• June 14, 2010

In the 1980s, public health officials in Barcelona, Spain, began to notice a series of asthma outbreaks that resulted in unusually high numbers of emergency room visits. The cause of the occasional day-long asthma spikes remained a mystery to officials for nearly a decade, until finally they identified defective grain silos at the city’s busy port complex. The silos had an inadequate filtering system, and on days when soy beans were unloaded, allergen-laden dust from the beans escaped and caused widespread asthma attacks. When the silos were identified and taken out of use, the outbreaks stopped.

“The key moment in the investigation,” says 2006 Robert Wood Johnson Foundation (RWJF) Health & Society Scholar David Van Sickle, Ph.D., “was asking patients where their attacks began. When the team plotted the answers on a map, they could see the clustering near the harbor.” Complicating the epidemiological sleuthing was that soybean dust had not until then been identified as an asthma inducer under such circumstances.

A medical anthropologist by training, Van Sickle first encountered the Barcelona story while working at the Centers for Disease Control and Prevention (CDC) in Atlanta, Ga. Asthma has rarely been the subject of CDC investigations, he says, even though it is a widespread condition affecting millions of Americans and claiming thousands of lives a year. “CDC and local health departments often conduct joint investigations of disease outbreaks,” Van Sickle explains. “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.”

Finding ways to gather such data and put it to immediate use was the focus of Van Sickle’s work during his time as a Health & Society Scholar. He points out that, in Barcelona, the pieces of the puzzle came together over the course of several years, as public health officials first had to take notice of the excessive number of asthma attacks, then trace them to a geographic location, then sift through the many possible causes and then overlay the dates of the attacks with the dates of soy-bean unloading in a specific silo.

A New Tool for Patients and Public Health Officials

Van Sickle’s work as a Health & Society Scholar and since has focused on developing a tool aimed at making it easier to solve such mysteries. His tool is an asthma inhaler equipped with a global positioning system (GPS) device. When patients take a puff from the inhaler, the GPS mechanism collects the patient’s precise location, as well as the time and date, and reports that information to a database. The patient is then able to keep exact track of her or his inhaler usage, and by aggregating the data from multiple users, public health officials can construct a real-time picture of where and when patients are suffering from attacks.

A key goal of the project is to help individual patients better manage their asthma. In fact, studies show that as few as one-quarter of patients with asthma adequately manages the disease. Van Sickle’s device allows patients and their physicians to keep an eye on asthma and recognize when they need more help to control symptoms. “Right now, there are few ways for physicians to keep track of how their patients are doing when they’re not in the office. In some cases, physicians ask patients to keep daily asthma diaries,” he says. “Study after study shows the diaries are unreliable, because patients don’t always fill them out, or fill them out in the parking lot before going in to see the doctor,” relying on sometimes faulty memories.

‘Asthmapolis’ Goes to Washington

Van Sickle’s “Spiroscout Inhaler Tracker” and his “Asthmapolis” data aggregation tool are now being tested by the CDC in a 12-state area in the Midwest, with particular focus on rural areas. But they made a more public debut in Washington, D.C., on June 2 at the Institute of Medicine at the Community Health Data Forum sponsored by the U.S. Department of Health and Human Services (HHS). The forum is an outgrowth of President Obama’s Community Health Data Initiative, which is making HHS health data available so that software developers and others can put it to innovative and constructive use. Van Sickle’s device was one of seven data-driven applications showcased at the gathering’s plenary session, and Van Sickle presented alongside entries from Google, Microsoft, the National Association of Counties and others.

At the same forum, RWJF and the University of Wisconsin presented their County Health Rankings, an annual “check-up” for each county in the United States, allowing patients, policy-makers, public health officials, consumers and others to learn about the health status of their communities, and compare their counties with others, nearby or across the continent.

Van Sickle’s device, the County Health Rankings and the other data-crunching tools offer the promise of better informed decision-making by patients, doctors, public health officials and policy-makers. Van Sickle makes the point that we know too little about the origins of asthma and what causes attacks. “Asthma continues to be a challenge. Known risk factors don’t completely explain the global prevalence patterns and time trends,” he says, “We may not uncover new risk factors or patterns like the ones in Barcelona, but we hope it will help patients manage their disease and sharpen our search for clues.”