Calling All Innovators! Asthma Care is Ripe for Disruption: Are You Up for the Challenge?

When my company announced they established a project to deliver training and resources to health care clinics, parents, schools, and health professionals about kids with asthma, it brought me back to my ER days: the sound of a child wheezing from asthma…. the lack of education and understanding to help prevent a child from getting to this stage… the fear in both the child’s and parents’ eyes. No child should experience this, which is why I ask YOU to help become an innovator. Let me explain….…

Everyone Knows Someone with Asthma

I will venture to say that everyone knows someone who has asthma; after all, 26 million Americans and 1 in 10 children have asthma. People who have asthma work with us, attend school with us, play with us, run with us and run past us. There isn’t anything someone with asthma cannot do, right? Well, almost. There is one thing that a person with asthma cannot do; they cannot do without an action plan. 

Like most emergency physicians, I have a profound respect for this disease.  I know that it kills; I’ve seen it kill. Ten people each day die from asthma. In the ER, we see many patients with asthma who didn’t need to be there. Asthma is the 3rd leading cause of hospital stays for children. They are there because they weren’t on the right drugs, didn’t understand how to care for their asthma or didn’t know what to do when they got sick. While some patients respond to treatment and go home; quite a few end up in the hospital and some die. Many, if not most, did not have an Asthma Action Plan(AAP). 

The Action Plan that Isn’t

The right to breathe seems so basic and the solutions so absurdly simple that it’s beyond frustrating! Despite strong clinical guidelines, national education campaigns, incentives and quality measures, only 10% of people with asthma are provided an AAP, while 30-70% fail to comply with their medication regimen.

The AAP helps a person with asthma know what medications they need, when to take them and when and where to seek care should they become acutely ill. Studies have shown that compliance with AAP is associated with reductions in pediatric asthma exacerbation and lower odds of oral steroid use -- two key markers of asthma control.

There are many reasons for this including difficulties taking the medication prescribed (inhalers are not intuitive); a lack of understanding of how the medications work and a mistaken belief that medication is only taken when ill. The complexity of the medication guidelines (400+ pages) and poorly designed clinician workflows that often fail to allow time for asthma education contributes to the problem.

Innovation Throw Down

Taking a page from the world of start-ups and entrepreneurs, asthma management is “ripe for disruption.” For example, an innovative partnership between an insurance company, Blue Cross and Blue Shield of Illinois and the American Lung Association of the Upper Midwest has confirmed that it takes a village to manage asthma. By leveraging claims data, Blue Cross and Blue Shield of Illinois was able to assist physicians to target interventions to those most in need and at risk. This community based intensive training program resulted in a 60% reduction in hospitalizations and 53% reduction in emergency visits over a 2-year period.  

What is lacking is the ability to scale a solution so all asthma patients are well managed. A wide range of barriers would benefit from fresh thinking. From the great need to simplify guidelines to creating an AAP that is mobile and easy to use. Or simple support tools that are agnostic to branded electronic records systems to applying human centered design principals to inhalers. And let us not forget the unicorn task of cracking the Holy Grail of compliance, ensuring each person with asthma has an AAP and sticks with it. 

Asthma is calling all innovators. I am hoping a few are up to the challenge in taking on asthma. Are YOU?

About the Author: Dr. Elif Oker is a board-certified, residency-trained emergency medicine specialist, accomplished physician executive with extensive experience in clinical medicine and business. A mentor to U.S. and global start-ups in the digital medicine ecosystem and beyond, she has a passion for connecting people and ideas to create contemporary solutions that improve the health of populations.

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Sources:

National Asthma Education and Prevention Program’s Guidelines Implementation Panel Report for: Expert Panel Report 3-Guidelines for Diagnosis and Management of Asthma. Partners Putting Guidelines in Action. U.S. Department of Health and Human Services, National Institutes of Health. National Heart, Lung and Blood Institute. December 2008

Kaferle JE et al. “A Team-Based Approach to Providing Asthma Action Plans.” J Am Board Fam Med 2012;25:247-0249.

“How Many People Have an Asthma Action Plan?” Australian Institute of Health and Welfare, The Australian Centre for Airways disease and Monitoring, Woolcock Institute of Medical Research. 2016

Kuhn L et al. “Planning for Action: The Impact of an Asthma Action Plan Decision Support Toll Integrated into the Electronic Health Record at a Large Health Care System. J AM Board Fam Med 2015; 28:382-393.