Children with asthma often struggle to manage their condition. Factors like poor medication adherence, a lack of symptom awareness and substandard education about their condition can all conspire to cause repeat attacks. This not only leads to multiple hospital admissions, which can be stressful and difficult for patients and their families, but ultimately leaves children’s lives at risk.

Once an emergency has passed and a child’s asthma has been brought under control, patients are often referred to their general practitioner for future management of the condition. However, families can be reluctant to leave the highly supportive care offered by paediatric specialists and often continue on as hospital outpatients. This can lead to children facing a long series of disruptive medical appointments, repeatedly pulling them out of school and leisure activities.

The NHS’s long-term plan recognises that this is a problem throughout the healthcare system and has set a target of reducing the number of outpatient appointments by 30%.

Now Activ8rlives, a brand of Cambridge-based lung self-monitoring developer Aseptika, has come up with a solution for this problem.

Moderate-to-severe management

Asthma+me is a medically-certified app designed to help children manage the symptoms of moderate-to-severe asthma. It is intended to be used with patients who are being treated in outpatient clinics for repeat attacks, aged six to 12.

In outpatient clinics, once a child’s asthma is controlled, their parents are taught how to manage attacks. This involves learning what to do in the event of an asthma attack, the importance of following care plans for their child, and how to detect when their child is at risk of an attack. They also need to make sure their child takes their preventer inhaler, which helps make the airways less sensitive and make an asthma attack less likely.

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“There is already a wealth of educational material available for parents of children with asthma,” says Activ8rlives managing director Kevin Auton. “But when your child has just recovered from their first asthma attack and has had a hospital stay, it is daunting and overwhelming. There is so much to learn.”

This is where Asthma+me comes in. Using Activ8rlives’ PUFFClicker Bluetooth device, parents can check that the right number of doses have been taken, and when. PUFFClicker works with pressurised metred-dose inhalers, counting doses, whether or not the inhaler has been shaken properly before use and has a timer to support improved inhaler technique.

Making asthma data accessible

All of this data is uploaded to the Asthma+me app. The app also contains information on how the child’s lungs are doing using an electronic peak flow meter, which measures how fast air can be expelled, as well as data on pollution, weather and temperature alerts.

This is all compiled into a report for parents, which can be sent to a paediatric centre for review during a clinic appointment.

Sheffield Hallam University consultant in paediatric respiratory and sleep medicine professor Heather Elphick, who works with Activ8rlives on the app, says: “It means clinicians have a much deeper understanding of exactly what affects their patient on a day-to-day basis, so they can make more accurate clinical decisions.”

The app is also accessible for children – it has a syllabus of 56 asthma management quizzes and short lessons built-in, which are presented through colourful illustrations and movies to engage young users.

Auton says: “In the future, it is hoped that by spending two to five minutes a day on these simple tasks, the need to have so many appointments will be reduced, and the child can spend more time at school and not have any more unscheduled visits to the hospital emergency room.”

Incorporating artificial intelligence

Moving forward, asthma attacks can be predicted by reviewing the key trends in data and reports generated by Asthma+me.

Auton says: “If the child has stopped taking their preventer inhaler, the use of their reliever inhaler has increased, their lung-function is decreasing, there are risks from environmental triggers such as high levels of pollution nearby, these trends become very obvious on the charts the Asthma+me app generates, which the parent can see.”

In a future version of the app, dubbed Asthma+me Smart, Activ8rlives wants to automate these alerts using artificial intelligence (AI). At the moment, the child’s clinician and parents are ultimately responsible for reviewing the information and seeing whether there’s any change in the treatment they’ve been taking, or their risk factors for attacks.

Elphick says: “We’re working on the exact detail of the AI at the moment, but we anticipate that there’ll be an automated notification either to contact somebody, make a change to the child’s medication, or just to watch them closely and recap a lesson or video on the app.”

There are an estimated 1.1 million children in the UK with asthma, 110,000 of whom struggle to manage their condition and need to be treated at specialist clinics. Asthma+me recently won Best Patient-Focused Technological Development in the 2019 CARE Awards. At a time when the UK has some of the highest asthma rates in Europe, this couldn’t be more vital.

“By making parents and their children expert, by providing the tools for self-management, education and training, the cycle of repeated visits to outpatient clinics can be broken,” Auton says. “Education, engagement and empowerment lead to lower use of NHS services for the families of children with moderate-to-severe and difficult asthma.”