Asthma requiring for consistent management Digital Healthcare Services
Steady self-management is very important for asthma which can suddenly be worsened by external environmental factors, even without symptoms. I met Kang Min-kyu, an Associate professor of allergy medicine at Chungbuk National University Hospital, who studies patient-tailored digital healthcare services from which patients can manage themselves conveniently and meticulously in their daily lives.
Q. Medieus Queen: Hello? I heard that you mainly study patient-specific prevention systems that are first tried, such as food allergy apps and drug side effects apps. Please briefly introduce yourself and tell me about your motivation for studying patient-specific prevention systems.
A. Kang Min-kyu, an associate professor at Chungbuk National University Hospital (hereinafter referred to as Kang Min-kyu): I am Kang Min-kyu, a specialist in allergy medicine at Chungbuk National University Hospital. I am in charge of diseases such as asthma, rhinitis, food allergies, and drug allergies.
The first treatment for allergic diseases is avoidance. It's very important to find out which substances cause allergic reactions when exposed to them, and how to avoid being exposed to them. Most other diseases are aimed at treating diseases, but allergy is both difficult and fun because it is not just about treating diseases, but also about the patient suffering from allergies and their environmental factors.
I'm very interested in how allergy sufferers can be free from allergens. When I was an allergy physician, I treated a food allergy patient at an outpatient clinic, and I diagnosed him as I studied the books and prescribed drugs accordingly. Then, the patient asked. "What food should I be careful of?" I said, "Don't eat food with buckwheat," because the patient was allergic to buckwheat. The patient asked me again."I don't know much about cooking, but what kind of food usually contains a lot of buckwheat?" Since I didn't know much about cooking or food, I didn't have anything to tell the patient. Of course, it may be in the field of clinical nutritionists to answer, "What is the food with a lot of buckwheat?" but it was a little weird because I couldn't answer anything.
As I couldn't study nutrition, I was thinking about it, and while looking for what allergens are mainly in Korean food, I found that school meals indicate what allergens are included in each food. So the school lunch menu and allergy-inducing ingredient information were made into a database. I printed an Excel file and gave it to patients with food allergies to see which food ingredients they were allergic to.
Then, I found out that food allergy accidents occur frequently in elementary schools, and I thought it would be nice to have an app that automatically informs me if the food that is allergic to is included in school meals. So, I made a "meal allergy notification" app. This app allows students with food allergies to enter information about their school, grade, and class. If they select allergy-causing ingredients when allergy-causing foods are included in the same day's meal, the "Allergy Alert" app automatically sends push alarms to the students, parents, and teachers to be careful in advance.
Currently, I am working for a healthcare platform that helps patients with drug allergies or severe drug side effects take drugs safely. Drug allergy patients may be taken to the emergency room due to anaphylaxis shock if they take the wrong medicine, but patients often do not know which medicine is dangerous. The problem, however, is that doctors and pharmacists often prescribe medicines that should not be taken because they do not know the patient's history of drug allergies accurately. If the accident continues, patients often don't go to the hospital even though they need it, and doctors sometimes don't prescribe medicine at all because they keep causing problems. So, we created a "drug allergy notification" app that can store patients' drug allergy information in a mobile phone app, and we also developed a function that tells them if they can take this drug right away when they search for a drug called A in the app. If you take a picture of the QR code that is printed on the prescription, it will tell you not to take the specific drug when it is prescribed. I received several awards and registered patents with this app. The review of patients' appreciation on the Google Play Store was very helpful.
Q. Medieus Queen: Asthma is common in infants and older people aged 70 to 80. What is the reason for the high incidence among certain age groups?
A. Kang Min-kyu: Children have a high prevalence of allergic diseases including asthma. As the residential environment became westernized and lifestyle changed, the prevalence of asthma in children increased rapidly by 10% ~ 15%, atopic dermatitis by 15 ~ 20%, and allergic rhinitis by 20 ~ 30%. Allergic diseases in children are mainly related to atopic reactions to allergic antigens such as house dust mites and pollen, and as they grow, symptoms are often lessened or well-controlled.
