Asthma Technology & Mobile Apps – PediaCast 242

Dr David Stukus and Dr Nabeel Farooqui join Dr Mike in the PediaCast Studio to talk about asthma. We’ll nutshell the disease and take a look at emerging technology for managing asthma — including the use of mobile apps!


  • Asthma
  • Asthma Technology
  • Asthma Mobile Apps




Announcer 1: This is PediaCast.


Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike!

Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast, it's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio.

It's February 13th, 2013 and this is Episode 242. We're calling this one Asthma Technology and Mobile Apps.

Now, I grew up in the 1980s and I don't know, as I say the word 'technology', then say it's 2013, feels like I just teleported to the future. But no, it just means I'm getting old.

So welcome to the program everyone, we are in the thick of winter. In Ohio, winter means thick clouds, sometimes snow, sometimes ice, sometimes sleet, sometimes rain, rarely sunshine. You know, sometimes, we get all these things in one day here in Ohio. And such is the life of an Ohio winter.

And one thing that rears its head in winter – not only in Ohio, but across the entire country and really around the world – is respiratory viruses. Things like influenza, which we covered before, but others like parainfluenza virus which causes croup, rhinovirus which is the common cold, respiratory syncytial virus also know as RSV, adenovirus and there are others – these respiratory viruses are a nuisance for any of us. But if your child or you suffer from asthma or reactive airway disease, then these viruses can become much more than a menace. They really can make daily control of your airway disease challenging. These things can cause your asthma to flare and sometimes, they can flare to critical or life threatening levels.


So keeping asthma under control is always a good idea. But in the winter and especially during viruses, it can be a particular challenge. Now, we talked about asthma in great detail before, back in PediaCast 186, Dr. Karen McCoy stopped by the studio. She's the chief of Pulmonary Medicine here at Nationwide Children's Hospital. It was back in October 2011 but it's still relevant. It's a great episode so check it out. And we'll put a link in the Show Notes to this show, 242.

There's no need to rehash all the details here today on asthma, although, we will hit the highlights. But today, we were really going to focus on asthma management and the effect technology has on it, particularly with regards to mobile apps.

And to help me talk about this, I have a couple of asthma and technology experts with me in the studio today. Dr. David Stukus is an attending physician with allergy and immunology here in Nationwide Children's. And Dr. Nabeel Farooqui is a fellow in Allergy and Immunology here at Nationwide Children's.

But before we get to them, I do have a couple reminders for you. This is your show, and as I mentioned before, we're making a renewed effort this year to get your questions answered here on PediaCast. It's easy to contribute and ask your questions, just head over to and click on the Contact link. That's all you have to do. I read every one of those that come through. So, if you want, just click it and say hello, that's fine too.

We also have another way to get your question answered. The weekly Ask Dr. Mike segment on Facebook has officially kicked off. Now, this is on the Nationwide Children's Hospital Facebook page, not the PediaCast Facebook page, although we should put a link to it there. You can ask your question and view the weekly video. We've also made a special YouTube playlist with all of the Ask Dr. Mike videos. And to find those, simply follow the link in the Show Notes at the There aren't many there yet. We're just getting started. But stay tuned as we add a new one every week and build up that collection.


And also, I just want to ask, just honestly here. I want you to forgive me upfront on this one. I'm not really comfortable in front of the camera. I've been behind the microphone for quite awhile, since my teenage years as a radio and skating rink disc jockey. But the camera, I'm not feeling as much loved. Just keep that in mind as you watch the videos. They may good for a laugh.

But, you know, it's about the information, folks, and getting your questions answered, so we definitely do that with those videos. So ask Dr. Mike, and again, we'll have links in the Show Notes for you.

One of the things I want to remind you that the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you do have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at

All right, let's take a quick break and I will be back with this week's studio guests. That's all coming up right after this.


All right, we are back and joined today, as I mentioned, by two great studio guests. Dr. David Stukus is an attending physician with the Section of Allergy and Immunology here at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University College of Medicine.

So welcome to PediaCast, Dr. Stukus.


Dr. David Stukus: Oh, thank you very much. I'm excited to be here and I appreciate the invitation.

