A highly innovative new technology platform developed by Ulster University spin-in company Respiratory Analytics has the potential to dramatically improve the quality of life of asthma sufferers around the world.
The Aflo is a piece of smart hardware that is attached to a standard inhaler device. By connecting to a smartphone app, the Aflo transforms the inhaler into a smart device which helps asthma sufferers use them correctly.
The technology is at the clinical trial stage at present. “The trial is assessing the Aflo against standard inhaler use and is being conducted with Ulster University,” says Respiratory Analytics co-founder and chief executive Dr Susan Kelly. “We should have our CE Mark by April, and we hope to have the product on the market before the end of the year.”
Kelly’s background is in the pharmaceutical sector, but her interest in respiratory illness was sparked in part by personal experience. “My husband and two of my children suffer from asthma,” she explains. “That made me aware of the problems people have with inhaler technique. They often struggle to use their inhalers properly.”
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Indeed, research shows that up to 90 per cent of users make errors with their inhalers. Even worse is the number of people who make errors so severe that they end up getting no medication whatsoever into their lungs – that’s around 50 per cent.
My husband and two of my children suffer from asthma. That made me aware of the problems people have with inhaler technique
It may sound quite simple, but the process of getting medication from a standard metered dose inhaler into the lungs is reasonably complicated. “The clinical guidance worldwide is to shake metered dose inhalers before use,” Kelly explains. “The purpose of shaking is to ensure the different molecules of propellant and active medicinal ingredients are mixed thoroughly before use. But a lot of people don’t do that.”
Then comes the speed of inhalation. “Depending on the inhaler being used, if the patient presses it and doesn’t breathe in at the right time, they can get no dose at all. If they breathe in too slowly the dose ends up in the mouth and they swallow it. Too fast and it can hit the back of the throat and they swallow it. That’s why the research shows that so people use their inhalers improperly.”
Kelly began working on the problem back in 2018, when she joined forces with her co-founders Prof Liam McDaid and Prof Jim Harkin, both of the Ulster University School of Computing, Engineering and Intelligent Systems.
“They had already been working on respiratory illness issues,” says Kelly. “We started working on this project together and formed the company in 2019. Metered dose inhalers were introduced in 1956 and revolutionised asthma treatment. There have been some technological advances since then, but these have plateaued in recent years. We looked at automating the process to help people use their inhalers correctly.”
Their research, which received funding from Innovate UK, has resulted in the development of the Aflo, an accessory to a medical device, which sits between the inhaler and the spacer tube that many patients use in conjunction with them.
The Aflo is connected to a smartphone app which guides the user through the whole process. At the outset, the app reminds the user to shake the inhaler for five seconds and an accelerometer in the device detects the shake. The app then prompts the user to breathe out, to press their inhaler, and to breathe in, and sensors in the device detect their breathing.
For the first time, all this information will be available to the patientt. Before this, they would have no idea what they were doing wrong
An amber light on the left of the Aflo comes on if the user is breathing too fast, and one on the right come on if they are breathing too slowly. A green light in the middle indicates when it’s correct. Three green lights flash when the process is finished. The patient then gets a report on the efficacy of their technique and this data can be shared with their clinician.
“For the first time, all this information will be available to the patient,” Kelly points out. “Before this, they would have no idea what they were doing wrong. And clinicians can see if their patients are using their inhalers properly and if their technique is right. That’s a big advantage.
“At the moment, it’s very hard for a clinician to know if a patient has an attack, if they have been using their inhaler properly, if the dosage is right and so on. This will help determine the correct course of action to take.”
There are now plans to move into other disease areas, with COPD next on the list. “The basic technologies won’t change, but the app will,” says Kelly. “We have a few other things lined up. Some medicines are moving from tablets to inhalable form, and that will allow us to address other disease areas.”