Remote monitoring to predict and prevent asthma attacks in preschool children

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Context of the research: Preschool children aged between 1 and 5 years are the age-group affected most by attacks of asthma and wheezing during childhood. They develop breathlessness, difficulty in breathing with coughing and noisy breathing (wheezing) because their breathing tubes (airways) become excessively narrowed. In most children, this occurs in isolated episodes precipitated by a simple cold. Preschool aged children account for 75% of all childhood hospital admissions for acute asthma. This admission rate has remained unchanged for over 15 years. The number of preschool children attending GPs for acute wheezing is also increasing, and there is a significant impact on parent/caregiver time off work and both parental and their child's quality of life. Although numerous technologies have been developed that allow school-age children and adults with asthma to monitor their symptoms and to predict attacks, none to date have focussed on predicting and preventing wheeze attacks in preschool children. This is despite significant morbidity and the demand on healthcare resources from preschool wheezing. Worryingly, frequent and repeated preschool wheezing attacks are known to have an impact on life-long lung health.Aims and Objectives: The aim of this project is to generate a bespoke home remote monitoring system for preschool children with wheezing which will allow detection of increased symptoms and will predict an impending wheezing attack, to alert parents to seek healthcare advice to prevent progression to a severe attack needing hospitalisation.Our objectives are; 1. to develop an app to be used by parents/caregivers that allows recording of wheeze symptoms, or use of any rescue inhaler medication for wheeze in the previous 24 hours.2. To relate the child's symptoms to how well their lungs are working (lung function) using wearable equipment that can monitor how wide open the child's airways are while they are asleep, and determine whether a change in their lung function can be used to predict the onset of a wheezing attack.3. To use the data from 1 and 2 to develop a personalised plan for each child that alerts parents/caregivers to the onset of a wheezing attack and to seek healthcare advice.Potential applications and benefits: Our aim is to combine data from the app and lung function monitoring to generate a personalised wheeze prediction plan to significantly reduce the current burden of disease. However, each component of the project, the app, the lung function monitoring and the bespoke plan are completely novel and not previously investigated. We will therefore generate preliminary data during this project to work out how effective each aspect is in predicting symptoms and attacks. We will also determine how acceptable each component is to parents/caregivers, how much they manage to record data and use the monitoring equipment. We will determine whether there are specific times when this approach can be used most effectively. The majority of preschool wheezers are admitted between September and March each year, so recording may not be necessary all year round. Also, the likelihood of an attack is especially high within a month of a previous attack, so lung function monitoring may only be needed in the period immediately after a recent attack to prevent a further attack. Even if all three arms of the project are not applicable, or suitable for all children, each technological approach can also be utilised independently, adding to more widespread application. This proof-of-concept project will allow us to develop a completely novel remote monitoring solution for patients with a high unmet clinical need, but who are a challenge to monitor and manage, and whose needs are frequently overlooked.