Dr. Mike Patrick: Yup, we appreciate you stopping by.

We're also joined by Dr. Nabeel Farooqui, a fellow with the Section of Allergy and Immunology here in Nationwide Children's. So a warm PediaCast welcome to you as well.

Dr. Nabeel Farooqui: Thank you so much Mike. It's a pleasure to be here.

Dr. Mike Patrick: So Dr. Farooqui what exactly is a Fellow? [Laughter] Now, we all know what a fellow is, in the generic sense, but in the world of medicine, what is a Fellow?

Dr. Nabeel Farooqui: Well, it means that you are an eternal student of medicine. I feel like I'm never going to get out of school. So, a fellow is a sub-specialist in any field. So, allergy and immunology, that is my primary focus. My background for that was in general adult internal medicine.

Dr. Mike Patrick: Right. So you're training to then become an attending physician in allergy and immunology.

Dr. Nabeel Farooqui: Correct.

Dr. Mike Patrick: Got you.

So let's kind of just nutshell asthma here for a moment before we talk about technology and apps. And as I mentioned, we did have a show that was really dedicated to everything about asthma, Episode 186. But Dr. Stukus, just sort of remind listeners, what causes asthma?

Dr. David Stukus: So asthma is something that's internal inside the body and it's inside the lungs. And there are two big components to it and that's one of the things a lot of people don't really understand about the disease. You have chronic inflammation and swelling that's present every second, every day. And then, you have the second component which is the spasming of the muscles around the breathing tubes, what we call bronchospasm.

And for a lot of kids, they may have symptoms on a daily basis. For some kids, they may have symptoms just intermittently whenever they get colds or viruses or things like that.

So asthma is inside the body, it's something that they're born with. And asthma presents differently for everybody. And that's another thing that leads it to being poorly recognized by primary care pediatricians and family practitioners. Poorly recognized by parents, they may think it is normal for a child to cough in a regular basis and not realize that there's something else going on inside the lungs. And we say it's a very variable disease, because it is.


Dr. Mike Patrick: Right, Now, the inflammation that's in the lungs, what sort of symptoms, then? You mentioned cough. What other symptoms does asthma cause?

Dr. David Stukus: So cough is one of the main ones and that can be on a daily basis or chronic basis or just intermittently. Children can also have wheezing that oftentimes, you can't really hear with your own ears. But sometimes you can, usually with a stethoscope. They can have breathlessness or shortness of breath. Or ultimately, if they have a severe asthma attack or exacerbation, they can have struggling with their breathing or increased work of breathing.

Dr. Mike Patrick: Sure. And how do you go about treating asthma?

Dr. David Stukus: So, first and foremost, you have to make sure you have the right diagnosis. And the hallmark of treatment is using short-acting bronchodilators, most common call arbitural, which is the rescue medicine. And then for children who have more chronic symptoms or more severe symptoms, then they benefit from using a daily control medicine.

Dr. Mike Patrick: And where do steroids kind of fit into? You know, parents hear the word steroid and your ears perk up a little bit. When do you use steroids with asthma?

Dr. David Stukus: So steroids are one of the treatments that we use for both control and therapy in the form of inhalers. So we call them inhaled corticosteroids or inhaled steroids. We can also use them in short bursts usually through the oral form or sometimes through an IV for kids who are very sick with asthma in the emergency department inside the hospital.

Dr. Mike Patrick: And so, the steroid medicine just reduces the inflammation and by reducing the inflammation you increase the diameter of the airways so air can flow a little bit better?

Dr. David Stukus: That's correct.

Dr. Mike Patrick: And with the bronchodilator, then you relax your smooth muscle. And again, that makes the diameter bigger so air moves in a little better.

Dr. David Stukus: Absolutely.

Dr. Mike Patrick: All right, so why target asthma with technology? What makes asthma good disease to fit with tech stuff?

Dr. David Stukus: So one of the biggest things with asthma is education – education of parent s, education of care givers. And with technology, we can use new and noble methods of delivering that education, whether it's through cartoons or videos or through specified personalized applications which we'll talk about today.


Dr. Mike Patrick: Yeah, sure. And there are just so many kids with asthma. I mean, this really has the opportunity to touch a lot of people's lives.

