In 2006, he began work on a prototype, an endeavor that turned out to be harder than he had imagined, chiefly because the sensor attachment had to be as durable as the inhalers themselves.
“The first prototypes were very ugly — like a coffee machine alongside of an inhaler,” Van Sickle recalls. He says colleagues joked that just carrying one around might be stressful enough to induce an asthma attack.
In 2008, Van Sickle launched a study of the device that was funded by the Centers for Disease Control and Prevention. He also founded Asthmapolis, a company that has continued to fine-tune the device. The latest version of the inhaler is equipped with a smaller, Bluetooth-based device that sends usage information to a Web portal that can display when and where patients have used their inhalers.
Rajan K. Merchant, of Dignity Health’s Woodland Clinic Medical Group outside Sacramento, began enrolling patients in another Asthmapolis trial last spring. He called the device the first major advance since the advent of the anti-inflammatory steroid inhaler in the 1950s.
‘Place should be a vital sign’
The Asthmapolis inhaler is part of a burgeoning field called geomedicine, which uses geographic information system (GIS) technology to correlate environmental conditions with health risks. The hope is that this data, integrated into a patient’s medical history, will help doctors and researchers fine-tune their diagnoses and treatments.
“Place should be a vital sign,” says Ethan Berke, a spatial epidemiologist at Dartmouth Medical School in Hanover, N.H., and a family physician.
Doctors have long connected place and health, Berke says, pointing to John Snow, often called the father of modern epidemiology for his work linking London’s 1854 cholera outbreak to drinking water contaminated by raw sewage. But today, technology has given them more precise and powerful ways to understand role of location in patients’ health.
“I would love it if I could bring up [a] map and see the grocery stores, parks” that patients have recently visited “right there while you are checking their blood pressure,” Berke says. Such information would allow him to better tailor his medical advice based on a patient’s lifestyle.“I can do that now, but I don’t have many GIS tools in the exam room.”
One of the chief instigators of geomedicine is Bill Davenhall, a manager at the GIS software company Esri. After he had a heart attack that he suspected was linked to environmental factors, Davenhall got Esri to build an app that integrates places a person has lived with a report of toxins found within three miles of those locations. Users can share that information with doctors.