Dr. Bipin Patel, CEO and Founder of electronRx, a deep-tech startup developing novel chronic disease and hospital patient management solutions, discusses how the increased utility of digital technologies can benefit respiratory disease patients.
Over the last decade, we have seen an unprecedented rise in the use of digital technologies, including smartphone apps and wearables. Smartphone ownership alone has increased from 3.67 billion in 2016, to more than 7.1 billion in 2024 [1]. Furthermore, a recent poll found that almost 40% of people in the UK own and currently use a wearable device [2].
An area in which digital technologies are having a particularly transformative impact is within the healthcare setting. The COVID-19 pandemic has undoubtedly accelerated healthcare technology adoption, including telehealth platforms and remote monitoring devices. Telehealth involves the use of communication technologies to provide remote access to healthcare services and medical information. This is often combined with remote monitoring devices which enable the collection of health data outside the clinical setting, such as in the home environment.
Among those conditions that have benefitted from the increased utility of digital technologies are respiratory diseases. Interstitial lung diseases (ILDs) are a particularly challenging and heterogeneous group of lung diseases characterised by fibrosis and inflammation of the lung parenchyma. The prevalence of ILD varies considerably across the world but may affect more than 150,000 people in the UK alone [3]. The condition is associated with a poor quality of life due to its impact on the patient’s physical and mental health. Digital health technologies could help empower ILD patients and overcome some of the challenges currently hindering the effective management of ILD.
Challenges in the management of ILD
Many ILDs are progressive, meaning that they are characterised by increasing and irreversible fibrosis, worsening respiratory symptoms and declines in lung function. Recent developments in the treatment of fibrotic ILD, especially progressive pulmonary fibrosis, highlight the importance of early diagnosis and identifying worsening disease early. Even then, treatment options are quite limited with only two anti-fibrotic drugs, namely nintedanib (Ofev) and pirfenidone (Esbriet), available to help slow disease progression. There are also non-drug strategies that can be employed to help manage ILD, including smoking cessation, pulmonary rehabilitation, and oxygen therapy.
Following the initiation of treatment, ILD patients should have regular follow-up appointments at specialist centres — the frequency of which will depend on disease severity. These centres offer clinical expertise and access to diagnostic services, including imaging facilities (e.g. high-resolution computed tomography) and full pulmonary function testing (e.g. diffusing capacity of carbon dioxide). However, the relative rarity of ILD means these centres are geographically dispersed and, consequently, accessing them may be difficult for ILD patients due to the need to travel long distances. The management of ILD at specialist centres is associated with reduced mortality and lower hospitalisations due to more differentiated diagnostic approaches and tailored ILD subtype-adjusted therapies [5,6].
Furthermore, ILD patients are at risk of suffering life-threatening acute exacerbations, characterised by the rapid onset of breathlessness, coughing and decreased oxygen saturation. Some common triggers include disease progression, infections, aspiration, or drug toxicity. ILD exacerbation often necessitates patients to undergo hospitalisation for antibiotics and supportive care measures. ILD exacerbations are associated with a poorer prognosis and high mortality rates [4]. The care of ILD patients is typically predicated on intermittent follow-up of patients at pre-specified intervals, consequently, the identification and pre-emptive treatment of these events can be challenging.
Digital technologies for ILD
The effective management of ILD requires that patients undergo close and regular monitoring to detect worsening symptoms or deteriorations in lung function which can indicate disease progression or the onset of an exacerbation. Consequently, digital technologies, such as home spirometers, portable pulse oximeters, lung sound monitors, and smartphone apps are increasingly finding utility in ILD. One survey found that 50% of healthcare professionals now use digital technologies to care for people with ILD, an increase from only 8% before the COVID-19 pandemic [6].
The use of home spirometers in particular has gained much attention in the monitoring of ILD. These hand-held devices measure a range of respiratory metrics, including forced expiratory volume (FEV1) and forced vital capacity (FVC). Examples include smart home spirometers which can transmit and provide real-time results via a connected smartphone app. These also offer a live video exam feature, enabling patients to connect directly to their healthcare provider. Studies in ILD patients have shown that home spirometry, although providing lower FEV1 and FVC values, correlates well with hospital values and may be useful for predicting disease progression [7–9].
