During my first year at Asthma UK the National Review of Asthma Deaths was published. There were many shocking findings – above all the tragedy of two out of three deaths from asthma attacks being entirely preventable if simple routine care was implemented.
So if routine care is that simple why isn't it happening? Why isn’t everyone with asthma on the right medication, taking it in the right way, at the right time and knowing what to do when symptoms worsen?
The inconvenient truth is that asthma isn’t simple.
The reality of delivering asthma care is that, unlike say diabetes, there isn’t a simple test that can diagnose someone’s current state; there isn’t a test that can tell you which of the multiple types of asthma someone might have and therefore which one of the over 90 inhalers they should be prescribed. There isn’t one way of taking an inhaler or even a standard dose as it all depends on which of the many multitude of combinations of triggers an individual has.
The reality of managing asthma is that it is unpredictable, complicated, yet entirely personal to each person with asthma. How can we expect already-stretched health professionals with scant specialist training and a short appointment to really get to the bottom of a condition that for one person could be life-threatening in winter and yet ‘disappear’ in summer; and distinguish that person from the next one with a completely different pattern?
No wonder many people with asthma, as they frequently tell us, find a routine review of no use or don’t turn up at all. Asthma is a variable condition; the annual review is more often than not during a period of wellness, not when it is needed most.
The other reality is that asthma care is delivered at huge scale with 1 in 11 of the UK population supposed to have at least annual reviews. That’s why we can’t simply default to demanding more money, more time and more training for increasingly squeezed GPs and Practice Nurses and financial pressures on the NHS. We need to think differently.
These are the underpinning principles for any redesign of how we deliver basic asthma care – solutions need to be personalised and intuitive, and need to require less from the person with asthma, rather than more. They also need to make it easier to manage asthma within the NHS and target scarce resources in ways and at specific people who need the care most.
As Asthma UK outlined in Connected Asthma, we believe that new technology is the key to fixing the broken asthma model.
The potential of smart inhalers
Smart inhalers are a relatively new innovation, adding sensors to existing inhalers so that people with asthma can automatically record when their inhaler is used – and be prompted when they haven’t taken their preventer inhaler. They were developed originally as a research tool to track inhaler use in clinical trials and were expensive. However, the decreasing cost of sensors and widespread use of smartphones means these devices could be made available for everyday use.
Linked to a smartphone, many people with asthma could soon be able to view their inhaler use over time and share their data with their GP to give them a clearer picture of how they are managing their asthma. Such data could also help asthma research to reach new goals. However, such technology could also overwhelm the NHS – financially and in terms of system change – if not implemented in the right way.
We want to play a pivotal role in speeding up the adoption of promising innovations for asthma – but we will also highlight the dangers of poor planning in bringing in new technology. How we choose to implement asthma digital health in the NHS in the next five years is likely to set the direction for the next 20 to 30 years.
Our latest policy report launched today, Smart asthma, highlights the potential for smart inhalers to transform care for people with asthma – but stresses the possible pitfalls if their introduction into the NHS is not properly planned and gaps in the underpinning research left unfilled.
We have consulted industry, expert clinicians, eminent academics and policy specialists in the course of developing this report. We are aware that it is easy to get carried away with the promise of new technology or underestimate the impact it can have. That’s why we are ensuring we bring the voice of people with asthma to the decision-making process about smart inhalers. Our overriding and unapologetic duty is driving improvement for the 5.4 million people in the UK with asthma, and the families who have lost a loved one as a result of a failure in asthma care.
It is for these people’s sake that the recommendations in this report should be seriously debated and considered, and the future implementation of digital asthma care taken up at the highest levels of the NHS.
Read more about smart inhalers in our blog: Smart inhalers – your questions answered
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