Dr. David Stukus: Absolutely. Some estimates have up to 30% or three in 10 children, or you know, on the average childhood classroom today, it'd be 9 kids in every classroom.

Dr. Mike Patrick: Yeah, wow.

Dr. David Stukus: So that's a lot of kids with asthma. So if you're going to devote the time and energy to use in technology, you want to focus on the disease that affects a lot of kids.

Dr. Mike Patrick: And, you know, you've mentioned that a lot of kids may have asthma but their parents don't call it asthma or know it asthma and maybe their doctor hasn't diagnosed it. And I guess with, you know, the prevalence of mobile apps and mobile technology, that if they look up 'cough', they may come across this and figure out, "Oh, hey, maybe my kid has asthma," and they can bring it up with their doctor. And so, it's kind of an education tool in that sense, too.

Dr. David Stukus: Absolutely.

Dr. Mike Patrick: So, in particular with the mobile app, what makes asthma good fit for mobile app?

Dr. David Stukus: Well, people are out and about and we have busy daily lives. So if you have a mobile app you can have on your person at all times, whether you're at school or out with friends or even when if you're at home, you'll have access to something that will help you actually manage your asthma and give you real time feedback whenever you have problems.

Dr. Mike Patrick: Yup. And for the physicians out there, and we do have a lot of clinicians in our audience as well, they probably heard the term 'asthma action plan' before. So this is a way to put a child's asthma action plan in the parent's pocket or in the kid's pocket.

Dr. David Stukus: Yes.

Dr. Mike Patrick: Because, right about now, as I think about it, a lot of kids have their own iPhones.

Dr. David Stukus: Right, we actually want to take parents out of the equation to some regard. Well, in some aspects of it.

Dr. Mike Patrick: Sure.

Dr. David Stukus: But you're absolutely right, and asthma action plans and asthma treatment plans are the hallmark of managing anybody with asthma and everybody should have one. And this gives you a way to take it from the piece of paper that you hang on the refrigerator and actually putting it in your pocket on a mobile device.

Dr. Mike Patrick: Sure. So Dr. Farooqui, this has really been your pet project. Tell us about the mobile app that you're designing and how did you come up with the idea. I guess, let's start with that. Where did this idea come from?


Dr. Nabeel Farooqui: So, I was really fortunate, I had really fun childhood and I was exposed to technology at a very early age. I think it was mid-80s when my dad brought home our first family computer and the first thing I did was I took it apart. And his jaw dropped to the floor. But that was my inquisitive nature to kind of figure out technology, how it works, why it works, how we can make it better.

So, I've incorporated a lot of that kind of ethos into my daily life and looked at medicine through that lens. So fast forward to the smartphone era and I feel like I'm a kid in the toy store.

Dr. Mike Patrick: Yeah.

Dr. Nabeel Farooqui: You know, I think the potential to really make neat innovative guideline based medical technology is just right at our hands now. And we're living in a very exciting time. As an asthma patient myself, that was kind of the natural fit to be the disease that I would kind of focus some of my efforts and technology on,

Dr. Mike Patrick: Yeah. So you were looking for an app for your own use.

Dr. Nabeel Farooqui: Right.

Dr. Mike Patrick: And it's like, "Hey, there's not anything out here."

Dr. Nabeel Farooqui: Absolutely. I mean, that was really the Aha moment for me. That I think I have a good idea and I can really contribute something to the space which would be useful to others and something that I would use myself as well.

Dr. Mike Patrick: Yup. So how do you go about making, starting with them? You got this idea,"Hey, let's make a mobile app." Step us through that process going forward.

Dr. Nabeel Farooqui: You know, it's a really interesting process. To be honest, this is the first time that I've done, actually done it myself. So it was definitely a learning process for me as well, but I'm kind of having that innate sort of desire to immerse myself with technology. I've kind of surrounded myself with a lot of friends and people kind of in that space. And most of my friends are actually not doctors. A lot of them are computer scientists and engineers and everything.


So, one of my friends who I partnered up with has a very successful IT company who writes software. We had always been collaborating, bouncing ideas off each other. Like, where can we do something? So when I ran my app idea by him, he thought it was a great idea. So helped me with the actual coding part of it, but I actually did all the design work, the framework and everything and made sure that the content was really solid.

