Getting Asthma Under Control

Asthma is the most common lung condition in the world affecting 339M people with an estimated 1000 people dying every day* from the condition. In the U.K. 8M people have been diagnosed with 5.4 being treated (the primary reason for the disparity being, I guess, those that have grown out of it), with the U.K. having one of the highest rates of childhood asthma in the world, and providing the NHS with an estimated annual bill of 1BN GBP! Air quality, poor inhaler technique and adherence being among the factors linked to the poor outcomes, it is clear to me that we can do something about this if we work together. Especially given the rather counter-intuitive fact that many athletes like Sir Mo Farrah, Sir Bradley Wiggins, and Chris Froome accomplish what they do in spite of their asthma suggesting clearly that better outcomes are eminently achievable. So, who would like to collaborate with me to create change -starting in the U.K.? 

Who am I, and why do I care? My first asthma attack. I remember it vividly, it was my 8th birthday party and I had run down my garden with friends as fast as my legs could carry me. I grew up in the suburbs and countryside, rather than the city, so space was not at such a premium, and the garden was weirdly long. So, there I was running when I suddenly became aware that breathing had become incredibly hard. It was scary. It probably coincided with a freshly mown lawn or pollens. I’m allergic to all of them now but who knows if one was the trigger? I walked back up the garden slowly, cautiously. A doctor was called out, and I was diagnosed and treated. Interestingly I do not recall the details here and am optimistic that my health records will be made available to me (online) so that I can piece it all together.

My second asthma attack was some weeks later. This time I woke up in bed. The ‘attack’ didn’t slow me down or spoil my fun, it was a different beast altogether. I couldn’t call out, or even talk. In fact, it took all of my concentration and effort just to draw whatever breath I was able. I remember being almost paralysed with fear. I didn’t know what to do, but I could hear the television and my parents downstairs. The journey downstairs to the living room felt like it took forever, but perhaps it was as much as half an hour in reality. Every step was excruciatingly slow with very long pauses between each. I have no real sense now looking back of just how bad the attack actually was, but at the time I didn’t think that I was going to make it all the way to the living room.

I’m now in my forties and haven’t had another asthma attack until doing some research for this post. The threshold for an asthma attack is much lower, or less severe than I had previously understood. So now I know that I’ve had hundreds. Of course, I’m a grown-up and I know my triggers now and what to try to avoid, mostly. I’ve always known my key triggers. Dogs, cats, horses, any animal, in fact. Freshly cut grass, hay, dust, mould, pollens (of almost every variety) and a bunch of other triggers as well, but animals in particular. They are my kryptonite. All that said, the severe childhood attack that I recounted above was probably triggered by a freshly painted bedroom.

It’s funny, my parents really don’t really recognise how serious asthma can be, they conflate it with a ‘bit of allergy’. As dog and cat lovers, they just think that I’m making a fuss. But when in a ‘pet’s lair’ I don’t get a bit ‘itchy and sneezy’, it’s not just an allergy. My airways start to constrict, my breaths become shallow, I slow everything down, stop talking and just focus on the immense effort of breathing. My back aches, and I keep taking my inhaler for the little relief that it provides. This, of course, happens in spite of me taking my preventative inhaler, and any strong anti-histamines prior to the occasion. I take the inhaler with unfailing regularity. I’m adherent, but animals don’t seem to care, and with the advent of ‘hypoallergenic’ dogs, my social inconvenience goes further. I am told almost convincingly by people that I am not allergic to their dog. “You’re absolutely fine” I am instructed. I am not.

I am working for an agency focused on ‘bridging the gap to healthier lives’, by focusing on patient needs, and until this post I’d really thought about my experience of asthma and had not even considered myself as a patient -or anything like it. I still don’t. If memory serves I’ve not researched my condition online. I’ve not talked to another patient about asthma, and never confided in others what I have already shared with you here. This post was provoked by the recent news article that four people die every day due to asthma, and the U.K. has the worst control (the predicted outcome of an adherent ‘patient’ with severe asthma is much better when compared with someone who has moderate asthma but is not adherent) in Europe. 

Could the U.K.'s asthma outcomes be better, or should we resign ourselves to preventable deaths and the worst outcomes in Europe? Of course they could be better; the questions is how can this can be accomplished? You could look at adherence, awareness, understanding, collaboration, motivation, and treatment as distinct but often overlapping concerns and opportunities, but what is key to motivating the individual to take more responsibility? What will enable them to take more interest in their condition and gain as much control as possible?

I believe that if you can enable and motivate an individual to take their peak flow, maintain adherence to their treatment plan, and then understand the connection between the two we can increase the individual's motivation to control their condition better in the long term. I have a peak flow meter that I was given many years ago. I have only ever used it once or twice because feedback is too limited. Inevitably a solution that really empowers people is going to have to leverage digital capability. 

Optimal understanding and control will come from the following incremental layering of value I suspect. Not necessarily in this order, but as a guide the following progression will change the way that asthma is understood and controlled:

• Make the peak flow data digital (automatically) and plot the data so that I can see the ups and downs in my lung capacity
• Show me the connection between my peak flow and my adherence by automatically tracking the treatment too
• Inform my conversation with the G.P. and asthma nurse so that the prescribed products are personalised to me because they are based on my actual data
• Plug in external data points relevant to me such as weather, pollen, and pollution to provide me with correlated data to form new connections and insight to provide, among other things, advance warnings
• Enable all of this data to be viewed in aggregate at a population level for the benefit of individuals and health providers
• Provide predictive analysis based on all of the above that can be plugged into other data sources, and vice versa, to extend the utility of the data set well beyond the concern here of asthma, and in beneficial ways that we can only guess right now. 

So, this all seems fairly straight forward doesn't it!? All I need to do now is get pulmonologists or those healthcare professionals with a particular interest or experience in asthma or respiratory challenges, G.Ps, nurses, NHS technology accelerators, charity, the product manufacturers, (adherence and maintenance) technology providers, and of course patients in the room to plan how we can do this at scale.

Who is with me? Who would like to collaborate on an event where we share our unique perspective on the challenge and overcoming it to affect real change in asthma control in the U.K.?