Your phone will see you now, about your asthma

The use of technology in health is one of the fastest evolving areas in the digital revolution, and asthma is no exception. From cough monitors, smart inhalers to digital peak flow meters, digital tools are transforming the asthma journey for patients and health providers alike, potentially revolutionising the way asthma is managed.

Asthma is one of the most common lung conditions in New Zealand, affecting one in eight New Zealanders. There are rising rates of asthma attacks too – with a 33 percent increase in asthma attacks in the last decade, and an asthma attack occurring every 2.5 minutes on average.

Why New Zealand has such high rates of uncontrolled asthma remains a mystery but what we do know is that with so many New Zealanders affected by it, good asthma control is crucial. New Zealand has made remarkable progress in improving treatment, but emerging technologies are likely to make asthma care more efficient and personalised.

Digital support for living well with asthma

Asthma is so common that the seriousness of the condition is often overlooked; most of us know someone with asthma. But one person’s asthma is not the same as another’s. Asthma is highly heterogenous with significant variability between people and even within the same person. This variability in symptoms is what makes asthma difficult to manage. The good news is that this variability also makes asthma an ideal condition for digital technologies to support asthma care – by improving self-management, personalising information, supporting diagnosis and monitoring, and predicting when an asthma attack might happen.

Supporting self-management

Asthma action plans have been shown for years to improve asthma management, but many New Zealanders with asthma don’t have them. Digital action plans may be more effective and easier to use. Digital action plans combine symptom questionnaires and peak flow measurements with automated feedback algorithms to help patients manage their asthma. Some also include integration with various digital devices and mobile apps.

Digital or ‘smart’ inhalers have also been developed. These can track the date and time of medication use and provide feedback to patients. One of the first digital inhalers was developed in New Zealand and was shown in an NZ study to improve medication taking by over 50 percent. It was also shown to improve asthma control in children admitted to hospital with asthma.

These digital inhalers can also provide feedback to patients on inhaler technique. Similarly, digital smart spacers with flow sensors can detect inhalation errors – overseas, smart spacer-driven education reduced daily inhalation errors by over a third. The real-time feedback these devices offer is invaluable for ensuring patients use their inhalers correctly. Researchers at the University of Auckland are running the world’s first smart spacer study.

Personalising health information

Wouldn’t it be nice to have a personal health assistant available 24/7? Digital technologies are making this a reality for asthma patients. Through search engines and AI-powered tools such as ChatGPT, patients can ask questions about their condition and receive accurate, timely answers. Recent research has evaluated ChatGPT-3.5’s responses to common asthma-related questions and showed an impressive 80 percent accuracy.

There’s something for the kids too, with serious video games (games created for a purpose, rather than pure leisure) designed to teach children about asthma through interactive online gaming.

Diagnosis and monitoring

These new technologies make life easier for health providers too, offering a more precise method of diagnosing asthma. Traditional methods, such as patient history taking and clinic-based spirometry, can be inconsistent. Digital tools such as smartphones, wheeze detectors, AI cough monitors, and smartwatches can provide objective evidence of respiratory symptoms and airflow variability.

Such tools can be used in the comfort of a patient’s home and can build up a comprehensive picture of their condition over time. For example, smartphones can record respiratory symptoms, capturing both sound characteristics and patterns of breathing. Wheeze detectors and AI cough monitors can help provide objective evidence of wheezing and cough patterns. Digital technologies also help with symptom tracking, lung function monitoring and identifying environmental triggers such as pollution and allergens.

The ultimate goal of asthma management is to go into remission or ‘outgrow’ asthma symptoms, defined as a high level of asthma control with no asthma attacks over a prolonged period. Digital technologies can play a crucial role in this by providing continuous, objective data that can help healthcare providers assess when a patient may be approaching remission more accurately and adjust treatments accordingly.

Predicting asthma attacks

Imagine a world where your smartphone alerts you to an impending asthma attack, giving you time to take preventive measures. Though current models predicting asthma attacks are not yet in use, research is underway in New Zealand to see if everyday technologies such as our smartphones and smartwatches can capture the biophysical changes that happen before an attack and predict when an attack might be coming. This could transform asthma care completely, and reverse the increasing asthma attacks we are seeing in this country.

Digital technologies are changing the paradigm of routine asthma care, in a good way, providing more effective, personalised, and equitable treatment for all patients. The journey from diagnosis to remission is complex, but with emerging tools and strategies, we can make good asthma control a reality for the millions living with asthma.