Dr. Mike Patrick: So who did you design your app for? Is this for adult asthma patients? Kids? Parents? All of the above?

Dr. Nabeel Farooqui: Well, I think that's a great question. So I think technology isn't useful unless it works for the audience that it's intended for. And I think a great example of that is the electronic medical records; any doctor can tell you that a doctor did not design this.

Dr. Mike Patrick: Yes. [Laughter]

Dr. Nabeel Farooqui: So keeping that in mind, we wanted to bring the patient in the forefront. So this is an app which is targeting patients and keeping them in mind first, but they can use which will really make an impact in their asthma, in their education about asthma and then, their asthma outcomes? So this is where our core strength really lies, in that we've kind of brought the patient in the forefront and kind of taken all factors out of the equation.

Dr. Mike Patrick: So, it's really teenagers, adults could use it. I mean, and younger could probably, too, if they're tech savvy.

Dr. Nabeel Farooqui: Absolutely.

Dr. Mike Patrick: Which many are more so than their parents.


Dr. Nabeel Farooqui: Absolutely. Our initial roll, that is targeted at older children who can, like you said, use smartphones and all, and teenagers. But that's one of the great things about technology, is that it's scalable to all age groups.

Dr. Mike Patrick: Yeah, right. So let's dig down a little bit deeper. What are some specific features of this app?


Dr. Nabeel Farooqui: So I think at its core, the concept of the asthma diary is really what sets this app apart. So asthma diaries are basically logs that patients usually keep and we recommend this to all of our patients, to keep a symptom diary along with the medication diary. So this is something which does it very intuitively and very easily and having it in digital format will give you real time feedback on what symptoms you were having and correlate it with the type of medication, that you use a rescue medicine, for example, if you were supposed to trigger and start to have some shortness of breath.

So based on that we have an electronic algorithm which is based on National Asthma Guidelines which will activate your asthma action plan and give you advice on what next therapy step needs to take place. So, based on that, the user actually gets a lot of visual feedback. There's actually an asthma indicator status bar which will tell them whether they're doing well, they're not doing so good or if they're having an asthma emergency.

So not only will they be keeping track of their symptoms but with that visual feedback it would give them a better idea of what sort of parameters are taken into account when talking about asthma and controlled asthma. And I think that's a real key piece of information that will help a child really understand what good asthma control means and kind of help work towards that more.

Dr. Mike Patrick: Yeah, right. Now, is it customizable to the specific medicines that a person may be using or maybe prescribed?

Dr. Nabeel Farooqui: Absolutely. We've made it totally customizable and I think that's one of the advantages of having this in an electronic format as opposed to paper asthma action plan. And that, we've taken that into account and separated out what is your controller medicine, what is your rescue medicine. And it will remind you when to take your controller. It will remind you and give you information on triggers and what will set off your asthma and when to take the rest of the medicines.

Dr. Mike Patrick: Sure.

Dr. Nabeel Farooqui: And you'll get reminders throughout the day about avoiding your specific triggers and that's individualized to each patients.


Dr. Mike Patrick: And these are push notifications, so it'll come up like "Hey, don't forget to do your flow vent right now."

Dr. Nabeel Farooqui: Right, we were really taking advantage of the fact that we want the kids to play with their smartphones. They're going to be sitting there playing Angry Birds – or I think Temple Run is the new fad out there these days – and they'll get a push notification that "Hey, it's time to take your flow vent."

Dr. Mike Patrick: Yeah.

Dr. Nabeel Farooqui: So I think that…

Dr. Mike Patrick: It definitely help them with what it is that they need to do without their parent.

Dr. Nabeel Farooqui: Absolutely.

Dr. Mike Patrick: I mean, parents obviously want to be a part of the process but it's nice when you can have the kids started do things on their own and kind of take ownership of their disease at an early age.

Now, forgive me because I didn't ask you this before the show. I'm just curious, so the next step will be, and I suspect this isn't built in to it yet, and there's so much liability that we talked about between patient and doctors. But is there a way or in your mind a dream of being able to connect the patient to their doctor through the app?

