mHealth for asthma: Help me manage it myself!

According to the WHO, around 600 million people worldwide suffer from chronic respiratory diseases such as asthma. Key in the fight against these diseases is therapy adherence, but many sufferers often find this difficult. The result is increased hospitalization, which ultimately comes at the expense of the healthcare system. Smart and mobile technologies could change that.

A major hurdle to self-management of asthma is the low level of knowledge sufferers have about their disease. Studies show that many patients need repeated training to internalize and properly execute the inhalation process. Smartphone apps can help. This is because many of them contain explanatory videos and provide a questionnaire to be completed regularly or a diary function, enabling sufferers to gain a better sense of their own disease, understand it better and thus self-manage it more effectively.

The app "Kata" complements these services with augmented reality and artificial intelligence so that patients can be given direct feedback on their inhalation maneuver without the need for a doctor to be on site or to assist remotely.

In early 2019, a study was published that investigated the extent to which the interactive mHealth intervention ADolescent Adherence Patient Tool (ADAPT) supports the self-management of adolescent asthmatics and improves adherence to treatment with inhaled corticosteroids. Using the app, a Control of Allergic Rhinitis and Asthma Test (CARAT) had to be completed weekly for monitoring purposes. It also included short educational and motivational videos, a medication alert, and the ability to chat with other users and the pharmacist. The digital offering was shown to have a positive impact on adherence.

Many smartphone apps work in conjunction with inhalation or measurement devices. A position paper presented in November 2019 by the German Respiratory League, the German Society for Pneumology and Respiratory Medicine and the Association of Pneumological Clinics refers to these as eDevices. These include smart add-ons – hardware that can be connected to an existing inhalation device – on the one hand, and smart devices on the other. These are integrated solutions in which the electronic components are built into the inhalation device. In the app, the collected data and measured values can be made visible to the patient and made available to the attending physician. Furthermore, there is supplementary hardware for the mobile application, which primarily serves to monitor progress and activity. These include peak-flow meters, spirometers, FeNO meters, and activity and sleep trackers. The data can be transmitted to the smartphone via Bluetooth.

With Vivatmo me, Bosch has developed the first FeNO meter for the home. "Users simply exhale into the hand-held device as steadily as possible for just a few seconds. The exhaled breath is analyzed with the device measuring the so-called FeNO value, a measurement of fractional exhaled nitric oxide (NO). This is a marker that indicates the degree of airway inflammation due to an allergic reaction," explains Dr. Stefan Gebauer of Bosch Healthcare Solutions GmbH in an interview. Vivatmo me can be connected to the associated smartphone app, a digital asthma diary in which information on medication, personal condition, additional values from peak-flow meters, for example, or asthma attacks can be entered. "It allows the user to better navigate his disease and detect correlations – and spot allergy triggers that can cause an inflammatory response.," Gebauer says. Based on the final report, the therapy can be adjusted with the doctor.

In addition to apps and eDevices, wearables are now available for patient-specific asthma management. Respia is the world's first wearable chest patch. "It seemed to be the most convenient and the most accurate way, since it is almost like a wearable stethoscope," says Katherine Kawecki, director and co-founder of Respia, explaining the idea behind the product. "Respia checks the same things a doctor would look at in an auscultation. Then it makes an educated prediction based on probabilities of both demographic data combined with historic data of the individual user." Using an algorithm, Respia can even detect an impending exacerbation.

Smart shirts like Hexoskin's can measure lung function via the movements of the wearer's chest and abdomen. Since various other parameters such as heart rate, activity intensity or number of steps are also recorded, the shirt is suitable not only for people with respiratory diseases, but for anyone who wants to measure and optimize their general health. Samsung has filed a patent application for an intelligent shirt specifically for diagnosing lung diseases.

Thanks to the new Digital Care Act, it is possible in Germany not only to have pneumological digital aids prescribed, but also to have them reimbursed. On the other hand, however, the security requirements for digital aids such as apps are also increasing.

For the users themselves, the large range of products in the app stores poses a challenge. This can quickly lead to uncertainty. The PneumoDigital seal of the German Respiratory League, which tests and certifies apps according to important criteria – especially with regard to data protection – offers orientation.

Digital offerings help increase asthma patients' adherence to treatment, better connect patients and physicians, and improve care, thereby avoiding hospitalizations and ultimately reducing costs. By allowing patients to measure simple lung function parameters themselves, data is generated that benefits patients, physicians and researchers alike. Physicians receive accurate information about their patients' condition – even when they are not in the office. This is particularly important during the corona pandemic, when patients are postponing or missing doctor's appointments out of fear. For the individual patient, this means an individualized treatment plan at all times. This means that geographical distance, time zones, possible language barriers or even regional differences in the quality of treatment and therapy can be overcome. Another advantage is that digital health solutions are less cost-intensive and easier to implement than analog solutions.

So everyone should have an interest in the development of mHealth offerings for respiratory diseases such as asthma: Patients, physicians, health insurers, government and developing companies. In times of increasing patient numbers and a lack of medical personnel, supplementing the existing care system with digital health solutions is inevitable.