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The issue of compliance is an ongoing preoccupation of ours. No asthma medicine is effective if you don’t take it as directed. Dr. Chiaramonte wrote a piece a couple of years ago about an article by Canadian researcher Paul O’Byrne Larry asked the question, “Do we need better drugs?” O’Byrne seems to believe we need better patients, concluding: “There is little doubt that the greatest opportunity to further improve outcomes in asthmatic patients is to develop ways to enhance adherence to the effective treatments that are currently available.”
Easier said than done. Larry wrote, “Home peak flow monitoring can give them a ‘reality check.’ This will help those who comply. But sadly, we are creatures of convenience. It is generally the most seriously ill who have kind of discipline it takes to monitor themselves regularly. For those with intermittent symptoms, it’s a question of out-of-sight, out-of-mind.”
So how can we keep the state of asthmatic lungs front and center in the lives of patients, particularly younger patients? The answer, like everything else, is to tie it to everyone’s extra appendage—their phones. We have covered almost every innovative use of mobile technology—notably Asthmapolis and AsthmaSense. The newest idea comes to us from a group of St. Louis area entrepreneurs headed by Andrew Brimer and Abby Cohen called Wing. This smart phone enabled portable spirometer combines digital precision, record keeping and analysis. Combined with game playing. We spoke with Abby recently. Henry Ehrlich
AAC: Thanks for taking your time. First, tell our readers about the state of the mobile compliance marketplace. Where do Asthmapolis and AsthmaSense stand these days and why are you different?
Abby: Thanks so much for having me! We are at an exciting time in general with the proliferation of technology to help patients gain more control over their health. Chronic diseases are seeing a lot of innovation right now including asthma! There are a number of organizations approaching asthma management in different ways including Propeller Health (formerly Asthmapolis) and AsthmaSense, but at Sparo Labs we are focused first and foremost on the person who is facing the challenges of asthma on a daily basis.
We worked closely with patients to design Wing—the first FDA-cleared, over-the-counter, smartphone-connected device for measuring lung function. Rather than just tracking when someone takes their medication like Propeller Health or Adherium, Wing helps patients understand how their medications are affecting them by measuring and tracking Peak Flow and FEV1 with medical-grade accuracy. Tracking adherence is valuable, but it doesn’t necessarily provide immediate value to a patient. With Wing, we have incorporated the Asthma Action Plan stoplight zone system to directly help patients self-manage their asthma by detecting early warning signs and taking action to prevent attacks. We have found that tracking lung function also helps motivate adherence because the patient can see the impact of medications on their numbers. Using Wing’s cloud-based platform, you can also efficiently communicate how you have been doing to your physician through a 30-day summary report. This way your care team can provide you with more personalized care, such as optimizing your treatment plan throughout the year.
AAC: From the look of it on your website, Wing seems to consist of a mouthpiece that attaches to a phone. What happens when you blow into it? Does it measure the force of the exhaled breath? Does it listen for wheezing? How and where is that data processed?
Abby: Wing is a pocket-sized sensor and powerful companion app. Wing guides you to inhale deeply, then blast your air through Wing to measure your lung function. Wing incorporates training, fun game mechanics, and ATS reproducibility criteria into a measurement session to ensure the best data for patients and their physicians.
We built the technology that Wing uses from the ground up and, unlike typical spirometers, Wing is very robust. It uses a microphone as its main sensor and has no moving parts or battery. The sensor is powered by the phone itself! All processing and storage happens right on your phone and our cloud-based system.
One of the exciting things about harnessing the power of the cloud, is that there are all sorts of ways we can aggregate and analyze the data to improve the experience, add more value, and learn new insights about asthma. For example, we are currently using machine-learning to develop automated and personalized coaching on the user’s technique when they use Wing to do a lung function test.
AAC: You interviewed hundreds of patients and providers. Was there such thing as a typical interview? Did you ask the same questions over and over to ensure apples-to-apples data, or did you wing it each time (pun intended)? Could you give us an example of something that surprised you that made its way into the finished product? Was there something that surprised you that you thought would make it into the finished project that you threw out after the interviews?
Abby: Yes! We took a very human-driven approach to the development of our interface. Prior to designing Wing’s product requirements and features, we met with patients and providers to learn more about their asthma story, and also understand current gaps in care. While each discussion was unique, we followed the same general discussion guide for the conversations. This gave us the flexibility we needed to explore different anecdotes, but still enabled us to identify trends between conversations. As we got further into the development, we also incorporated task-based usability testing to ensure that Wing was not only meeting patient needs, but that it was also easy to use and understand. Of course, this process never ends. We are constantly looking for feedback from users so that we can make the experience even better!
One thing that surprised us was that most people just want to know what they need to do. I am an engineer by training, so I love data. At the end of the day, you want the data to be accessible, but not in a way that clutters the most crucial information. This is why we put lung function percentages and color zone front and center in the results interface, with more detailed info lower down.
AAC: Could you describe the space ship game, or whatever it’s called? When did you get the idea that this would be a way to leverage compliance? Could you tell us what the actual process is? Do you get credit for, say, I am not a gamer but when I see all these people on the subway courting repetitive stress injuries, but how does your game stack up for holding patient interest?
Abby: We built game mechanics into the Wing interface to help drive healthy habits for keeping up with your asthma. These game mechanics were specifically designed to encourage people to measure their lung function each day in the morning and evening with Wing. The game is centered on space exploration. Users blast off on daily missions to colorful and exotic planets in the galaxy, collect mysterious alien artifacts, and return home to cash them in for points. You can then use the points you earn to upgrade and customize your spaceship. This game design helps build healthy habits and provides a fun visualization to help motivate good lung function maneuver technique.
AAC: How did you test the beta version?
Abby: We did all sorts of testing. For for the FDA alone, we had to do performance testing, mechanical ageing testing, usability testing, biocompatibility testing, electrical safety testing, and more! On top of this testing, we did additional beta testing by giving Wing to about 30 adults or children with asthma for several months to get feedback on usability and patient satisfaction. For us, we see the design and development process as very iterative – we are always looking to improve Wing based on patient feedback. So, while we are not longer in the “beta testing” phase, we are still working directly with Wing patients to develop new features and provide more value.
AAC: Thanks for your time.
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