Dr. Nabeel Farooqui: Absolutely. Absolutely. That is actually a feature that we definitely plan on developing in the future and giving provider analytics. So for example, a group of patients coming to a certain clinic would have this app deployed, the doctor would then have a desktop client which would then give you real time feedback on where your patients are, what they're doing.

The ultimate goal would be to prevent an acute care visit, whether that's an urgent care, that's an emergency room, and help prevent a hospitalization.

Dr. Mike Patrick: Yeah.

Dr. Nabeel Farooqui: So if you can do that with kind of real time analytics on the doctor's end, you can improve overall health whether that's healthcare dollars, whether that's personal health for each individual patient.

Dr. Mike Patrick: And I'll point out, just the common sense part of me wants this out to parents, that asthma can potentially be life threatening.

Dr. Nabeel Farooqui: Absolutely.


Dr. Mike Patrick: And so, if your child's having trouble breath, you wouldn't want to rely on app to tell you yeah, this is what you do or rely on the app to get in touch with your doctor. I mean, this is something you want to seek medical health as soon as possible.

Dr. Nabeel Farooqui: Absolutely.

Dr. Mike Patrick: So, the other apps that are out there now, not to mention any names or direct people in any particular place, do any asthma apps that you've seen go this far in terms of customization and helping? I mean, is there stuff out there already in there?

Dr. Nabeel Farooqui: There are some options out there already. But I think what really sets us apart is this is design from the ground up by asthma specialists. We know what patients need. And I think we have the experience to help deliver on that. So that's really what at its core.

I think one of the pitfalls of medical technology in general is that entrepreneurs are at the forefront, business people are at the forefront. Computer engineers are at the forefront developing all these things. They're very smart people and they come up with great technology, but I think what's really missing in the equation is having a core of standard medicine, really, and building your technology around that.

Dr. Mike Patrick: Yeah.

Dr. Nabeel Farooqui: So I think that's where our strength lies.

Dr. Mike Patrick: Now, this would probably be branded with Nationwide Children's Hospital but folks are welcome to use it regardless of where they get their care.

Dr. Nabeel Farooqui: Well, initially the deployment is going to be for Nationwide Children's Hospital only but eventually we may have.

Dr. Mike Patrick: How do you control that… I'm probably jumping a little bit ahead of myself here.

Dr. David Stukus: Sure. No.

Dr. Mike Patrick: How do you control that it's just for patients at Nationwide Children's initially.

Dr. Nabeel Farooqui: Yeah, that's a great question. So distribution will be through the iTunes Store but it will be through the Enterprise iTunes Store. So if someone were to search for this on iTunes, they wouldn't find it. However, if they are a Nationwide Children's Hospital patient, they will be given a special code by the clinics to go through iTunes and download that app.


Dr. Mike Patrick: There's a bunch of people out there right now going, "Oh, are you serious?"


Dr. Mike Patrick: But you do plan rolling it out more on a widespread once you've tried it and see how things work and what's good about it, what's bad about it, how can we improve it before it goes out to the general public?

Dr. Nabeel Farooqui: We've discussed that in our group internally.

Dr. David Stukus: And the other important thing is, why we think our app will be special is because we are actually going to study it. And we're going to try it out to a group of patients and see what features of it work and potentially what didn't work and then make it even better.

Dr. Mike Patrick: Plus, if you have that backend of someone kind of monitoring the patient's statistic, you need a program plugged in for a doctor to have the backend to communicate with the software.

So there's a ton of benefits, I think we've kind of talked about this. We've gone along for this app in terms of asthma patients and parents, can you think of another benefits that we haven't covered? I mean, the big thing really is taking ownership.

Dr. Nabeel Farooqui: Absolutely. I feel through patient empowerment, education, improved self awareness and self-management, we can get patients feeling better. And from the parents' perspective, it's just going to help the family unit help identify patients at risk and hopefully intervene before things kind of get out of hand.

Dr. Mike Patrick: And what are some pitfalls then for patients and parents who are using the app?