Portable pulse oximeters are also being used in ILD to monitor blood oxygen saturation levels based on the transmission and adsorption of red and infrared light. Various options are available for home use, including traditional finger devices. Other newer devices such as wearable ring monitors have the advantage of enabling continuous oxygen saturation monitoring during a patient’s daily activities. Studies have shown home oxygen monitoring is practical in ILD and can provide additional information which can help determine a patient’s oxygen requirements [10,11].
Another technology being used in ILD is lung sound monitoring. These devices utilise microphones to detect the presence of abnormal lung sounds, such as a wheeze, rhonchi, crackles and changes in cough frequency and intensity. Sounds collected by the device are uploaded to the cloud to facilitate efficient analysis and enable the tracking of respiratory metrics. However, these devices need to undergo further development and validation in ILD populations to determine their true potential.
Smartphone apps that can measure multiple physiological variables are also attracting interest in the monitoring of ILD. Examples include electronRx’s purpleDx app which measures key respiratory biomarkers, including heart rate, respiratory rate and tidal volume utilising only the smartphone camera. The purpleDx app also enables the transmission of collected data and a connected clinical dashboard to enable review by healthcare providers. Although these technologies are relatively new, their ability to improve ILD outcomes holds great promise.
Moving the needle on ILD care
The development of digital technologies capable of analysing large volumes of complex physiology data combined with the increased usage of telemedicine offers the potential to revolutionise ILD care. These technologies can enable the closer monitoring of ILD patients without requiring patients to travel to or attend additional clinic visits. Improved monitoring can enable earlier detection of disease progression and exacerbations, and evaluate treatment responses, helping to improve ILD patient outcomes. Some evidence already exists demonstrating the feasibility and reliability of home spirometry and pulse oximetry in the management of ILD. Additional studies are needed to fully evaluate the potential of newer technologies, such as lung sound monitoring devices and smartphone apps to improve outcomes in ILD but these too could play a significant role in the management and treatment of respiratory diseases in future.
References
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5. Marijic P, Schwarzkopf L, Maier W, et al. Comparing outcomes of ILD patients managed in specialised versus non-specialised centres. Respir Res. 2022 Aug 27;23(1):220. doi: 10.1186/s12931-022-02143-1. PMID: 36030227; PMCID: PMC9420269.
6. Nakshbandi G, Moor CC, Johannson KA, et al. Worldwide experiences and opinions of healthcare providers on eHealth for patients with interstitial lung diseases in the COVID-19 era. ERJ Open Res. 2021 Aug 31;7(3):00405-2021. doi: 10.1183/23120541.00405-2021. PMID: 34471631; PMCID: PMC8256489.
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8. Moor CC, Mostard RLM, Grutters JC, et al. Home Monitoring in Patients with Idiopathic Pulmonary Fibrosis. A Randomized Controlled Trial. Am J Respir Crit Care Med. 2020 Aug 1;202(3):393-401. doi: 10.1164/rccm.202002-0328OC. PMID: 32325005.
9. Khan F, Howard L, Hearson G, et al. Clinical Utility of Home versus Hospital Spirometry in Fibrotic Interstitial Lung Disease: Evaluation after INJUSTIS Interim Analysis. Ann Am Thorac Soc. 2022 Mar;19(3):506-509. doi: 10.1513/AnnalsATS.202105-612RL. PMID: 34534053.
10. Cardeñosa SC, Palomo M, Francesqui J, et al. Home Oxygen Monitoring in Patients with Interstitial Lung Disease. Ann Am Thorac Soc. 2022 Mar;19(3):493-497. doi: 10.1513/AnnalsATS.202103-319RL. PMID: 34793688.
11. Santos CD, Santos AF, das Neves RC, et al. Telemonitoring of daily activities compared to the six-minute walk test further completes the puzzle of oximetry-guided interventions. Sci Rep. 2021 Aug 16;11(1):16600. doi: 10.1038/s41598-021-96060-w. PMID: 34400715; PMCID: PMC8367992.
Author biography
Dr Bipin Patel is the CEO and Founder of electronRx, a deep-tech startup developing novel chronic disease and hospital patient management solutions. He is a key digital health thought-leader with over 20 years’ experience in medical engineering, drug development and commercialisation and holds a PhD in Medical Engineering from UCL, UK.
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