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Digital Tools Can Improve Efficiency & Effectiveness of Respiratory Therapy-The HSB Blog 6/7/22



Our Take:


The continuous monitoring of chronic respiratory conditions with digital tools allows patients to better understand conditions and assist clinicians in monitoring effective dosages and treatments for illnesses. Digital health technology allows patients to utilize tools such as smartphone applications, remote patient monitoring, digital inhalers, and self-education tools to combat an increasing litany of health conditions and has been shown to be an effective treatment for disease. In addition, with projected temperature increases due to climate change and ever-changing atmospheric and weather conditions adding pollutants and irritants to the atmosphere, respiratory illnesses are expected to increase in incidence in the future.

Key Takeaways:

  • It is estimated that over 300 million people worldwide suffer from asthma, 64 million with COPD & 30% of the European population suffer with Allergic Rhinitis.

  • With increased hazardous climate conditions, COPD is predicted to become one of the leading causes of death worldwide by 2030.

  • Evidence indicates that digital inhalers enhance medication management and guide clinical care in patients with asthma or COPD.

  • Continuous monitoring for chronic respiratory conditions can produce the expected efficacy needed and effectively determine the appropriate number of doses for inhalation therapy.


The Problem:


As noted in “Climate Change and Respiratory Health” accelerating climate change poses a particular threat to people living with chronic disease, including respiratory issues like asthma, chronic obstructive pulmonary disease (COPD), allergies, emphysema, and lung cancer. While nations work to reduce greenhouse gasses by 80 percent by 2050 in order to curb many of these health consequences, some effects are inevitable and persons living with respiratory disease and their caretakers will need to adapt to a changing climate.” While more recently the world has begun to focus on issues of Environmental, Social, and Governance (ESG), one often overlooked issue is that the state of the worlds respiratory health is directly related to many of the current changes the world’s population is going through. As pointed out in “Climate Change and Respiratory Health” as the world’s climate worsens & summers become hotter and drier, there is an increase in the pollution of the atmosphere, in the unpredictability of extreme weather conditions, in wildfire incidences, of allergies per season, and diseases spread by weather related vectors become more prominent.

The risk to human health is increasing with the change in climate.

For example, a study by the World Health Organization (WHO) in 2018 concluded that chronic respiratory disease accounted for about 7% of all deaths during the year. These chronic conditions are not only an issue for patients and communities but they are an added stressor on the healthcare system. It is estimated that over 300 million people worldwide suffer from asthma, of which of 10-15% suffer from uncontrolled asthma. Allergic Rhinitis affects up to 30% of the European population & 64 million people suffer from COPD according to the Journal Allergy. They also note it is predicted that COPD will become the leading cause of death worldwide by 2030 and that these percentages are either set to stay the same or rise with the increases in global temperatures brought on by climate change.


The Backdrop:


While respiratory health solutions such as inhalers and spirometers have been available for some time, digital health offers updated formats of these devices and others including home respiratory monitoring devices, and digital inhalers that facilitate continuous monitoring of one’s own respiratory conditions. For example, according to a 2018 research study in the Journal Allergy, mHealth tools for chronic respiratory diseases were able to measure the functionalities of 112 different applications. The applications’ functions included self-monitoring, personalized feedback, and patient education on conditions such as asthma, COPD, rhinitis, and rhinosinusitis. In addition, as a recent article in Medical Informatics noted, predictive AI algorithms for remote monitoring interventions may have the potential to improve current chronic condition management strategies.


Moreover, as noted in a recent article in Pulmonary Therapy, other forms of research involve the use of digital inhalers for asthma and COPD. These are inhalers that monitor the time and date of dosing, thus promoting collaborative care between clinicians and patients. This will provide a more in depth understanding of inhaler use. Digital devices record the inspiratory flow with inhaler use and can guide proper inhaler technique which is likely to be a clinically useful lung function measure. For example, companies like NuvoAir use a Bluetooth enabled spirometer that remotely monitors lung function,a sensor that attaches to asthma and COPD inhalers, and an integration with Fitbit devices. This data is tracked through remote monitor systems that detect changes in the way you cough during the night.


Implications:


As noted earlier both COPD and asthma are common diseases worldwide and currently affect over 300M people. Both diseases require inhalation therapy methods in order to effectively monitor conditions. As noted in “Role of new digital technologies and telemedicine in pulmonary rehabilitation” the continuous monitoring for chronic respiratory conditions can produce the expected efficacy needed for the lower occurrence of systemic side effects and effectively determine the appropriate number of doses for inhalation therapy.” In addition, as the aforementioned article from the Journal of Medical Informatics noted, the effectiveness of remote Bluetooth monitoring for chronic conditions demonstrated that “impact studies [show ]some evidence of improvement in process and outcome measures [as well as the fact] that remote monitoring interventions may have the potential to improve current chronic condition management strategies.”

Moreover, the use of smart phone applications like the Propeller Health from ResMed which includes digital inhalers for asthma and COPD have proven effective in research and been well received in the market. For example, as noted in the previously referenced article in Pulmonary Therapy, “evidence indicates that digital inhalers enhance medication management and guide clinical care in patients with asthma or COPD, with benefits of increased medication adherence having the potential to improve clinical outcomes”. Similarly, a recent TechCrunch article entitled “Inspired by founder's childhood asthma, NuvoAir raises $12m to tackle respiratory illnesses” reported that digital health technology companies like NuvoAir determined that with the correct amount of funding poured into research for respiratory diseases, data could better inform people with ongoing respiratory illnesses about their conditions and help them manage their health more efficiently. Using devices like these, clinicians are able to more precisely monitor dosing, titrate dosing based on weather conditions and irritants and even monitor patient responses to dosages, all of which would help move treatment from point-in-time therapy towards more effective, adaptive and efficient continuous monitoring.


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