Childhood friends who went their separate ways but later both ended up in academic research, together developed a system to help those with respiration disorders catch their breath.

They developed Inca, the Inhaler Compliance Assessment device. Attached to either of the two main types of inhalers used by those with asthma and other respiratory disorders, it helps the patient gain more from their medicine and use their inhaler more efficiently.

Prof Richard Costello is associate professor of medicine at the Royal College of Surgeons in Ireland and a consultant respiratory physician at Beaumont Hospital. He linked up with old school pal Prof Richard Reilly who pursued degrees in bioengineering and is based at Trinity College Dublin.

Their collaboration delivered the Inca inhaler monitoring device but it was a long time coming. “We met up 10 or 11 years ago and talked about the potential for collecting biomedical signals and integrating them into systems,” Prof Costello said.

They kicked around a number of ideas such as a mobile device that could act like an electronic stethoscope that could pick up the sounds of wheezing, but they eventually settled on something they hoped would greatly improve drug compliance for patients with asthma and chronic obstructive pulmonary disease.

Respiratory physicians have long realised that patients can have considerable difficulty in taking their drugs properly, something that causes a low compliance rate, Prof Costello said. Expensive drugs are wasted, dose rates can fall and poor response often causes a doctor to try a stronger drug when the real problem is achieving ordinary compliance.

Data collection tool

Attempts to solve this problem led to the development of a small data collection tool that could be clipped onto the inhaler. It includes a microphone that can pick up the sounds made when the inhaler is used, firmware to collect and store these recordings, and a tiny battery pack to power the whole thing.

"It was very humble beginnings, soldering things and listening to the sounds of inhalers at my kitchen table in 2009. It was a phase where we were developing the device and getting preliminary data to get capital for grant funding," he says. "The Health Research Board took a punt on us early on and this allowed us to get more people involved."

They eventually had a team of 20 between Trinity and the RCSI. They had engineers, nurses, doctors, statistical experts, psychologists and even an ethnographer.

The data collection tool is important but the real heart of the Inca system is mathematical algorithms that can interpret what the recorded inhaler sounds actually mean.

"When the inhaler is fired it produces a sound file and we can download the file and run it through the signal processor to give us feedback on how the patient had done," Prof Costello says. "The TCD guys turned those sounds into numbers and they did fancy signal processing to automate the sounds."

He praised the work of the engineers and then the nurses and doctors who began to collect and interpret the sounds. These provided much more data than they expected, he says.

Fitted with Inca, the new “smart inhaler” can record when a patient uses the inhaler, how well it was used and if there was a problem, and a suggestion of what might be done to help the next time. All of this slowly emerged as they studied inhaler use by nearly 1,000 subjects.

“It gave us an enormous insight into behaviours, so much so that just listening to a given inhaler sound gave insights into the actual personality of the individual using it,” he says.

Patchy compliance

The most compliant users were the ones who also always turned up for their appointments on time. Those with patchy compliance were the ones who arrived late or missed their appointments, Prof Costello explained.

Importantly, Inca can be used as a training device to help patients use their inhalers more effectively. Patients who received extra support from doctors and nurses improved inhaler adherence by 7 per cent in three months. Those without training actually saw a 1 per cent fall in adherence.

Better use of the inhalers caused another significant benefit: a “massive reduction” of 90 per cent in the requirement for extra prescribing, Prof Costello says.

The patient trials that began in 2011 all involved the use of Seretide, a drug for asthmatics produced by GSK that delivers €9 billion a year for the company.

The Inca team has collected a large amount of data that show that the device works. The RCSI and TCD licensed aspects of the technology to Vitalograph Ltd, a respiratory device manufacturer, and it has been developing the technology. They have also been involved in negotiations with commercial interests with a view to commercialising Inca.

The Inca project is unusual in that there is already data to show it works, there is clear benefit to patients, and savings can be made by healthcare systems.

It even offers ways to improve patient-doctor contacts, Prof Costello believes.

“Some doctors look at non-compliance as being the patient’s fault, but from our work it seems more of a problem related to how we communicated to them or how the system was set up, barriers for them being able to express their concerns,” he says.

“Once we started to get this objective information we started to understand the problems.”