A Good and Cheap Asthma Solution

I am a big fan of cheap, simple solutions to complex problems – but really, who isn’t? One example is a column we wrote a while back on incentivizing doctors to do a better job of washing their hands to fight hospital-acquired infections. Similarly, this New York Times article described a study at a V.A. hospital in Pittsburgh where “the rate of hospital-acquired infections dropped after hospital workers began using relatively inexpensive precautionary measures like discarding blood pressure cuffs after one use.”

Along those same lines, here’s an interesting e-mail we got recently from a blog reader named Eric Green:

I thought your readers might be interested in some of the work I’m doing as part of my M.D./Ph.D studies at Stanford University. I traveled to Mexico this spring as part of a course at Stanford with the goal of developing inexpensive technologies to improve medical care in health clinics in rural Mexico.

I invented an extremely low-cost version of a device, known as a spacer, that dramatically increases the amount of medication that can reach the lungs of a child to relieve the symptoms of an asthma attack. I replaced an expensive device with a single sheet of paper with a precise system of cuts and folds that is shipped flat and folded into its final form on-site. This production and distribution strategy allows the device to be delivered at less than one percent of the cost of current alternatives and saves children and their families from traveling hundreds of miles to be treated in the nearest big-city hospital. My plan is to start distribution and clinical trials in Mexico in the coming months.

I asked Eric for some more details about how his device will challenge the status quo. Here’s his reply:

For treating asthma attacks, Mexican health centers are supplied with metered-dose inhalers (similar to those used in the U.S.), which are a cheap and effective way of generating aerosol particles, but these devices are not sufficient to deliver the medication to a child’s lungs. Successful use of an inhaler requires that a child coordinate a deep breath with discharging the inhaler. This is challenging for a young child, particularly one gasping in the midst of an asthma attack. As a result, medication does not reach the lungs but is instead lost to the air or absorbed in the mouth and throat, where it causes undesirable systemic side effects.

To overcome these problems, inhalers are used in combination with a device commonly called a “spacer.” A spacer is a chamber that attaches to an inhaler, captures the discharged medication and holds it until the patient inhales it. Versions of this device in the U.S. are commonly made of plastic and cost about $50 here, and even more in Mexico because of shipping costs.

This project began with a trip to the Higueras Health Center in Nuevo Leon, Mexico. There I met Jose Antonio, a young physician working and living in this Center. He told me the story of Jesus, a child arriving with his mother in the middle of the night and gasping for breath. Antonio knew the right treatment immediately but had no way to deliver it. Although he had a refurbished nebulizer sitting in the corner of the room, it had not worked for years.

He then took me to a side room with a humidifier and explained how he desperately had tried to get medication to Jesus’ lungs by pouring it into the humidifier, closing the door and hoping. It was the combination of his own feeling of frustration, the powerlessness and anxiety of the child’s mother, and the suffering and fear of the child that compelled me to address this need. Furthermore, it was the observation that a single much-needed device could break down the wall that keeps the community physician from giving the suffering child the medication he needs.

We have performed initial benchtop testing of the device in collaboration with a company in the Bay Area and confirmed that it can effectively transmit medication in the laboratory. We are currently planning clinical trials that we expect will be underway in Mexico in the fall of 2007.

Green’s innovation was recently selected as one of ten finalists worldwide in the Changemakers Collaborative Competition, which attempts to find “disruptive innovations” that will provide healthcare solutions across the globe.

I am neither smart nor experienced enough to tell if Eric Green’s paper spacer is a true lifesaver (I hope it is), but I am pretty sure that creative thinking like this is what has kept our species alive and thriving for tens of thousands of years, and hopefully for tens of thousands more in the future.