Vol. 18 • Issue 8 • Page 14
Allergy And Asthma
New technology that can track symptoms and medication dosages anytime and anywhere has the potential to usher asthma management into the emerging mobile information society.
?All it takes is an iPhone® and an add-on application for patients with asthma to record their health information. This app allows patients to enter medication dosage and peak flow meter readings in a password-protected database.
The highest, lowest, and average peak flow measurements for each day then are graphed on a color-coded chart to reveal normal, marginal, and dangerous readings. An optional feature allows patients to email a monthly report of these measurements and medication administration to their clinician.
A researcher out of Wisconsin is taking patient symptom monitoring a step further by incorporating a global positioning system into a rescue inhaler. Every time the patient uses his bronchodilator, the exact time and location of the inhalation are recorded.
New asthma management tools such as these are needed because mounting evidence shows many patients with severe asthma are dramatically noncompliant.1Fewer than half of all patients who take inhaled asthma medication adhere to their prescribed treatment regimen, leading to poor clinical outcomes, including severe wheezing, lower asthma control scores, and death.1-3
Tracking bronchodilator usage remotely “lets us identify patients who have uncontrolled asthma and might benefit from more attention, changes to their medication, additional medication, or consultation with their clinician,” said David Van Sickle, PhD, of Wisconsin School of Medicine and Public Health, Madison.
Results also are communicated to patients through a weekly email that shows medication usage and gives advice from the national evidence-based guidelines on asthma control.
“We see some people become aware of locations and exposures and then taking steps that would hopefully minimize and mitigate those in the future,” he said of initial studies of this device.
Many patients also need to pay more attention to how much medication is left in their metered dose inhalers. A device is available that uses a microcomputer to monitor doses left in the inhaler, daily usage, and a 30-day usage history.
The small, battery-operated apparatus snaps on top of the inhaler and remains out of the way while patients administer medication. Some dry-powder inhalers have built-in dose counters.
With the youngest patients, asthma noncompliance often results from the time required for nebulized drug delivery – up to 30 minutes.
The combination of a squirmy child and rushed parents can bungle or even cut short medication administration. Child-friendly nebulizers shaped like fish, cows, cars, bears, and more can help reduce children’s restlessness during treatment.
“If (patients) are not getting the full amount, they are probably not getting the full effect of the drug,” said Stanley J. Szefler, MD, of National Jewish Health in Denver. “There are attempts now to make the nebulized form of delivery a little bit faster.”
The latest nebulizers on the market are small, powerful, and portable. Nebulizers using jet technology or ultrasonic vibrating-mesh technology typically deliver medication within 10 minutes.
In the office, written asthma action plans can inform patients about the value of their medication and how to use it. Trigger control plans can help them avoid exacerbating their condition.
However, these plans no longer are confined to one-dimensional pieces of paper. Interactive educational tools that incorporate online games and tutorials, animated videos, coloring and story books, and even life-like instructional dolls can help reinforce these messages to children and their families.
For a list of references, visit www.advanceweb.com/respiratory.