mHealth: Asthma Gets Its Tech On
I have a couple of constant companions in life--about 95% of my waking life, I have two things in close reach: my inhaler, and my iPhone. Realistically, I'm more likely to be able to tell you where these things are than where my wallet is (seriously). I try to maximize the smart in smartphone, and sometimes take that to the next level. Part of this, is integrating what's known as mHealth into my life--the M in mHealth is simply for mobile. And, it makes sense: I need my health tracking technology to keep up to my life, and be where I am, otherwise it's not going to do a lot of good.
mHealth isn't just for twenty-five-year-old health bloggers with asthma, though. mHealth Is about making health experiences more tangible for everybody with a mobile device, and increasing knowledge about your experiences to help provide useful information that can be used to assist patients in making appropriate, timely decisions regarding their health and medical care 1. (Anantharam, Banerjee et al.) For those of us with asthma "timely decisions" can be huge: with a massive, nearly infinite, number of things that can impact our respiratory health, having a way to accurately record and interpret this data is important. These things include our asthma triggers--which may be known or unknown, and are not necessarily straightforward to determine. At present, mHealth really only gives us information regarding the data that we actively give it. In an article I read, however, they use a "multimodal" technique to gather this information--sensors are used to passively gather data, and asthma control questionnaires are also actively responded to, alongside other information which requires the patient to take a more "active" role--logging symptoms, identifying triggers if possible, or doing simple self-tests to add quantitative data (numbers) into the log.1 Enviornmental conditions, triggers, wheezing (sound sensor), respiration measurements (radio wave sensor), exhaled nitric oxide measurements and GPS, accelerometer data were used in the sensor kit in this study to better detect patterns in a child's asthma--particulate matter1, also known as "stuff in the air" can also collect important environmental data, and can--with enough effort--be accessed by those of us with asthma to gain better understanding of our lungs. In the above study, known as kHealth, indoor air quality information was collected via a sensor, as well as temperature and humidity levels1. A different study used oxygen saturation, immunotherapy (allergy shots), activities, symptoms and symptom duration, activities, and oxygen saturation 2--however, this sounded as if a lot more active involvement was required than in the kHealth study previously described. Combining this data (usually, in mHealth, via the Cloud) can help detect patterns, and provide alerts of when asthma may be worsening, when conditions are present that may cause asthma to worsen, and generally take some of the unpredictability out of asthma. This is done by providing actionable and relevant (aka useful to YOU) information, that can actually help guide those of us with asthma to create meaningful change.
What do I mean by meaningful change? What if an app on your mobile device could tell you You're entering this area (also known as a geofence) and you've experienced worsening asthma symptoms 4 of 6 times you've been here previously, or You've been more active than usual in the past month, and you've had a reduction of asthma symptoms--let's watch and see if there's a correlation. There is real possibility that by making information tangible and delivered in a timely and applicable format, that it could have a massive positive impact on determining why asthma is or is not controlled, and where barriers for each individual patient may be experienced--and then develop a plan to work around them. As stated in a 2015 article "No [app] provides comprehensive asthma information while at the same time possessing the characteristics of an efficient tool for self-management of [asthma],"2
The kHealth system, in the study I read, was used on four 5-17 year old kids with asthma 1 --we can, for the younger set at least, assume that the system was mostly set up and monitored by parents. The article noted that there was a learning curve involved, but primarily--aside of logging--technology simply involved understanding Bluetooth technology pairing and knowing when to charge devices.1 These tasks, in my opinion, are not difficult to teach or master--my 81 year old grandmother has no problem charging her iPad and cell phone, and can navigate issues with her Fitbit with minimal assistance--and, if I ever remembered to write down the steps to re-pair her Fitbit if it disconnects, I'm sure she'd be able to get it working again! Barriers to using mHealth systems and health technology effectively are minimal--and can be minimized further with proper instruction. A drawback of the second study, which used the iPhone as a primary measurement tool, in my opinion, was the use of the camera on an iPhone or iPad to measure heart rate and oxygen saturation 2--a technology I've personally tried and found inaccurate. (Though, maybe I should do a comparison some day!)
Benefits of mHealth for asthma: What does the literature tell us?
Perhaps even more important for people with asthma than most, mHealth can provide us with the following information 1
- Predictive nature of data: Data gathered can predict asthma symptoms so that pre-treatment can occur.
- Speed of onset—mHealth can tell us how quickly our asthma may worsen based on previous reports
- Indicate for us—and our doctors—our level of asthma control, and when it may be worsening—or if it has been stable.
- Asthma becomes more predictable as mHealth can assist in determining triggers. For instance, if all possible triggers that you have been exposed to are checked off a list—even if they are not the correct trigger at the time—patterns will be established and rule in or out certain triggers.
- Ensure correct dosing of medications—combined with asthma control information, data gathered by a mobile phone or tablet can assist a doctor in determining whether more or less medicine is needed—and potentially when it is needed.
In June, I worked to build my own mHealth platform using QR codes, Google Driive, and IFTTT. I'm always navigating ways to make this more passive--and get the most information possible from what I am logging. Unlike my system, the kHealth platform only keeps data that it deems as important1 --making it easier to "decode" this data. I may be a nerd, but mHealth research like this reminds me that one day, maybe this information will be more easily accessible to me--and easier for the rest of the world to use to gain better asthma control... One tap on a touch screen at a time.
Have you ever gotten "moon face" as a side effect of prednisone?