Pulmonology Advisor interviewed David Van Sickle, a former Epidemic Intelligence Service officer at the US Centers for Disease Control and Prevention (CDC) and now CEO of Propeller Health, about addressing adherence challenges in asthma and chronic obstructive pulmonary disease (COPD), the effects of climate change on both conditions, and potential future directions of research.

Editor’s Note: This interview was edited for length and clarity.

Pulmonology Advisor: What are some of the technologies Propeller Health is working on in terms of bettering the lives of patients with asthma or COPD?

David Van Sickle: Asthma and COPD represent 2 of the most frustrating challenges in health care. In the past 100 years, we have made huge leaps in developing new medicines and understanding the complexity of the diseases. Yet, patients today are not doing as well as they could be, and doctors do not have the tools they need to deliver more personalized treatment.

Sadly, both patients and clinicians have lowered their expectations for life with asthma and/or COPD.

What’s more, the stakes for these diseases are huge. Approximately 235 million people across the world have asthma, and COPD will be the leading cause of death by 2030.1,2 Patients’ lives are interrupted consistently by these diseases, through missed school, missed work, and missed moments with family and friends. All of this affects the healthcare system because the lack of preventive management leads to massive costs in hospital utilization. And as the effects of climate change worsen, the air is becoming more unbreathable, creating the conditions for a major public health crisis.

This is where Propeller comes in. Propeller helps relieve the burden of asthma and COPD by giving patients and their providers a tool that delivers constant care via their smartphone or computer.3 Patients do not have to wait 3 months to see their doctor and struggle to remember how they have been using their medications; instead, Propeller connects their existing inhaler to their smartphone via a small sensor and delivers insights on symptoms, triggers, and medication use to the Propeller app. Through the Propeller platform, patients receive reminders to take their medication, forecasts on asthma conditions, and tips for reducing symptoms.

Propeller can reveal a patient’s most common environmental triggers, helping them avoid flare-ups in an increasingly unbreathable world. And with the patient’s consent, the platform can communicate with the patient’s physician to show how the patient is doing between appointments.

Pulmonology Advisor: Do the sensors attached to inhalers also measure adherence to medication?

Mr. Van Sickle: Yes. Adherence is one of the biggest challenges in managing asthma and COPD. While existing medicines have the ability to significantly improve patient outcomes, adherence rates to those medicines often fall below 50%, meaning that patients are not reaping the benefits of their treatment.4

To address this challenge, Propeller detects every time a patient uses their asthma or COPD medication and displays data on usage in the Propeller app. If a patient forgets to take their controller medication, the Propeller sensor beeps to alert them and remind them to stay adherent. One of the greatest benefits of Propeller is its ability to help a patient improve their adherence to controller medication and communicate with their physician about when, where, and how often they are using their medications.

Pulmonology Advisor: How has the study of air pollution’s effect on respiratory disease changed since you worked with the CDC?

Mr. Van Sickle: Since I left the CDC in 2006, awareness of the negative effects of air pollution on human health has grown substantially. We are seeing an increasing number of acute air pollution episodes in cities worldwide, and as a result of those episodes and the advancement of technology, data on air quality is increasingly available.

That said, I believe we still are not as concerned about air pollution as we need to be. Air pollution — both ambient (outdoor) and household (indoor) — is the biggest environmental risk to human health, killing millions of people every year. Only 1 in 10 people lives in a city that complies with the World Health Organization’s air quality guidelines. And the effect of poor air quality is worse for vulnerable populations: the very young, the very old, people in low-income communities, and people with preexisting respiratory disease.5

In the last year, we have seen several troubling moves by the US Environmental Protection Agency to discard the scientific approach to air pollution in favor of regulatory rollbacks for corporations. We have more ability than ever to understand the effect of air pollution on human health and invest in its control, and we need to take advantage of that ability in order to reduce human suffering.

Pulmonology Advisor: What direction(s) do you think the research should take next?

Mr. Van Sickle: While Propeller has published 19 peer-reviewed publications, the potential for research using digital health tools is just getting started. We would like to expand our work in Louisville, Kentucky, to other cities around the United States, using Propeller to assess the effect of air pollution on respiratory disease. And we will continue to expand our study of asthma and COPD to more patient groups and more environments, leveraging the power of digital health tools to deepen our understanding of how the diseases manifest themselves in daily life.

Pulmonology Advisor: What has the response of healthcare providers been when presented with the technology Propeller has developed?

Mr. Van Sickle: Allergists, immunologists, and pulmonologists are keenly aware of the challenges of treating respiratory disease day-to-day, particularly when it comes to improving patient adherence to medication and understanding how patients are faring between office visits. Many have accepted low patient adherence as the status quo because until now we have not had the tools to improve adherence outside the office setting.

The healthcare providers we have worked with are excited to have a digital health tool that can drive adherence, communicate with patients, and deliver clear, objective data on the patient’s experience outside the office setting. We believe that as digital health tools become more ubiquitous, they will become an expected and integrated aspect of clinical practice, no different from any other standard of care for respiratory disease.

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Pulmonology Advisor: What would you like to see more of in clinical practice?

Mr. Van Sickle: As with any new technology, adoption and scale are the primary challenges. We encourage respiratory providers to reach out to us and learn more about implementing Propeller in their practice, which is a simple process. Research shows that patients on Propeller experience dramatic improvements in adherence, healthcare utilization, and symptom-free days, and find the system accessible and easy to use.6 In the next few years, we would like and expect to see greater acceleration toward the integration of digital medicines across clinical practice.

Disclosures: David Van Sickle is the CEO and cofounder of Propeller Health.

References

  1. World Health Organization. Chronic respiratory diseases. Asthma. www.who.int/respiratory/asthma/en/. Accessed June 11, 2019.
  2. World Health Organization. Chronic respiratory diseases. Chronic obstructive pulmonary disease (COPD). www.who.int/respiratory/copd/en/. Accessed June 11, 2019.
  3. Propeller Health. www.propellerhealth.com/
  4. Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MCJM, Verhamme KMC. Medication adherence and the risk of severe asthma exacerbations: a systematic review. Eur Respir J. 2015;45(2):396-407.
  5. World Health Organization. Ambient (outdoor) air quality and health. www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health. Published May 2, 2018. Accessed June 11, 2019.
  6. Carl JC, Isakov D, Winners S, et al. Use of remote electronic monitoring improves asthma outcomes through improved adherence. Am J Respir Crit Care Med. 2018;197:A1164.