It's Here! Home Monitoring For Asthma

 During a period where office visits are reduced when possible and safe, and when some lung function testing maneuvers are avoided (spirometry) because of increased risk for asymptomatic infection spread, it is a great advantage to have quality home monitoring options.  The Capmedic device does this and provides the additional benefit of coaching asthma patients through proper lung function and allowing your asthma doctor to monitor compliance.  Dr. Susarla

CapMedic Measures Lung Function, Makes Sure Inhalers Used Correctly

The FDA has cleared the CapMedic device that helps to make sure that metered dose inhalers (MDIs) are properly used, even by young patients.

MDIs are most commonly employed to deliver asthma medications deep into the lungs, but to work effectively they have to be used correctly and on a consistent schedule.

The CapMedic snaps onto the top of many inhalers and, using built-in lights and a tiny speaker, it works to nudge users to inhale the medication correctly and at the right time. When a person is ready, the device talks them through all the steps, like shaking the inhaler, properly squeezing it while keeping it upright, and timing the inhalation just right.

The same device can snap onto an accompanying plastic adapter to turn it into an accurate at-home spirometer for lung function measurement. It can now measure FEV1, the maximum amount of air that the patient can push in a second, and PEF, the maximum flow one can generate at a steady rate.

Readings about usage and spirometer data are stored on an accompanying smartphone, helping patients, parents, and caretakers, make sure that the inhaled medication regimen is adhered to.

“Decades of studies have shown that almost 90% of patients are unable to use MDIs correctly – a result of their complex, multi-step usage requirements. The Cognita team has conducted drug deposition studies showing a tenfold improvement in the delivery of medication from just 4-5% to 45% when inhalers are used correctly,” said Rajoshi Biswas, Ph.D., Chief Scientific Officer and co-founder at Cognita Labs, in the announcement. “Getting an effective daily dose means patients are more likely to avoid costly, life-threatening hospitalizations.”

Read article here.

COVID-19 Infection and Transmission in Children

Are children at significant risk for a COVID-19 infection?  Although there may certainly be high risk groups, the data do not seem to support this.

Age-dependent effects in the transmission and control of COVID-19 epidemics

The COVID-19 pandemic has shown a markedly low proportion of cases among children1,2,3,4. Age disparities in observed cases could be explained by children having lower susceptibility to infection, lower propensity to show clinical symptoms or both. We evaluate these possibilities by fitting an age-structured mathematical model to epidemic data from China, Italy, Japan, Singapore, Canada and South Korea. We estimate that susceptibility to infection in individuals under 20 years of age is approximately half that of adults aged over 20 years, and that clinical symptoms manifest in 21% (95% credible interval: 12–31%) of infections in 10- to 19-year-olds, rising to 69% (57–82%) of infections in people aged over 70 years. Accordingly, we find that interventions aimed at children might have a relatively small impact on reducing SARS-CoV-2 transmission, particularly if the transmissibility of subclinical infections is low. Our age-specific clinical fraction and susceptibility estimates have implications for the expected global burden of COVID-19, as a result of demographic differences across settings. In countries with younger population structures—such as many low-income countries—the expected per capita incidence of clinical cases would be lower than in countries with older population structures, although it is likely that comorbidities in low-income countries will also influence disease severity. Without effective control measures, regions with relatively older populations could see disproportionally more cases of COVID-19, particularly in the later stages of an unmitigated epidemic.

Read article here.

Telemedicine , The Right Way

An emergency declaration from the State of Texas has made it easier for physicians to take care of patients during a time where routine clinic visits pose substantial risk of infection spread.  A host of well marketed telemedicine organizations, some promoted by your insurance company have swooped in, attempting to fill the gap.  They are missing one crucial element - YOUR doctor.  

Adapted from the Texas Medical Association, here are answers to common questions on the patient side:

1. What technology do I need for telemedicine?

Texas law says that  telemedicine services can occur through:

• Real-time audiovisual interaction between you and the doctor (for example, a simple digital camera on a laptop or a desktop with secure broadband internet);
• For many, a "Facetime like" interaction can take place with your doctor using a simple downloadable app on your smart phone
• A telephone only consultation for new or follow-up patients may be appropriate in some circumstances

2. Are initial in-person visits mandatory?

No.  For some medical conditions, the standard of care has always been in office visits.  In office, we have the opportunity for a more comprehensive exam and additional testing to evaluate lung disease.  However, given the risk of infection spread in offices, emergency rooms, and urgent cares, even initial visits can take place through telemedicine.

3. Can the patient be at home for a telemedicine visit?

In short, yes. The new state law removed the requirement for a clinical place of service, as long as the standard of care is uncompromised.  Keeping you at home improves the chance of flattening the curve while still providing you access to a board certified medical specialist.

 See TMA information here.

Schedule a telemedicine visit here.