Sam Etherington is just 19 but has been in intensive care three times.
Sam, a security guard, has struggled with asthma all his life. Diagnosed aged three, he has tried inhalers of, “all colours and sizes,” has missed school and had numerous hospital stays. His symptoms are worst at night.
He said: “Sometimes I’d wake up and it felt like there was a tight belt around my chest and someone was pulling it.”
Sam’s third intensive care stay underlined the importance of taking his inhalers as prescribed.
Sam Etherington holds his inhaler. Photo rights: Vodafone
“If I was in a rush on a school morning, I didn’t always take my preventer inhaler,” he said.
“When my treatment was reviewed after I got out of intensive care, I was told that that could have contributed to the attack and to keep it beside my bed and prioritise taking it in the morning.”
Sam, who lives near Durham in England, isn’t alone in forgetting to take his asthma medicine. Around half of patients with chronic illnesses don’t take their drugs as prescribed* and some only see their doctor for 10 minutes a year**.
Some 30 million under-45s in Europe have asthma and it is estimated that two in three of the 1,000-plus deaths a year from the condition in the UK could be prevented with good basic care, including better use of medication and more detailed advice from GPs.
The charity Asthma UK says the condition is, “ideally placed to be transformed by technology,” and pharmaceutical giants including GSK, Novartis and AstraZeneca are investing in smart inhalers – digital sensors that clip on to existing inhalers and record when each puff is taken.
Paired wirelessly with smartphones, tablets and computers, they can remind someone when it’s time to take their inhaler and coach them on how to use it properly.
If agreed, the information can be shared with the patient’s doctor, allowing them to check how well and how often the patient is using their inhaler so they can make more informed decisions about treatment.
Photo rights: Vodafone
Even simply knowing that a patient is taking their inhaler can help.
Anna Murphy, a consultant respiratory pharmacist, said: “I’ve been to patients’ houses and they have 80 or 90 inhalers sitting underneath their bed – they are just not using them.
“This isn’t about checking up on patients. It’s about getting the fundamentals right and working with them to get the best out of their treatment.”
Jen Townshend, a consultant paediatrician and founder of the Beat Asthma website for young people, said: “Asthma can be serious and taking your medication properly can make a huge difference.”
Mobile phones may also have another role in helping people with asthma breathe easier in future.
Dominick Shaw, a professor of respiratory medicine at Nottingham University, who is researching smart inhalers, said: “You could imagine in five or 10 years’ time your smartphone telling you what your environment is like.
“For instance, you might get a message telling you which pollution hot spots to avoid, if there is a certain virus in your area during the flu season or if a cold snap is due. If cold air upsets your asthma you might not go for a run the next morning.”
Sam’s asthma has improved recently but developments in technology could help him and other chronic sufferers breathe more easily in the future.
The internet of things (IoT) – in which devices from traffic lights and lamp posts to the latest medical gadgets are connected by telecoms networks, allowing them to talk to each other and us – could transform the way conditions like asthma are treated.
In the London borough of Greenwich for example the mobile industry association, GSMA has installed hundreds of sensors that collect data on air quality before relaying the information to administrators trying to improve air quality and health in the city.
Jon Lee-Davey, Vodafone Group’s healthcare lead in its IoT division, said: "Information about other factors, such as high volumes of traffic, temperature, wind and humidity could also be collected and factored in, allowing people with asthma to plan their day and better manage their condition.”
Smart inhalers are likely to operate on an opt-in basis, meaning data will only be shared with the patient’s consent and healthcare regulators in the US and Europe are issuing guidance and putting safeguards in place. But cybersecurity is likely to still be a concern for many.
There are also questions over whether doctors will have time to deal with all the data generated by the devices
Dr Murphy, of University Hospitals of Leicester NHS Trust, said it is vital that medics don’t see the devices as a quick fix because discovering someone isn’t taking their medicine properly is only part of the problem.
Much as showing someone they are overweight by putting them on the scales doesn’t guarantee they will lose weight, simply monitoring someone’s inhaler use won’t necessarily mean they change their habits.
Cost will also be an issue, with some warning that the devices are unlikely to be available to all. However, others argue we cannot afford not to embrace the technology.
Asthma UK said more research is needed before the inhalers are widely used and stressed that “robust” privacy safeguards are essential.
However, it added that smart inhalers could “revolutionise asthma care” and the data they gather could one day be used “to help prevent, treat and hopefully one day cure asthma.”
*World Health Organization, 2003, Adherence to long-term therapies, [online] Available at: http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf?ua=1 p. XIII
**Dr Andy Whittamore, 2017, Smart inhalers - your questions answered. 9 February. [Blog] Available at: https://www.asthma.org.uk/about/media/news/smart-inhalers-questions-answered/
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