In the elderly, asthma is often caused by allergic factors such as smoking, fine dust, air pollution, and poor lung function. As they often have comorbid diseases and side effects, they have difficulty controlling asthma well. Research has recently shown that elderly asthma patients are three to four times more than young people, but in fact, allergic diseases including asthma, are more evenly distributed across all ages.
In some cases, asthma symptoms continue to be severe even as an adult, and new asthma occurs as an adult. Recently, there are also many young asthma patients due to pet allergies. There are often cases where you didn't have allergies when you were young, but you developed allergies while raising pets after you became an adult. Asthma patients with pet allergies often have severe symptoms, so there are cases where allergic immunotherapy is required.
Q. Medieus Queen: If you have insufficient asthma symptoms, you often don't know if you have asthma. I wonder what symptoms are repeated even if asthma is insufficient, and how to distinguish between asthma and colds, which people confuse a lot.
A. Kang Min-gyu: Like the cases of chronic diseases such as high blood pressure and diabetes, patients often do not know much about asthma until it becomes severe. Or even if you have symptoms of shortness of breath or cough, you may think of it as normal aging.
And as symptoms of asthma usually repeat the cycle of good or bad, when it was bad, you decide to go to a hospital, but if the symptoms slowly improve, you may cancel your reservation thinking that you have recovered.
Even if symptoms such as shortness of breath, cough, and wheezing do not persist, if the symptoms appear repeatedly, it would be better to suspect asthma and visit the hospital. Or if breathing difficulties or coughs are repeated in certain situations, you should also suspect asthma.
In addition, allergic patients with asthma and rhinitis usually say that they are "living with a cold." However, colds are caused by viruses coming in, so you should have systemic symptoms such as a severe fever or swelling of your throat. Most patients who often catch a cold often mistake the worsening of their allergic disease for a cold. For the worsening allergy, patients should take allergy medicine, and for asthma, patients get better quickly if they inhale inhaled steroids. However, in general, they have repeatedly analgesic anti-inflammatory drugs and antitussive expectorants prescribed from the hospital. Allergic patients do not catch a cold if they take allergy medicine steadily, and even when their allergies get worse, they can get better quickly if they take allergy medicine properly. If there are people around you who say, "I often catch a cold," it would be good to recommend that they get treated for allergies.
Q. MEDIEUS Queen: Please advise on what to do with asthma patients who are unable to wear masks for a long time these days when wearing masks is essential due to COVID-19.
A. Kang Min-gyu: I think asthma patients are uncomfortable with wearing masks. Asthma is a problem but in the case of rhinitis, it causes uncomfortable to breathe with the mouth while the nose is blocked, which makes it more uncomfortable if you wear a mask. According to a recent study, patients with asthma and chronic obstructive pulmonary disease can lose lung capacity and have difficulty breathing if they exercise with health masks such as N80, as well as N94.
However, patients with chronic diseases must wear a mask in places where there are many people because they are more dangerous when they get COVID-19. If you feel uncomfortable breathing while wearing a mask, it is recommended to take off your mask immediately and rest in a quiet and open place more than 2m away from others. The government has not made it mandatory to wear a mask in places where you can distance yourself from others outdoors.
Q. Medieus Queen: Asthma is a condition that requires constant care even after treatment in the hospital. What are the management methods and how can digital healthcare services help asthma patients who need constant treatment?
A. As you said, asthma is a disease in which patients' self-management is important. Asthma requires constant management because symptoms can suddenly worsen due to external environmental factors such as pollen, allergic substances, and colds. The most important thing in constant care is to take the asthma medicine you inhale steadily. It is also important to clean the home environment and thoroughly sanitize such as hand washing, but it is most important to maintain inhaled steroids steadily.
And what's important is that the patient responds appropriately when asthma worsens. There is a term called "self-directed asthma control," but asthma is a disease that repeats good or bad like a roller coaster, so it is recommended to consult your doctor in advance to decide how to treat asthma when it gets worse. Depending on the degree of asthma deterioration, we provide behavioral guidelines to patients in advance. When patients' asthma worsens, asthma is often controlled if they raise the stage of asthma treatment according to predetermined behavioral guidelines.
