Over the last few months respiratory health has become a major area of focus within the medical community and beyond, as COVID-19 on takes its toll. However, respiratory conditions have long impacted the American public. In fact, the CDC reports that 19.2 million US adults have asthma.
As in many areas of health, today we are seeing the rise of digital for monitoring and treating respiratory illnesses.
“While most of the attention and use of digital health for chronic care management has gone to players in diabetes, hypertension and related spaces … there is a growing interest in respiratory conditions, asthma and COPD,” Grace Colon, president and CEO of InCarda Therapeutics, said during a panel at BIO Digital. “Asthma, COPD and other related diseases costs the healthcare system over $130 billion a year. Chronic respiratory disease is a really interesting case study for digital health, because, unlike diabetes and hypertension, the best measures for patient status and success are still being developed and validated.”
While there may be opportunities in the respiratory space, caring for these types of conditions have their own unique obstacles – including being hard to put a measure on.
“One thing that is unique abut respiratory disease [is] that the exacerbations of these diseases are not something measurable,” Raolat Abdulai, clinical director of research at Sanofi, said on the panel. “They’re not measurable by a blood test or diagnostic. These exacerbations are patient reported.”
However, Abdulai said she sees telemedical and digital as ways to help manage these conditions in the future, but both patients and providers need to be on board.
“The tool we are going to need will have both a provider interface, as well as a patient interface, so that way the provider will be able to gather that information from the patient. Perhaps telemedicine, which has been advanced quite a bit by the recent events, could be helpful,” she said.
Even with the latest telehealth advancements, the lack of at-home assessment tools can make these digital visits difficult.
“I think the thing that is really challenging for respiratory patients in general, above and beyond maybe other specialties, is that, as we were talking about earlier, there is just a lack of tools that are in the home to assess the patient, either from a diagnostic perspective or a monitoring perspective,” Bhairavi Parikh, vice president of digital health at Respiratory Care ResMed, said on the panel.
Implementing digital in clinical trials
While the logistics of the at-home technology is still being ironed out, one place that digital is rising is clinical trials. Abdualai noted that the number of participants in clinical trials overall is down due to the coronavirus.
“Covid has had a dramatic effect on the clinical trial system. However, I want to be a little optimistic,” she said. “I think that telemedicine, in conjunction with connected devices that measure lung function and adherence, may provide us an insight on how to translate some of the smaller studies in the past, done with digital tools, into much larger clinical trials.”
As in many areas, patients access to digital, and digital savvy can create inequities that need to be taken into consideration, she said.
“I think one of the bigger barriers we are going to face in the feasibility of clinical trials is the lack of technological infrastructure, both on the provider side and the patient side. This is particularly highlighted in the context of health disparities. There may be people who are able to get access to some of these tools based on their socioeconomic and income levels.”
Understanding the patient journey
Panelists stressed that digital tools don’t only help the patient, but can also give providers and researchers better insights into what a patient experiences outside the four walls of a hospital.
"I often hear physicians talk about, 'I knew my patients were sick, but once I started monitoring them I really realized just how sick they were,'" Michael Markus, CEO of HGE Health, said during the panel. "All of a sudden, with these new technologies, you have visibility to these exacerbation events that were never being recorded other ways. You can start seeing worsening of symptoms."
Sanofi is now developing a longitudinal digital real-world research study on asthma that employs digital tools and connected devices, which, according to Abdulai, will collect data that can help the pharma company develop a model for the asthma patient journey.
“Once you have a better idea of the asthma patient journey … you are then able to translate this into developing better therapies, biomarkers – and shaping their whole digital strategy,” she said. “This will also help you figure out ..., if you want to add a digital therapeutic, how would you go about doing that? As you know, there are three pathways for digital therapeutics – having a stand-alone digital-therapeutic, a companion digital-therapeutic or a combination digital-therapeutic. But you won’t know how to apply that for patients with asthma and COPD if you don’t understand their patient journey.”