Dr. Nabeel Farooqui: Absolutely, and Dave can also speak more to this. You know, as we learn more about asthma, we're learning that it's not just one disease. The hot word of in our field is asthma phenotypes, and that's just a fancy word of saying that everyone with asthma is different. Everyone's going to be triggered by different asthma trigger. Everyone respond differently to treatment. So as such, your medical plans cannot be a cookie cutter. Everyone has to have an individualized management plan.


Although I think we have a very solid core based on guidelines with the technology that we're using currently, one of the advantages of using technology is that we can use adaptive algorithms to actually tailor your asthma action plans for each patient.

Dr. Mike Patrick: Yup.

Dr. Nabeel Farooqui: And that's definitely a direction that we're taking surely in the future.

Dr. Mike Patrick: You know, I can see in Central Ohio and in the surrounding areas, suddenly a bunch of people whose asthma's managed by their primary care doctors say, "Can you refer me to the Allergy Clinic at Nationwide Children's? Because this app sounds really cool" So, you guys may have an untoward effect on how busy your clinic is.

Dr. David Stukus: We welcome that.

Dr. Nabeel Farooqui: Absolutely, we love to see patients.

Dr. David Stukus: If I may, I think the biggest thing and other scary pitfall would be obviously, if the app were to take the place of the advice from your physician.

Dr. Mike Patrick: Yeah.

Dr. Nabeel Farooqui: Absolutely.

Dr. David Stukus: We have lots to do. And we'll be very straightforward when anybody wants to use that. In my experience, I was co-director of the Asthma Center clinic, I see a lot of kids with asthma. For those children who are able to take their medicine on a regular basis and then activate their asthma action plan in timely manner when they start to have symptoms, they don't make their way to my office. So, these are for all those kids who actually don't remember to take their medicines for whatever barriers they may face on a regular basis or just don't know or aren't equipped with the ability to treat their symptoms.

Dr. Mike Patrick: Yup.

Dr. David Stukus: So I think that's really the strongest…

Dr. Nabeel Farooqui: Absolutely.

Dr. Mike Patrick: And I guess I can see why that would be kind of a little bit of a barrier to just general release of this because you don't want people picking it up – because it's such a great program – and then trying to use that as a vending machine for their asthma management.

Dr. Nabeel Farooqui: Yeah, I think that's one of the features that set asthma apart from a lot of the chronic diseases is that when you feel good, you think everything's great and you don't need any of your medicines. But that's actually when you do need your medicines to help you continue feeling good inside.

Dr. Mike Patrick: What kind of timeframe are we talking about here in terms of roll-off?

Dr. Nabeel Farooqui: So Dave mentioned the clinical study that we're doing. So we're actually actively recruiting right now for a pilot project. We're going to be looking at various metrics and everything. And we're working closely with the marketing department here at Nationwide. Hopefully, the hospital will roll it out within the next couple of months.


Dr. Mike Patrick: Now, if there are folks out there who may already be a patient in your clinic, who might be interested in being in the pilot study, how do they get more information or indicate their interest of being part of it.

Dr. David Stukus: Well, if they're patients that are known to us, they can certainly contact our clinic and we can see if they meet eligibility criteria. Right now, they have to be between 9 and 16 years of age. And they have to be on a controller medicine because if we're designing an app to help them remember to take their medicine, they need to be on the medicine everyday to begin with.

Dr. Mike Patrick: Right. And you have some strict criteria going in because it's also a research study in terms of using this. And so you want a specific population and I suspect that you're going to look at "Is the control better with the app versus another group who's not using the app?" Or something of that nature.

Dr. David Stukus: That's correct.

Dr. Mike Patrick: And our audience is pretty adaptive. Because we talk about research studies all the time, so when you have your research which I'm sure will be published and I'm sure you'll come back, right?

Dr. Nabeel Farooqui: Absolutely. I'm going to say yeah.

Dr. David Stukus: And we'll tell you about the next big one.

Dr. Mike Patrick: Yeah, that's right. That's right.

So Dr. Stukus, let's say there are other folks out there who treat asthma and they're thinking, "Oh, this is a great idea." I mean, just speak to what they would benefit from this. Let's look couple of years from now, let's say it does get rolled out and it's something that you licensed to other asthma practitioners to use, what kind of benefit do you see from their perspective?

