Care for the 5.4 million people with asthma in the UK has seen no significant improvement in recent years, despite the widespread availability of treatments that are effective for the majority. New ways of delivering asthma care are urgently needed.
Smart asthma outlines the opportunities for smart inhalers to help improve how asthma care is managed by healthcare professionals, and self-managed by people with asthma. With connected devices expected to be increasingly used in the future, the report also considers how widespread deployment of smart inhalers can be facilitated, and the potential barriers to achieving this.
Asthma technology to drive NHS innovation
Connected devices for asthma are becoming increasingly available – particularly smart inhalers which can objectively track, monitor and prompt medication use. Initial research suggests a willingness among the asthma population to carry a connected device. There is therefore a major opportunity for people with asthma, healthcare professionals and the NHS to use data from these devices over the coming decade to improve asthma outcomes in the UK. However, there could be adverse and costly effects if these technologies are not developed and rolled out thoughtfully.
A focus on new approaches for asthma
Asthma is very common, total medication costs are high, and adverse outcomes are largely preventable. The use of digital technologies like smart inhalers could save the NHS time and resources at a time of unprecedented financial pressure. In contrast, continued suboptimal asthma management will have long-term effects in failing to reduce preventable harm. Tailoring treatment to manage an individual’s asthma “pattern” requires significantly greater monitoring than is currently achieved through infrequent healthcare practitioner review
Realising the UK’s competitive innovation model
The UK is a global leader in academic and commercial research, and through the NHS can co-develop, test and commercialise innovation at scale. Given that 85% of asthma cases are treated within primary care, there is significant potential to develop connected technologies that utilise the electronic health records provided through primary care. Smart inhaler developers have initially focused on the United States market, which risks these connected devices evolving without seizing on the benefits of the UK’s health system and expertise.
Future-proofing connected devices for asthma
The persistent and successful use of connected devices will rely on modernisation of clinical and administrative practice. As devices like smart inhalers become increasingly used, clinicians will need to adapt to use the data collected as a core part of their assessment and monitoring – helping to support their management of patients and informing face-to-face consultations. This will also require different approaches to procurement. Commissioners will no longer be purchasing just medication in the form of inhalers, but also other components to make the whole system work – such as the sensors, cloud services, user mobile apps and clinical support systems. How these are sold and priced from the start could have far-reaching impacts on models of implementation.
User-centred design of technology
Digital devices to support self-management have experienced setbacks in being accepted by users. The development of connected technologies for asthma must ensure the variety of the patient population is reflected.
Supporting clinician care
Asthma is a variable condition, and people with asthma often do not seek support or assessment at times of need or increased risk. Annual asthma reviews are not always of use to patients, and their volume currently contributes substantially to the already-stretched provision of primary care services. The use of data from connected devices will challenge this current approach and could enable fewer face-to-face consultations and more personalised care according to need. Connected devices will allow clinicians to manage asthma at scale and facilitate true risk stratification. By alerting patients and clinicians when symptoms require specific action, smart inhalers could help reduce the complacency that current systems encourage, and facilitate a shift to greater self-care and self-activation. Engagement with clinicians is crucial in helping ensure that the data collected through connected devices to help inform asthma care are appropriate, timely, robust, and correctly interpreted.
Ensuring compatibility across the NHS
Little work has been done to determine how apps and devices will link to NHS systems in a standard manner and make interoperability the norm. This is crucial for data to be used to make clinical decisions or to automate management steps. With over 90 inhalers on the market and many people with asthma prescribed at least two, people with asthma must also be able to switch between their inhaled treatments (or use multiple treatments) seamlessly, and without being tied to a particular mobile health offering or needing multiple apps.
Research opportunities and challenges
Current research on connected technologies in asthma to date suggests:
- There is clear imperative to undertake a programme of research relating to newer connected technologies.
- People with airways disease appear to generally accept and interact with connected devices.
- Data from smart inhalers can provide clinically relevant insights.
However, key research gaps are yet to be addressed and could hinder success unless addressed in full. Filling these gaps will require industry, the NHS, and academia to work together in partnership.