Recently, there are also digital healthcare platforms for asthma self-care. There is also an app called "Breath Care," and we also created an asthma self-management app for the elderly in Sejong City last year. This year, we are working with Professor Shin Kwang-soo of Chungbuk National University and Professor Han Hyun-wook of Cha Hospital to develop an asthma patient management platform using smart healthcare devices. The app we are planning is to provide a patient-tailored asthma forecast through the identification of which month each patient gets worse and what environmental factors are by artificial intelligence. And I'm also trying to implement a function that allows my asthma information to be helpful to others because if the asthma of a patient with similar characteristics deteriorates, it is likely to worsen my symptom.
Q. Medieus Queen: Lastly, as a professor who studies a variety of digital healthcare services for patients with chronic respiratory allergies, please tell us what you are preparing for in the future
A. Kang Mingyu: I'm currently preparing two things.
First of all, I would like to develop a smart healthcare-based primary medical asthma treatment guideline and platform to help asthma patients in Chungcheongbuk-do receive treatment not only at university hospitals but also at primary medical institutions. After a patient with severe asthma comes to a university hospital to determine the cause and receive appropriate treatment, if asthma improves, I want to make sure that the patent should be well treated in the primary medical institution by the doctor. The problem is that the university hospital did an expensive test and worked hard to identify the factors of the patient, but when he was sent back to the primary medical institution, these important factors of the patient were not well conveyed. Therefore, I want to develop a clinical decision support system (CDSS) related to asthma treatment and management to help doctors of primary medical institutions use the individual characteristics of patients on CDSS to easily treat patients.
The other thing is, I want to develop a platform that helps patients take their medicine safely. Patients with drug side effects suffer a lot from side effects. I am working on the expansion of a platform where patients can store their drug side effects information in MyData and check it at hospitals and pharmacies. There are often cases where you feel sleepy and have a stomachache after taking medicine. And sometimes, even if you take certain medicines, there are cases where it doesn't work. I am developing a system where these minor side effects are automatically identified on the platform and recommends patients take safe and effective drugs. Currently, we aim to start a business with this item within this year.
A. Kang Min-kyu, an associate professor at Chungbuk National University Hospital (hereinafter referred to as Kang Min-kyu): I am Kang Min-kyu, a specialist in allergy medicine at Chungbuk National University Hospital. I am in charge of diseases such as asthma, rhinitis, food allergies, and drug allergies.
The first treatment for allergic diseases is avoidance. It's very important to find out which substances cause allergic reactions when exposed to them, and how to avoid being exposed to them. Most other diseases are aimed at treating diseases, but allergy is both difficult and fun because it is not just about treating diseases, but also about the patient suffering from allergies and their environmental factors.
I'm very interested in how allergy sufferers can be free from allergens. When I was an allergy physician, I treated a food allergy patient at an outpatient clinic, and I diagnosed him as I studied the books and prescribed drugs accordingly. Then, the patient asked. "What food should I be careful of?" I said, "Don't eat food with buckwheat," because the patient was allergic to buckwheat. The patient asked me again."I don't know much about cooking, but what kind of food usually contains a lot of buckwheat?" Since I didn't know much about cooking or food, I didn't have anything to tell the patient. Of course, it may be in the field of clinical nutritionists to answer, "What is the food with a lot of buckwheat?" but it was a little weird because I couldn't answer anything.
As I couldn't study nutrition, I was thinking about it, and while looking for what allergens are mainly in Korean food, I found that school meals indicate what allergens are included in each food. So the school lunch menu and allergy-inducing ingredient information were made into a database. I printed an Excel file and gave it to patients with food allergies to see which food ingredients they were allergic to.
