone for management of health.

Fast forward two decades, and smartphones and smart devices such as watches are one of the most commonly used and owned pieces of technology. Global data estimates that the current number of smartphone users in the world is over 6.6 billion, meaning at least 84% of the world’s population own a smartphone. Even in low-middle income countries, mobile phone penetration has surpassed 90% in recent years, though internet connectivity still lags. This has provided unique opportunities to revolutionise the way healthcare is being delivered; the costs of mobile technologies are becoming increasingly affordable, enabling most people around the world to benefit.

Mobile phones are also user friendly and generally do not need much literacy or technological proficiency to use. In New Zealand, the often quoted ‘digital divide’ between Māori and non-Māori is closing, at least when it comes to owning or having access to a mobile phone: data from Te Puni Kōkiri shows equivalent rates between Māori and non-Māori, with high usage particularly in young Māori. A survey from 2015 reports 91% of New Zealanders use their smartphone every day, and 86% use their smartphone to look for reference information, with the most common use of apps being for referencing or information (79% of respondents).

These data highlight the great potential for using common digital devices such as smartphones to manage our health, both as a country and globally for humanity. If anything, the coronavirus pandemic has only served to accelerate the development of digital health technologies and heighten the importance of using technology in our lives – not only for communication, but for health management and accessing information.

Technology innovations in respiratory health

There are a variety of digital technologies that have been developed for respiratory health. Apps have been around since the early 2000s, with health apps becoming commonplace thereafter. Apps for respiratory health can serve a range of functions:

• informing (providing information); • instructing (providing instructions to the user); • recording (capturing user-entered data); • displaying (graphically showing data); • guiding (providing guidance based on user-entered information such as recommending treatment or medical care); • reminding (alerts or reminders to the user); and • communication (such as communication with a with a healthcare provider or links to support networks).

These apps have shown benefits for improving asthma control; though what affect the app has will depend on the functionalities on the app. Beyond smartphone apps, there are also medical devices that support asthma and respiratory self-management such as smart inhalers, smart peak flow meters and even smart spacers.

Smart inhalers have existed since the 1980s, but have only become more developed for everyday use since the late 2000s. These devices attach onto asthma inhalers and can give reminders for when doses are due, feedback on inhaler technique, and reports on medication-taking trends based on dosing records. Some of the devices can sync with an app or portal, and integrate with medical records so health providers and individuals with asthma can make decisions about treatment based on a review of medication use. Use of smart inhalers with an audiovisual reminder function was shown to improve asthma medication taking by 50% in a 2015 study in New Zealand, with improvement in overall asthma control.

Smart peak flow devices were developed more recently in 2017, with the primary function of recording peak flow readings digitally. The meters can also give the user reminders, live feedback and recording of their peak flow, with a digital animation on-screen to encourage optimal peak flow, and motivational messages, rewards or challenges to encourage regular peak flow monitoring. The device can link to a computer or mobile phone so users can keep track of their peak flow measurements and patterns in the context of their personal best scores, and share their readings with their healthcare team. The impact of smart peak flow on asthma management has not yet been fully explored.

Other digital innovations include ‘smart’ or intelligent spacers, which can record medication-taking and whether the inhaler had been shaken before, activated soon after shaking, and if a sufficient volume had been inhaled from it. How these spacers can help with asthma management is currently the topic of research studies overseas. There has also been increasing interest in the use of smart spirometers and smartwatches in recent years to monitor and manage asthma – both innovations to watch for in this space.

How can we use these digital advances in our everyday respiratory management?

These digital advances have the potential to support more seamless and timely data transfer between health systems, improved communication to streamline patient care, and sharing of up-to-date information. These innovations can also empower people to take more ownership of their own respiratory health by being able to check and monitor their own asthma status, their medication management, and their own health data.

These technologies are likely to serve as an extra tool to support individual self-management, but are unlikely to replace traditional healthcare completely. In the future, systems may be able to apply artificial intelligence and machine learning to understand and foresee changes in respiratory health.

What are some things to consider with digital technologies?

The advent of digitisation provides great opportunities. However, with great opportunities also comes great responsibility. Data governance, privacy and confidentiality and the effect on health inequities require consideration. There is a need for robust processes to be developed to safeguard the data and ensure that use of technologies does not worsen inequities due to differences in access between populations.

Despite the increasing innovations available to us at our fingertips, there remains a need to have non-digital systems to support any digital processes. As with all digital advances, no level of smart technology can completely replace in-person care – as technologies continue to evolve and become more sophisticated, so too should the role that we play as technology users, in managing these innovations.

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