Smart Inhalers: An Holistic Approach to Asthma Management
Identifying where Metered Dose Inhalers (MDIs) fall down and how an holistic solution with Smart-Tech integration could pick them back up.
Second only to pills, inhalers are the most commonly prescribed medication form in the world¹, with MDIs having the largest presence on the inhaler marketplace. However, they are far from being faultless. Is this a consequence of its simplistic, cost-efficient design, or because of a deeper routed issue that lies with lack of user-centred consideration right at the start of the design phase, 40 years ago? With devices rapidly adopting smart technology, how could this advancement aid the user’s experience of MDIs?
Just how (un)Intuitive are they?
To begin with, we must first establish where their downfalls lie when it comes to usability. First impressions carry a lot of weight when it comes to correct usage. With us humans not necessarily being renowned for our patience, how we perceive the product in the first three-to-five seconds begins to paint a picture of how we perceive the operation of the device.
This is an area that MDIs excel at, partly down to their bare-bones design, but also with help from an array of subtle detailing and intuitive features that often go over-looked. Raised lines on the underside of the device act as a universal indicator for a touchpoint. The subtle colour difference of the mouth-piece cap is a call to action, whilst the orientation of the logo communicates the orientation that the device should be held in.
Where does it all go wrong then?
The real issues arise when it comes to the administration of the medication. When the responsibility is passed onto the user. It has been found that the number of Asthma sufferers who are incorrectly using their inhalers could be as high 84%² . This is a worrying statistic that is inexcusable when it comes to medication administration. An analysis of the user flow highlights where the problems present themselves.
The first issue that the user encounters is when shaking the device to mix the propellant and medication. A large proportion of users either don’t shake the device at all prior to use or fail to shake it for long enough for it to be worthwhile³. It’s the latter of the two that I want to focus on, as I believe it is the hardest to overcome. ‘Shake the device’ is a bit ambiguous, and as a result, it leads to more questions than it answers; ‘How long for?’ and ‘How vigorously?’ are both questions that are open to interpretation. That’s exactly the problem, it’s all relative. What one individual deems to be sufficient isn’t what another will. With no confirmation, they will both perceive themselves as correct and potentially inadvertently continue to incorrectly use the device.
Absence of Feedback
A lot of the other highlighted steps can be grouped by the devices’ lack of feedback. An issue that is present through the entirety of the administration process is incorrect breathing. Controlled breathing is an imperative action and something that has a serious impact on the success of the dose. With just 40% of medication reaching the lungs being the best-case scenario, it needs all the help it can get⁴!
With each stage being entirely reliant on the user, who’s perception of time during potentially stressful situations may be somewhat altered, it comes as no surprise that they are potentially not holding their breath for the specified duration. But without any feedback, how are they to know how when the time has elapsed?
How smart tech could help
Trusting the user to memorise the steps for correct usage is bit of a large ask, so is relying on them to carry notes with them on the off chance they will require medication. So a mobile application that communicates the steps for administration suddenly makes a lot of sense.
With there being no denial that breathing underlies the deep-rooted issues that MDIs carry, this would be a sensible issue to tackle. Visual breathing techniques could be used to remove the reliance on the user, and improve overall efficiency.
A fuss-free, stripped-back interface would effectively communicate the duration for each stage of breathing, without requiring the user to fixate on keeping count themselves.
It can go further than just correct breathing techniques too. By introducing commands it would ensure that the user completes the entire administration process correctly. As mentioned previously, shaking the device is commonly forgotten which has a staggering impact on the effectivness of the dosage. This makes it the perfect example of the importance of a step being reiterated to the user in a digital format.
Let’s take it a step further
Up to this point, the solution could simply be a stand-alone application. By creating an holistic solution where the inhaler is the centre of the solution, the potential for more successful usability is exponentially increased.