Dr. David Stukus: Well, I would hope that this would supplement a lot of the education that they're already providing. So this won't take the place of it but this should be, like we said before, a take home tool that their patient can actually use. And whatever treatment plan they put their patients on, they can kind of plug it with the system and have their patient utilize it. Then, they can actually use the feedback for whenever they enter their symptoms and medication usage at the next visit and say, "Oh, it looks like you used your arbitural 14 times last month. Let's talk about that, it seems like things aren't going so well."


Dr. Mike Patrick: Yeah, and so at that point, if you can interface the app with their chart…

Dr. David Stukus: Let's not talk about electronic medical records.


Dr. Nabeel Farooqui: It becomes more complicated.

Dr. Mike Patrick: But you know, in the future looking forward, you could see that kind of application in the product.

Dr. David Stukus: That's one of our goals.

Dr. Mike Patrick: What are some pitfalls for doctors in relying on an asthma app?

Dr. David Stukus: So, on the doctor side of things, technology is evolving very rapidly and we are very behind the game. So if all of a sudden, if you're patient is using a technology or mobile app and you start getting reports from that patient, you may not know what to do with it. So it's going to be increasing the awareness of physicians that their patients are actually utilizing these tools and how can they actually use the information to better serve them. That's going to be biggest challenge that we know.

Dr. Mike Patrick: And I can see some doctors being leery of that. Because let's say they're getting that information, if they're not keeping up on it, someone can say, "Hey, you should have known that my asthma was getting out of control even though I didn't tell you."

Dr. David Stukus: Correct. Yeah, we don't want this to… Again, this should not take the place of individualized advice or phone call. If you're not feeling well, you need to do something about it and/or call your physician.

Dr. Mike Patrick: Absolutely. So what other projects do you have coming down the pipeline? Give us a little clue.

Dr. David Stukus: So we've also developed, we've been part of the development team. We have used an iPad to deliver education in the primary care setting. This was developed through a generous fund through the Hamilton Parker Foundation. You should note that our mobile app was actually started from a generous fund from the Heffner Family Foundation. So these are two private families that have donated money specifically to develop these tools for children with asthma. With the iPad, we have developed modules to deliver asthma education in the office setting using videos and cartoons and quizzes and interactive feedback designed to help increase education and awareness.


Dr. Mike Patrick: Now, for the folks out there who were disappointed that your child has asthma and can't use this app, the videos are available for anyone to watch and they're great educational videos. I've taken a look at them. And we do have a playlist in YouTube with all of the videos listed. So, really anyone out there that wants to see some asthma education videos, they're available, 17 of them in all – how to use an inhaler with a spacer and a mouthpiece, how use it with a mask, without a spacer for older teens and adults.

Although, really, older teens and adults, you get better delivery if you use a spacer, right?

Dr. Nabeel Farooqui: You do. So we recommend that.

Dr. Mike Patrick: Just want to point that out.

Dr. David Stukus: Absolutely, yes.

Dr. Nabeel Farooqui: I think that happens when a teen sees a spacer is that "You think I'm a kid, I know how to use this spacer." But you'll be surprised that how little medicine actually gets to your lungs without a spacer.

Dr. Mike Patrick: Do you use a spacer with your asthma?

Dr. Nabeel Farooqui: I do.

Dr. Mike Patrick: So there you have it, you should use a spacer. I've been indoctrinated into this. I'm going to tell people use your spacer.

Dr. Nabeel Farooqui: [Laughter]

Dr. Mike Patrick: The dry powder inhalers, the twist-halers, how to use a nebulizer, control versus rescue medicine, steroid use in asthma, exercise induced asthma, asthma symptoms, coughing, shortness of breath, wheezing, labor breathing – so it's really a nice collection of asthma educational videos.

Dr. David Stukus: Thank you. We spent a year and a half developing this. And we initially wanted just to see what was out there and maybe we could license it for ourselves or pay some money to use it. And there wasn't very good educational tools especially in video format regarding this, so we decided to develop it by ourselves. And we're proud of it and I think we did produce some high-quality educational videos.

Dr. Mike Patrick: And we'll put link to those in the Show Notes so folks can find them pretty easily.

