Asthma care provides an exemplar of both the brilliance and the imperfections of technology. The mass availability of convenient, affordable, effective asthma inhalers completely transformed the daily lives of people with asthma. Outcomes improved dramatically as a result, but these have plateaued in part because inhaler design can make it difficult to be used correctly. Billions of pounds have been spent worldwide trying to drive correct adherence, and yet with limited results. As with many other aspects of our lives it is the promise of new technologies linked to the mobile phone that might finally deliver the personalised lifetime asthma support that people with asthma need.
The Nuffield Trust’s report, Digital requirements for new primary care models, highlights how technology can help to enable primary care to meet the historic demands and pressures it faces. With 85 per cent of asthma patients managed exclusively in primary care, it’s essential that asthma is placed at the heart of new technologies.
There is no doubt we need a revolution in how asthma is managed. In the UK around £1 billion is spent annually on asthma treatments that we know are imperfectly used. Around 2-3 per cent of primary care consultations are for asthma. Given the demands on these appointments and the financial challenges the NHS faces we urgently need a shift towards supported self-management and less reliance on overstretched clinical services.
Digital technologies are the best hope to help us achieve this. In our new report, Connected asthma, we look at some of the types of technology already emerging – from predictive algorithms that could help identify those most at risk of an attack to digitally-provided asthma action plans and smart inhalers.
A smarter type of inhaler
In our report, we highlight how smart inhalers linked to smart devices have emerged. These use sensors able to measure when and how inhalers are taken in real-time. This shift from infrequent in-surgery data collection about someone’s asthma to a constant stream of personalised precision data delivered remotely via a mobile phone is likely to drive dramatic reconfiguration of models of care. Smart inhalers are already starting to be used within the USA, and the early results from clinical studies are very encouraging – one trial saw a 60 per cent improvement in asthma control.
Smart inhalers have the potential to help people take their medication at the right time and right dose in response to their condition and personal environment, as well as improve inhaler technique. The stream of precision data combined with other data sets could also enable a whole new area of research discovery. It could be transformational for asthma care, which is why market analysts are already predicting that the smart inhaler market could reach $3.56bn by 2024.
Supporting people with asthma remotely
The Department of Health in England wants to see 25 per cent of patients with chronic conditions monitor their symptoms remotely by 2020, using digital tools to aid self-management. Given the size of the asthma population, its relatively high proportion of younger people compared to other long-term conditions, and asthma’s evidence base on self-management, we believe asthma is ideally placed to drive this move towards tech-enabled care.
But we should see that transformative change goes beyond simply monitoring symptoms, and be realistic about how much time a population used to digital automation will spend doing so, especially when a condition, and the need for monitoring, is likely to be lifelong. Automating data collection, wirelessly transferring data and then linking the rich pool of currently-available patient information in the NHS, is the key to better supporting people with asthma. Health care professionals would be better informed on their patients’ health, and would be more able to stop asthma attacks by focusing resources on those most at risk of an asthma attack in real time. For those whose asthma is well-controlled, that could mean they do not need to attend routine GP appointments such as their annual review – which an estimated two-thirds of people with asthma do not attend – releasing those appointments.
Innovations tailored to users’ needs
Asthma UK is a partner on myAirCoach, a project funded by the European Commission that aims to develop a holistic, personalised asthma monitoring system. Through this ambitious project of innovation, we’ve helped to ensure the views and needs of people with asthma have driven the development of the system. Coupled with learnings from our work improving our own digital services, this provides interesting insights for anyone working on technology enabled asthma management. What it clearly shows is the need for any new developments to be driven firmly by the needs of the user, and possibly different groups of user, rather than starting with replication of old clinical approaches.
For example, Asthma UK recently developed a segmentation of the UK adult asthma population based on over 900 variables including national health data sets and Experian’s Mosaic Public Sector. We’ve found that many of those in groups at higher than average risk of an asthma attack are also high users of technology, but don’t currently have technology solutions for asthma matching the user experience of the apps and digital tools they are using in the rest of their lives. People with asthma span all ages and very many are of working age or still in full time education - they are the typical digital native and will be the future ‘consumers’ shaping the NHS of tomorrow.
The myAirCoach findings show the views of people with asthma and health care professionals about new technologies. For example, people with asthma are more wedded to the operating system of their mobile phones than their brand of inhalers. Around 45 per cent of people with asthma would be willing to change the brand of their inhaler to have access to a mobile health system; but only 20 per cent of iPhone users and 32 per cent of Android users would be willing to change their operating system to have access. And already one in four of the 5.4 million people with asthma say they would feel comfortable replacing routine check-ups with a mobile health system that monitors their symptoms, despite the fact no such system is available yet.
Tech that requires big changes in everyday usage and habit, delivers a poor user experience, or requires anything other than limited data input simply won’t be used – certainly not over a lifetime. User-centred design is paramount to ensure that the tech innovations being produced will give enough everyday value to those that could benefit from them to ensure large scale sustained adoption.
Kick-starting asthma tech in the UK
Whilst some technologies may take a little time to get fully embedded in NHS systems, there are others which would be simple to introduce quickly – for example, digital asthma action plans. If you have an action plan, you are four times less likely to be admitted to hospital, but only 30 per cent of people with asthma have one, with nearly all provided in paper format. Whist there is increasing guidance about technology adoption from the NHS we need that pathway to be as simple and agile as possible so tech innovations for asthma are, where shown to be effective, adopted within the NHS. At the very least the NHS needs to get the basics in place urgently – paper-free action plans and data sharing can be done right now.
Delivering technology-enabled asthma management
Outcomes for asthma have plateaued in recent years and this must be changed. We’ve highlighted that some technologies already exist and need to be introduced at scale. But we also need to ensure there is a constant pipeline of new technologies that are effective, safe and that people fully embrace.
This will all require a number of partners to help achieve it – using the expertise of academics, industry, healthcare professionals, policy makers, regulators and most critically, people with asthma.
Please note that views expressed in guest blogs on the Nuffield Trust website are the authors' own.
Boycott K (2016) ‘The digital revolution in asthma care’. Nuffield Trust comment, 17 August 2016. https://www.nuffieldtrust.org.uk/news-item/the-digital-revolution-in-asthma-care