Aside from Respire’s primary function of administering a dose of medication, it’s the inhaler's secondary function of an integrated PEF meter that makes things really interesting. PEFs provide a GP with a significant amount of information;
‘Your score can show whether or not your condition is getting worse. It can also check if your medication is working, and indicate whether you’re having an asthma attack’. — National Health Service, 202⁰⁵
Relying on a user to carry a Peak Flow meter with them at all times is a bit of a large ask, however by integrating it into the one device it removes this requirement. Respire allows users to log their Peak Flow measurements at the time of an attack, allowing a clear picture of their symptoms and triggers to be created.
Asthma in particular is far from consistent; environmental changes, life-style alterations as well as activity levels all impact the symptoms of Asthma. Identifying these triggers is key to managing the disease, but doing so demands a lot of commitment from the user. Respire communicates with the mobile application and automatically logs the doses the user administers. This then provides the user with data that helps build a bigger picture of their triggers.
Respire’s additional feature of a PEF metre allows for the monitoring process to be taken a step further. It enables the user to monitor their symptoms immediately after the attack. This key data can then be transferred to their GP, who can then build a comprehensive picture of their possible triggers.
The data can also be used to monitor and log the severity and duration of the attack. Which can show if the attacks are worsening over time.
An argument for the absence of a device like Respire in today’s marketplace could be down to its comparably higher cost and ongoing technical support. With conventional MDIs being available on prescription and costing a relatively small amount to manufacture and distribute, they certainly have the market monopolised.
However, growing popularity in personal healthcare devices could challenge this. A recent article published by Deloitte gave positive insights into the investments of the emerging health care tech sector⁶.
OMDIA Technology have predicted a $5million increase in the personal health device market. Again, showing the increasing demand for smart medical devices.
You don’t have to analyse the market to witness the growing popularity. A quick scroll through your phones app store will reveal an extensive list of apps focused on monitoring and tracking elements of the user’s health. Although scrolling through all of them may take you a while, as there is an estimated 318,000 health related apps on the Apple App Store⁷!
So could a device that offers the user intelligent asthma management through tracking and monitoring be on the horizon? I certainly think so, it would be great to hear your thoughts.
¹ JB,. and BK, R., 005. Problems With Inhy
aler Usse: A Call For Improved Clinician And Patient Education. [online] PubMed. Available at: <https://www.ncbi.nlm.nih.gov/pubmed/16185371> [Accessed 6 June 2020].
² Prnewswire.com. 2020. 84% Of People With Asthma May Be Using Their Inhalers Incorrectly, Propeller Health Study Finds. [online] Available at: <https://www.prnewswire.com/news-releases/84-of-people-with-asthma-may-be-using-their-inhalers-incorrectly-propeller-health-study-finds-300799662.html> [Accessed 8 June 2020].
³ Rice University. (2017, February 28). Inhaler users get about half as much medicine as they should from each puff: Researchers measure impact of inhaler patients’ common mistakes. ScienceDaily. Retrieved June 8, 2020 from www.sciencedaily.com/releases/2017/02/170228131126.htm
⁴ Ruth, D., 2017. Inhaler Study: How Much Medicine Makes It To Lungs?. [online] News.rice.edu. Available at: <https://news.rice.edu/2017/02/28/inhaler-study-how-much-medicine-makes-it-to-lungs/#:~:text=%E2%80%9CIn%20the%20best%20case%2C%20a,that%20drops%20to%207%20percent.> [Accessed 9 June 2020].
⁵ 2020. [online] Available at: <https://www.nhs.uk/conditions/peak-flow-test/> [Accessed 14 June 2020].
⁶ Micca, P., Boozer Cruse, C. and Shukla, M., 2020. Health Tech Investment Trends: How Are Investors Positioning For The Future Of Health?. [online] Deloitte Insights. Available at: <https://www2.deloitte.com/us/en/insights/industry/health-care/health-tech-investment-trends.html> [Accessed 14 June 2020].
⁷ Hall, R., 2020. Health Apps: How Mobile Apps Are Improving Our Lives & Well Being. [online] MindSea Development. Available at: <https://mindsea.com/health-apps/#:~:text=The%20mobile%20health%20app%20market,available%20just%20two%20years%20ago.> [Accessed 14 June 2020].