All right, well, I want to thank both of you for stopping by the studio today to talk about asthma technology and mobile apps.

Dr. Nabeel Farooqui: Well, thank you.

Dr. David Stukus: Thank you.

Dr. Mike Patrick: I want to remind everyone out there, links are in the Show Notes over for this episode. We will have a link for that all about asthma, PediaCast 186. And we'll also have a link to the Allergy and Asthma Clinic at Nationwide Children's. So if you do want to become one of their patients, it's easy to get in touch with them. And again, we'll put a link in the Show Notes for you.


We'll also have a link to the Nationwide Children's Hospital Facebook page. We have the brand new Ask Dr. Mike segment and also the YouTube playlist of the Ask Dr. Mike videos.

All right, so once again, thanks to Dr. David Stukus and Dr. Nabeel Farooqui for stopping by to talk about asthma technology and mobile apps. We really appreciate it. And we will talk more about the asthma app as we find out more about it. So, when the research study comes out, we'll have them back to talk about it. And if it does go more global, we'll let you know about that, too.

So let's take a quick break and I will be back with a final word. It's a super fun final word too, so you'll definitely want to stick around. It's coming your way right after this.


So we are back with the final word. And the final word is 'seven'. Now, I know seven is a number but it's also a word, so it counts. Seven ways to keep your kids entertained until spring breaks and they can stretch those legs outside.

And for these seven things, we do have a special Pinterest board called Entertaining Your Kids. So if you head over to Pinterest, look up PediaCast and just check out our board and you'll find these seven ways to entertain your kids until spring break.

Let's count them down backwards. They're really not in any particular order.

Number 7, design a Hot Wheels or Matchbox car course in the living room with masking tape roads on the carpet, up and over the furniture. You get the picture, fun stuff.

Number 6, make a bubble fort with a king size sheet and a fan. Oh, why didn't my mom think of that one? That's a great one.


Number 5, fill up an empty blow up swimming pool with pillows and create a special little reading nook. And maybe put that in the blow-up fort and that would be cool.

Number 4, make a spider web in a doorway with a blue painters tape, scrunched up little balls of paper, call them insects, throw them at the sticky side of a web. And you can even turn it into a bit of friendly competition to see who can get the most paper bugs to stick.

Number 3, this one's for the little ones. Stick dry spaghetti noodles in a base of play dough and then let them stack Cheerios around and up and down the noodles. Sounds like fun, supervised, of course.

Number 2, use a tension rod in a doorway and hang a decorated fabric to make a puppet theater. Or you can move higher and cut a little doorway in the fabric to create a fort entrance, maybe into that blow-up or with the reading nook, for instance. Or it could be a cool facade like a veterinary office. The cats would love that one.

And finally, number 1, get a roll of big circle or small circle bubble wrap, some non-toxic markers and color the circles in patterns and then hang it in the window's for instant stained glass.

So there you have it, seven ways to keep your kids entertained until spring breaks and they can stretch those legs outside.

And that's my final word. Again, you can find all seven those things in our special Pinterest board called Entertaining Your Kids and we'll put a link to it in the Show Notes over at

All right, once again, thanks to all of you for joining us today. And thanks to our guests, Dr. David Stukus and Dr. Nabeel Farooqui.

I do want to remind you that iTunes Reviews are helpful. If you have not written a review on iTunes for PediaCast, we'd appreciate you doing so. It takes a couple of minutes of your time.

Also links on your websites, on your blogs, on your social media pages are appreciated as are shares and re-tweets and re-pins and all those things. We are on Facebook, Twitter, Google Plus, and Pinterest. And be sure to tell your family, friends, neighbors and co-workers about the program.


Also, be sure to tell your child's doctor when you go in to for the next well-checkup or sick office visit. Let them know about PediaCast's evidence-based information that they can trust telling their patients about. And we do have posters available under the resources tab at

Once again, if you have a question for me or you want to point me in the direction of the new story, or you have a topic idea or you just want to say hi, just head over to and click on the Contact link. I read every one of those that come through.

All right, once again, thanks for being a part of the show and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long everybody!


Announcer 2: This program is a production of Nationwide Children's.

Thanks for listening! We'll see you next time on PediaCast.

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