Then, I found out that food allergy accidents occur frequently in elementary schools, and I thought it would be nice to have an app that automatically informs me if the food that is allergic to is included in school meals. So, I made a "meal allergy notification" app. This app allows students with food allergies to enter information about their school, grade, and class. If they select allergy-causing ingredients when allergy-causing foods are included in the same day's meal, the "Allergy Alert" app automatically sends push alarms to the students, parents, and teachers to be careful in advance.
Currently, I am working for a healthcare platform that helps patients with drug allergies or severe drug side effects take drugs safely. Drug allergy patients may be taken to the emergency room due to anaphylaxis shock if they take the wrong medicine, but patients often do not know which medicine is dangerous. The problem, however, is that doctors and pharmacists often prescribe medicines that should not be taken because they do not know the patient's history of drug allergies accurately. If the accident continues, patients often don't go to the hospital even though they need it, and doctors sometimes don't prescribe medicine at all because they keep causing problems. So, we created a "drug allergy notification" app that can store patients' drug allergy information in a mobile phone app, and we also developed a function that tells them if they can take this drug right away when they search for a drug called A in the app. If you take a picture of the QR code that is printed on the prescription, it will tell you not to take the specific drug when it is prescribed. I received several awards and registered patents with this app. The review of patients' appreciation on the Google Play Store was very helpful.
Q. Medieus Queen: Asthma is common in infants and older people aged 70 to 80. What is the reason for the high incidence among certain age groups?
A. Kang Min-kyu: Children have a high prevalence of allergic diseases including asthma. As the residential environment became westernized and lifestyle changed, the prevalence of asthma in children increased rapidly by 10% ~ 15%, atopic dermatitis by 15 ~ 20%, and allergic rhinitis by 20 ~ 30%. Allergic diseases in children are mainly related to atopic reactions to allergic antigens such as house dust mites and pollen, and as they grow, symptoms are often lessened or well-controlled.
In the elderly, asthma is often caused by allergic factors such as smoking, fine dust, air pollution, and poor lung function. As they often have comorbid diseases and side effects, they have difficulty controlling asthma well. Research has recently shown that elderly asthma patients are three to four times more than young people, but in fact, allergic diseases including asthma, are more evenly distributed across all ages.
In some cases, asthma symptoms continue to be severe even as an adult, and new asthma occurs as an adult. Recently, there are also many young asthma patients due to pet allergies. There are often cases where you didn't have allergies when you were young, but you developed allergies while raising pets after you became an adult. Asthma patients with pet allergies often have severe symptoms, so there are cases where allergic immunotherapy is required.
Q. Medieus Queen: If you have insufficient asthma symptoms, you often don't know if you have asthma. I wonder what symptoms are repeated even if asthma is insufficient, and how to distinguish between asthma and colds, which people confuse a lot.
A. Kang Min-gyu: Like the cases of chronic diseases such as high blood pressure and diabetes, patients often do not know much about asthma until it becomes severe. Or even if you have symptoms of shortness of breath or cough, you may think of it as normal aging.
And as symptoms of asthma usually repeat the cycle of good or bad, when it was bad, you decide to go to a hospital, but if the symptoms slowly improve, you may cancel your reservation thinking that you have recovered.
Even if symptoms such as shortness of breath, cough, and wheezing do not persist, if the symptoms appear repeatedly, it would be better to suspect asthma and visit the hospital. Or if breathing difficulties or coughs are repeated in certain situations, you should also suspect asthma.
In addition, allergic patients with asthma and rhinitis usually say that they are "living with a cold." However, colds are caused by viruses coming in, so you should have systemic symptoms such as a severe fever or swelling of your throat. Most patients who often catch a cold often mistake the worsening of their allergic disease for a cold. For the worsening allergy, patients should take allergy medicine, and for asthma, patients get better quickly if they inhale inhaled steroids. However, in general, they have repeatedly analgesic anti-inflammatory drugs and antitussive expectorants prescribed from the hospital. Allergic patients do not catch a cold if they take allergy medicine steadily, and even when their allergies get worse, they can get better quickly if they take allergy medicine properly. If there are people around you who say, "I often catch a cold," it would be good to recommend that they get treated for allergies.
