At any moment, someone in the U.S. most likely is having an asthma attack. The breath-robbing disease afflicts around 25 million Americans, and every year about half of them lose control of their asthma. They may rush to the emergency room or reach for a rescue inhaler, a source of quick-acting drugs that can relax constricted airways in minutes. Predicting who is at risk of such crises is difficult, however, because the relevant statistics that would identify trends come from the patients' own recollections days or weeks after the emergency.

In several U.S. cities, a new technology may change that. In Louisville, Ky., in parts of California and in Washington State, asthma patients are using rescue inhalers topped with a small sensor that wirelessly broadcasts when, where and how often the device is used. The data pass through a secure server to patients' mobile phones and a physician's Web dashboard, providing an instant record of how well a patient is doing and archiving the information for future reference.

The device and data-monitoring system—which are collectively called Asthmapolis and which were approved by the U.S. Food and Drug Administration last July—constitute just one example of an emerging strategy in a movement so new that no one has yet coined a catchy name for it. That movement holds great promise because it combines traditional medical record keeping and public health surveillance with data mining and mobile phone technologies. Together these tools produce deep, up-to-date reports that can benefit patients and medical researchers, as well as public health and environmental authorities, all at the same time.

“If you think about the driving forces that are going to shape health care for the next 20 to 30 years, three things stand out: major aging in the population, massive growth of chronic disease, not enough caregivers,” says Steven DeMello, director of health care at the Center for Information Technology Research in the Interest of Society at the University of California, Berkeley. DeMello says that mobile diagnosis and surveillance could help blunt the impact of changing demographic trends by recognizing health crises early, by providing connections for remote care and by giving patients enough information to gain control of their disorder.

First Breath

Asthmapolis emerged from co-founder David Van Sickle's frustration with government asthma data, a feeling that burgeoned after he received his Ph.D. and while he was serving as a disease detective in the National Asthma Control Program at the Centers for Disease Control and Prevention. “Despite all that we know about asthma and how to treat it, the majority of individual patients actually have uncontrolled disease,” he says. “Their physicians can't course-correct, because patients don't report how poorly they're doing, and so they end up at higher risk of ER visits, hospitalizations, missed days of school and work—and that's all below public health's radar.”

Van Sickle realized that patients were already carrying around devices that could objectively report their status: rescue inhalers. Most asthma patients take slow-acting drugs daily to keep their condition in check; repeated use of an inhaler signals a developing emergency. Beginning in 2006, Van Sickle and several partners created a wireless sensor that is now being tested in various settings. In Louisville, for example, researchers are using the device to identify local environmental triggers of asthma; in Sacramento, the focus is on proper follow-up care.

The Louisville project's sponsor is the municipal government. Ted Smith, its director of innovation, says Louisville hopes to deploy at least 500 sensors to construct a yearlong portrait of the impact of the disease on the population and the role that the city's notably poor air quality plays in making it worse. The Sacramento project is based inside Woodland Healthcare and Mercy Medical Group, two subsidiaries of the health care system Dignity Health. The goal is to test whether patients' health is improved by real-time feedback of their symptoms to their physicians. Michael Patmas, Woodland's chief medical officer, says the project may benefit other patients as well. First, many local asthma patients are farmworkers whose dusty outdoor work provokes their attacks; better management of their health might keep them out of the ER and thus reduce overcrowding. Plus, comparing the aggregated data from the patients' sensors with local weather reports could allow the hospital to alert all patients to possible risks through, for example, short text messages (SMS). “If it's dry, and it's hot, and the wind is blowing in a certain direction, we can send an SMS warning: ‘Bad weather conditions today,'” Patmas says.

6 Comments

1. 1. drscarlat 06:03 PM 2/22/13

   One small gadget that has a great potential in making one healthier is the old fashioned....bathroom weight scales.
   This low tech device was shown in numerous peer reviewed articles to be especially helpful in monitoring the congestive heart failure patients' weight, since gaining a few pounds for these patients is usually due to fluid retention / salt overload, usually preceeding an exacerbation of the heart failure.
   A. Scarlat MD

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2. 2. AlexZiegler 06:09 AM 2/23/13

   In terms of getting people to use them as well as to counteract the afforability, assuming that the fitbit leads to health awareness and as a result people are encouraged to be healthier, it would just be a matter of someone doing a study to see if individuals within buisness who had the fitbit showed increased productivity. Once this connection is made, many people who wouldnt buy the fitbit normally wouldnt have to, buisnesses would because it would be in their best interest to. Not only that but its a good PR move as well.
   

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3. 3. Patbrry in reply to AlexZiegler 04:05 PM 2/27/13

   How much are fitbit paying you to tag their product in connection with mobile health articles?
   shill.

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4. 4. Patbrry in reply to AlexZiegler 04:09 PM 2/27/13

   Ahh, page2 - I apologise :)

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5. 5. szlfsmit 05:15 PM 3/1/13

   There are significant differences between consumer athletes and healthy consumers reflected by use of Run Keeper mobile apps and Fitbit health awareness devices versus mobile health devices to engage, monitor and support patients with a diagnosis.
   
   Software applications with dashboards summarizing the large volume of data and alerting both patients and their physicians and securely communicating the data and status directly into the patient's medical record in a standardized way remain as technical, legal, and organizational challenges.
   
   However, the potential to alter the common disease progressions (HTN ,DM, Obesity) to complications, high healthcare cost and suffering is great.
   
   (Disclosure- I am member of Woodland Healthcare Asthmapolis project team.)
   
   LFS
   

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6. 6. waldmanrachel 02:47 PM 3/22/13

   I wonder if this kind of mapping technology could be used to address gun violence by transmitting the location of registered weapons each time the safety is removed? It would instantly alert police if safety locks are removed outside of a gun range, hunting zone or other legal gun use space. For example, if a privately owned rifle transmits safety lock removal at say, a mall or school... well, the police would be on their way. Just an idea.

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