The challenge. All asthma patients know that they can help avoid asthma attacks if they steer clear of activities and environmental factors that trigger them. But it's not always easy to identify where and when asthma attacks occur, and patients often forget to record information that would help them avoid triggers in the future. What if patients had a simple tool that automatically tracked the location of their outbreaks? Could the information help patients control their asthma and help doctors provide more comprehensive treatment?
A new direction for asthma research. Medical anthropologist and asthma epidemiologist David Van Sickle, PhD, MA, had studied asthma since he was a graduate student at the University of Arizona in Tucson. His dissertation, funded by the National Science Foundation, examined the rising prevalence of asthma and allergy in India, a topic he had previously studied among American Indians in Alaska, Arizona and New Mexico.
But it wasn't until 2004—after graduating with his doctorate and accepting a position as an epidemic intelligence service officer for the Centers for Disease Control and Prevention (CDC) in Atlanta—that Van Sickle stumbled on the story of an asthma epidemic in Barcelona. In the 1980s, after several years of investigation, public health officials in that Spanish city finally identified the cause of the asthma attacks: soybean dust escaping from inadequate silo filters at the city's busy port complex.
"The key moment in the investigation," recalled Van Sickle, "was asking patients where their symptoms began. When the team plotted the answers on a map, they could see the clustering near the harbor."
Van Sickle understood that the Barcelona incident could open a new direction for asthma research. But he also knew that asthma had rarely been the subject of investigations at the CDC, even though the condition affects millions of Americans and claims thousands of lives a year. "CDC and state health departments often conduct joint investigations of disease outbreaks," Van Sickle said. "But only a tiny fraction of these investigations have focused on asthma. The reason is a lack of timely and specific data about the geography of asthma."
As a Robert Wood Johnson Foundation Health & Society Scholar from 2006 to 2008, Van Sickle was able to gather that kind of data and develop a tool that monitors the time and location of individual asthma attacks. "The goal is to capture data about asthma from daily life to help people better manage the disease, while aggregating data from everyone to improve public health," said Van Sickle. "I think of it as participatory public health." For more information on the program, see the Program Results.
A low-cost engineering solution. During his Health & Society Scholars fellowship at the University of Wisconsin-Madison, Van Sickle worked with a team of biomedical engineering graduate students to build the prototype of an inhaler equipped with a global positioning system (GPS) receiver.
Called the "Spiroscout," the small device attaches easily to most inhalers, the L-shaped medical pump that millions of Americans carry and use to deliver symptom-relieving asthma medicine. Through GPS, the Spiroscout automatically determines the exact time and location when a patient uses an inhaler and then reports that information to a database tracking service, which Van Sickle calls "Asthmapolis."
"Asthma is unique in that nearly everyone carries around the same medication and uses it as symptoms occur," said Van Sickle. "Knowing when and where these inhalers are used can help scientists better understand what exposures cause symptoms. Until now, identifying locations or exposures that pose a particular threat—whether they are at home, work, school or in the community—has been a struggle for public health experts."
In collaboration with the CDC, Van Sickle conducted two pilot studies of the GPS-enabled inhaler. The first, in 2009, followed 35 adults with asthma and allowed Van Sickle to remotely monitor their use of medication and provide a real-time assessment of asthma control.
After making the device smaller and lighter, Van Sickle began a second study in 2010 to map and characterize asthma patterns in the rural Midwest. "We found that the majority of people who enrolled came in with uncontrolled asthma," said Van Sickle. After tracking the patients with the device and providing e-mail feedback about its use, he says, "We see that their asthma control improves once we turn on these simple Web-based tracking systems and provide information on how they can recognize asthma triggers and use their inhalers. By the end of the study, the portion with uncontrolled asthma had fallen by half."
Media attention and new projects. Asthmapolis and Van Sickle's tracking device have received considerable press coverage in the Economist, Time, Slate and the New York Times, to name a few publications. NetExplorateur Observatory, a Paris-based organization that identifies and analyzes new global trends in digital technology, selected Asthmapolis as one of the Top 100 innovations in 2010–2011. Last year, the project was selected by NASA for their LAUNCH: Health program.
Van Sickle also participates regularly at health and technology conferences. In June 2010, he joined a distinguished list of technology groundbreakers in presenting innovations at a Community Health Data Forum, sponsored by the U.S. Department of Health and Human Services (HHS) at the Institute of Medicine (IOM) in Washington.
Now a fellow in the School of Medicine and Public Health, University of Wisconsin-Madison, Van Sickle continues research into asthma patterns, including their relationship to air pollution exposure, and interventions to remotely monitor medication use.
Van Sickle and two colleagues founded Reciprocal Labs in 2010 to commercialize a new version of the technology for health systems. The company plans to market an asthma management solution that lowers costs by improving asthma management. The first two major customers will begin in the fall of 2011, including a health system in California and the Southern Piedmont Beacon Community, one of the federal Beacon Community sites.
In June 2011, Van Sickle was selected as a White House Champion of Change. The program profiles "Americans whose work is helping our country rise to the many challenges of the 21st century". Each week, the White House staff invites the champions "to the White House to meet with administration officials and share with us what they are doing to build a better tomorrow," according to a media release.
Also in June Van Sickle presented results from the Asthmapolis pilot studies in the plenary session of the HHS and IOM Health Data Initiative meeting in Washington.
Van Sickle said his experience as a Health & Society Scholar gave him "the freedom and the responsibility to take risks with my research, and experiment with new ways to solve persistent problems in asthma. This kind of iterative, entrepreneurial approach would have been much more difficult to accomplish in a different fellowship or academic position."
RWJF perspective. RWJF created the Health & Society Scholars in 2001 to build the field of population health. "There is a growing recognition that health is the result of the interaction of multiple factors including socioeconomic and physical environmental factors and health behaviors," said Senior Program Officer Pamela G. Russo, MD, MPH, leader of RWJF's Public Health Team. "The evidence shows that these types of factors play a much larger role in determining health at the population level than do the traditionally considered health care and biological determinants of health."
"The program seeks to integrate paradigms and knowledge from a variety of disciplines to develop an understanding of how these determinants affect the health of populations, and thereby to design interventions with greater power to reduce health disparities," said Russo.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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