Brilliance and Imperfection: How medical technology has the potential to help people with asthma

23^rd April 2015

Over the last few decades safe and effective new medical technologies have been widely welcomed by patients and health care professionals alike, and helped to transform life expectancy. Asthma inhalers are one of these major medical technology success stories – launching in the 1970’s they enabled the delivery of new active compounds to the lungs to fight asthma attacks in a highly portable unit. The mass availability of these convenient, affordable, effective asthma inhalers completely transformed the daily lives of people with asthma. Older people with lifelong asthma talk of the joy of finally being able to go on family day trips or playing sport at school – the freedom that came from knowing emergency care was in their pocket and they wouldn’t be dependent on a highly breakable glass device in a bulky case.

However, asthma is an exemplar of both the brilliance and the imperfections of technology. Inhalers are a technology that has saved hundreds of thousands lives worldwide.  Yet still two people die needlessly of an asthma attack every day in the UK because people are not adequately supported to use this technology effectively. Many people with asthma make mistakes with their inhalers that are significant enough to reduce the effectiveness of their treatments. All treatment regimes are complicated but inhalers even more so, and decades later we are still spending millions of pounds each year trying to communicate to people how, when and why to use their inhalers. The next big challenge is to get treatments in a form which work with people , rather than trying to fit people to the technology. That’s why placing ‘consumer’ acceptance and usability as an equal partner to safety and efficacy is key to the next wave of healthcare innovation

The advent of e-cigarettes may well help test this in the real world. Currently there is huge interest in whether e-cigarettes will be an effective and safe way to achieve a breakthrough in smoking cessation. However it will also be interesting to see which forms and brands will be the eventual market winners. Will it be those with the safest, most effective and technologically advanced delivery system or those brands that can most closely replicate the weight, feel, social kudos and experience of conventional cigarettes within some basic safety and quality parameters? Technological perfection or the reskinning of the Marlboro Man? After years in brand marketing, being told the hardest, and most expensive, thing to do in marketing terms is to change entrenched customer behavior my money is on the latter. Technology can only succeed when it goes with the grain rather than against it – however ‘good’ for someone it might be.

Whilst sometimes sounding like a sceptic, I still genuinely believe technology will drive the next wave of change in personalised health care, enabling people to better self-manage their asthma. This will also drive an enormous change in healthcare roles and skills, as the recent report on The Future of Work outlined. Imagining the scenarios for 2030 this paints a picture of a future where work will change fundamentally with new business ecosystems co-developing innovation between sectors being the norm, and individuals with hybrid skills being winners in the workplace.

To enable this vision there will need to be a significant shift towards better user-centred development across a range of sectors and disciplines, and with behavioural design built in from the start. This is an emerging field and we will need new skills and capacity building, as well as change in research design and funding. At Asthma UK we are providing the ‘consumer’ insight to the EU myAirCoach programme to develop a Smarter Inhaler. Providing the patient perspective up front is a step forward, but even in a group which is open to usability it isn’t always easy to simultaneously support researchers’ enthusiasm for potentially life changing technologies whilst also acting as the voice of reason on what is likely to be acceptable in the real world. We need to ensure that considering user acceptance is not conflated with a reactionary mindset about technology.

However, we are optimistic that work going on with programmes such as the National Information Board’s workstreams will help to bring greater understanding of what all parties can contribute. Because the biggest risk is the one we have seen with asthma inhalers – amazing technology that saves lives but doesn’t get used to its full potential. If we stray too far from familiar routines, language and the new norms of digital behaviour, innovations will be rejected. Residual respect for healthcare professionals may mean this won’t be apparent in the doctor’s surgery, but somewhere in the real world the latest innovation will be ditched for something more important in someone’s life.

We desperately need new technologies that are effective, safe and that people fully embrace. This means a shift to putting patients/consumers/users/people in all their glorious messiness at the heart of wide-ranging collaborations between clinicians, technology leaders, data analysts and usability experts. That’s why I believe investing in consumer adoption and behaviour design needs to be as important in the future as the best clinical efficacy or safest technology.

Kay Boycott is the Chief Executive of Asthma UK