Q. MEDIEUS Queen: Please advise on what to do with asthma patients who are unable to wear masks for a long time these days when wearing masks is essential due to COVID-19.
A. Kang Min-gyu: I think asthma patients are uncomfortable with wearing masks. Asthma is a problem but in the case of rhinitis, it causes uncomfortable to breathe with the mouth while the nose is blocked, which makes it more uncomfortable if you wear a mask. According to a recent study, patients with asthma and chronic obstructive pulmonary disease can lose lung capacity and have difficulty breathing if they exercise with health masks such as N80, as well as N94.
However, patients with chronic diseases must wear a mask in places where there are many people because they are more dangerous when they get COVID-19. If you feel uncomfortable breathing while wearing a mask, it is recommended to take off your mask immediately and rest in a quiet and open place more than 2m away from others. The government has not made it mandatory to wear a mask in places where you can distance yourself from others outdoors.
Q. Medieus Queen: Asthma is a condition that requires constant care even after treatment in the hospital. What are the management methods and how can digital healthcare services help asthma patients who need constant treatment?
A. As you said, asthma is a disease in which patients' self-management is important. Asthma requires constant management because symptoms can suddenly worsen due to external environmental factors such as pollen, allergic substances, and colds. The most important thing in constant care is to take the asthma medicine you inhale steadily. It is also important to clean the home environment and thoroughly sanitize such as hand washing, but it is most important to maintain inhaled steroids steadily.
And what's important is that the patient responds appropriately when asthma worsens. There is a term called "self-directed asthma control," but asthma is a disease that repeats good or bad like a roller coaster, so it is recommended to consult your doctor in advance to decide how to treat asthma when it gets worse. Depending on the degree of asthma deterioration, we provide behavioral guidelines to patients in advance. When patients' asthma worsens, asthma is often controlled if they raise the stage of asthma treatment according to predetermined behavioral guidelines.
Recently, there are also digital healthcare platforms for asthma self-care. There is also an app called "Breath Care," and we also created an asthma self-management app for the elderly in Sejong City last year. This year, we are working with Professor Shin Kwang-soo of Chungbuk National University and Professor Han Hyun-wook of Cha Hospital to develop an asthma patient management platform using smart healthcare devices. The app we are planning is to provide a patient-tailored asthma forecast through the identification of which month each patient gets worse and what environmental factors are by artificial intelligence. And I'm also trying to implement a function that allows my asthma information to be helpful to others because if the asthma of a patient with similar characteristics deteriorates, it is likely to worsen my symptom.
Q. Medieus Queen: Lastly, as a professor who studies a variety of digital healthcare services for patients with chronic respiratory allergies, please tell us what you are preparing for in the future
A. Kang Mingyu: I'm currently preparing two things.
First of all, I would like to develop a smart healthcare-based primary medical asthma treatment guideline and platform to help asthma patients in Chungcheongbuk-do receive treatment not only at university hospitals but also at primary medical institutions. After a patient with severe asthma comes to a university hospital to determine the cause and receive appropriate treatment, if asthma improves, I want to make sure that the patent should be well treated in the primary medical institution by the doctor. The problem is that the university hospital did an expensive test and worked hard to identify the factors of the patient, but when he was sent back to the primary medical institution, these important factors of the patient were not well conveyed. Therefore, I want to develop a clinical decision support system (CDSS) related to asthma treatment and management to help doctors of primary medical institutions use the individual characteristics of patients on CDSS to easily treat patients.
The other thing is, I want to develop a platform that helps patients take their medicine safely. Patients with drug side effects suffer a lot from side effects. I am working on the expansion of a platform where patients can store their drug side effects information in MyData and check it at hospitals and pharmacies. There are often cases where you feel sleepy and have a stomachache after taking medicine. And sometimes, even if you take certain medicines, there are cases where it doesn't work. I am developing a system where these minor side effects are automatically identified on the platform and recommends patients take safe and effective drugs. Currently, we aim to start a business with this item within this year.
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