A new respiratory app to help people manage and monitor long Covid, asthma and chronic obstructive pulmonary disease (COPD) could be available to the public by the end of the year.

The app, which developers hope could also help with rehabilitation after chest or abdominal surgery, will be piloted in two separate studies in May among outpatients at the Royal Free Hospital in North London and from GP practices in the area.

If these are successful, it could quickly be made available to the more than ten million people in the UK suffering from asthma, long Covid and COPD.

The Lungy Health app, developed by University College London scientists and London-based startup Pi-a, uses screen visuals to guide the patient through breathing exercises that can help treat their condition.

And the camera and microphone can monitor a person’s breathing and the progress they are making. This reduces the need for face to face checkups and therapy.

Around one in five UK adults experience respiratory symptoms, such as breathlessness, due to diseases like long Covid – which affects up to 2 million people in the UK, asthma (8m) and COPD (1.2m) – and many of these could benefit from the new app, according to its main developer, Luke Hale.

The annual cost of asthma and COPD on the NHS in the UK is estimated as £3 billion and £1.9 billion respectively.

“I’m very excited by this because a huge proportion of patients could benefit. This app has been developed to be hugely scalable and accessible to everyone, so any patient with a smartphone can access it and use the technology,” said Dr Hale, an NHS doctor, UCL researcher and founder of Pi-a.

“There are currently 194,900 waiting to see a respiratory consultant 68,000 of whom have been waiting more than 18 weeks to see a specialist. And this would be a very small percentage of all patients with respiratory problems. It would only be those that have either poorly controlled breathing conditions or new lung problems.

“We’ve had some interest from US companies and startups who would like to incorporate the breath recognition technology in their own platforms – this would potentially enable it to scale much quicker. It may be that this breath-recognition smartphone technology ‘powers’ a number of other applications,” he said.

Professor Tony Young, National Clinical Director for Innovation NHS England and Founder NHS Clinical Entrepreneur Programme, who is not involved in the app but is familiar with the project, said: “I’m very excited by Lungy Health’s technology and to see what use cases develop for respiratory patients.”

“Respiratory disease places a huge burden on the NHS, especially at this time of year, and technologies like Lungy Health could help to ease this strain by empowering patients to monitor and self-manage their condition at home.”

“Innovation is essential to the future of the NHS and new technologies can make a huge difference to both staff and patients,” added Professor Young, who is also an NHS surgeon and director of medical innovation at Anglia Ruskin University.

The app will be trialled in two separate studies in May (Lungy Health)

The app has a range of visuals to help relax the user and to guide them through the process and keep things interesting.

According to Dr Hale, the exercises have the therapeutic benefits associated with breathing exercise such as reducing breathing complications, strengthening breathing muscles, reducing chest infections and increasing capacity for exercise.

It also has psychological benefits such as “improved mindfulness and reduced stress and anxiety”, he said.

An earlier ‘wellness’ prototype, which used breathing exercises to help with anxiety and stress, rather than respiratory conditions, suggested that the final Lungy app will prove a success, he added.

“The wellness version has been received very well – since December it has more than 10,000 downloads and a 4.9-star feedback rating. This demonstrates that people really enjoy using the new technology – which will make a huge difference for the adoption of Lungy Health, as one of the tricky barriers to overcome is for users to accept the new smartphone interaction via the breath.”

If this is backed up by the forthcoming trials, Dr Hale hopes the app can enable many more people to have ‘breathing exercise’ therapy and that compliance with those breathing exercises can improve significantly. The app could also reduce the strain on the NHS.

At the moment, people can find it difficult to keep up their breathing exercises homework after a face-to-face session with a physiotherapist as they are typically given a worksheet and left to carry them out on their own.

The hope is that the app makes the process more fun and easier to stick to.

The app may also be able to replace the need for occasional spirometer tests to check how the patient is getting on which could be done at home through the phone instead. Spirometry tests involve a visit to a GP or hospital and involve a plastic device, known as a spirometer, and that is relatively costly, at £15 to £20 and can only be used once. A separate trial, also starting in May, will look at the apps effectiveness as a spirometer replacement.

If effective, this means the app could provide an early indication of deterioration in lung conditions or show improvement. It would not be used in the initial diagnosis of lung conditions, which often requires extra equipment.

A spokesperson for Asthma + Lung UK said: “New ways of delivering asthma care are urgently needed. Care for people with asthma in the UK has seen no significant improvement in recent years, despite the widespread availability of treatments that are effective for the majority.

“Digital technology delivered via smartphones has the potential to help people self-manage their asthma at scale through improved understanding of their condition, how to recognise and avoid their condition worsening, and how they should respond if their condition worsens.”

When done correctly, breathing exercises can be a simple and effective way to improve physical and psychological health, breathing function, exercise tolerance and reduce chest infections.

Existing treatment to teach breathing exercises involves giving patients a worksheet and often an incentive spirometer: a one-use, plastic device that provides resistance to inhaling and encourages deep breathing. Compliance with breathing exercises is generally poor (the hope is the app can significantly increase that), and demand for respiratory physiotherapists has greatly increased due to Covid, an ageing population and the rising prevalence of respiratory disease.

Respiratory disease and mental illness place a huge burden on NHS services and society. Before Covid, the cost of respiratory illness was estimated at £9.9 billion a year, with hospital admissions due to respiratory disease rising at three times the rate of other admissions and 10,000 new diagnoses of lung disease in the UK every week.

The developers say Lungy Health is unique in that it uses the camera and the microphone together (providing much more data) to measure breathing, and enabling more accurate and consistent measurement of breathing function.

Other approaches use machine learning on just audio to determine the different breath phases (in, out) and respiratory rate.

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