The emergence of connected devices - including inhalers and wearable sensors - and mobile apps presents a wide range of new opportunities, particularly in healthcare. As we investigate new treatments for conditions like asthma and COPD (chronic obstructive pulmonary disease), the ‘internet of things,’ where devices are connected over the internet so they can ‘talk’ to us, applications, and each other, is allowing us to explore the benefits of interconnectivity and the rich patient data that these technologies can provide.
Working with experts in digital healthcare technology, we are using tools such as adherence monitors, biosensors and electronic diaries to better understand how our medicines interact with patients and inform our drug development decisions.
Making sense of sensor technology
Using sensor technology, we are applying our expertise in respiratory inhalers to monitor patients’ medicine usage patterns in our clinical trials. The technology works by automatically sensing when a patient’s inhaler has been activated; recording and wirelessly transmitting the usage information back to a remote storage system in real-time.
"By applying sensor technology in our clinical trials, not only will we find out when the patient takes their medicine but, as the technology develops, we may also be able to see if their markers of disease have improved, or if the patient had to take additional medications,” says Dave Allen, head of respiratory R&D at GSK. “These real-time indicators could make it possible to be more forward-looking and predictive, effectively testing our hypotheses and allowing us to make adjustments on-the-go.”
Disease management in a digital age
We are already using electronic diaries in many of our clinical studies to learn more about disease and to find out if patients feel better as a result of taking our medicines, or if there may be other factors at play that have been affecting their health. Using these diaries, patients self-report their symptoms and inhaler use on a daily basis. Combining the electronic diary with sensor technology, we don’t have to wait for patient visits to the clinic several days or weeks after treatment.
“Conventional clinical trial endpoints will remain critical to getting our medicines approved but they don’t always tell the full story,” Dave explains. “Asthma patients rarely talk about their lung function improvements when asked about their symptoms while COPD patients may not mention that it is their arthritic knee that is stopping them getting about, rather than their breathlessness.”
By combining digital sensors with physical activity monitors and electronic diaries in our clinical studies, not only will we know when and how often patients use their inhalers, we will also find out what happened to their symptoms, along with anything else that impacted on their day-to-day activities.
Integrating this information will help us better understand our patients and our medicines.
Helping patients to manage their own adherence
Patient adherence is a huge challenge for those people suffering from chronic conditions who often require daily maintenance therapies to control their symptoms.
"One of the main barriers to good asthma control is poor adherence” says Neil Barnes, head of respiratory medicine at GSK. “As a clinician it can be quite a challenge to judge whether a patient has taken their treatment or not. If you ask them they almost always say they have but when you actually get prescription records or if you measure it objectively, it is often less than fifty percent adherence.”
We believe that a major innovation in the future will be the development of integrated inhaler technology to help clinicians to understand adherence patterns and the barriers to adherence, enabling them to address challenges and improve their consultations. These smart inhalers would form part of a digital ecosystem that allows feedback to provider organisations, hospitals and patients. “It would be a major breakthrough in putting the patient and adherence at the centre of the management of asthma and of COPD,” adds Neil.
Just like the smart fridge that tells you when your lettuce is going limp, the thermostat that learns your heating preferences, or the lights that change colour depending on the time of day, in the future, the hope is that smart inhaler technology will be able to influence patients’ behaviour to help them get the most from their respiratory medicines.