Andrew Patterson talks to an innovative company developing electronic monitoring of medication, reducing excessive use by 40% for asthma sufferers with their new SMART inhalers

By Andrew Patterson

It’s been a big month so far for technology company Nexus6 which secured $4.6 million in new investment funding as well as featuring in one of the world’s most influential medical journals.

The Auckland based company has spent more than a decade developing a range of innovative high tech inhalers in the fight against asthma which have significantly improved the management of the condition.

New Zealand has the world’s second highest rates of asthma, behind the UK.

The problem is graphically illustrated on the website of the NZ Asthma Foundation where a young child holds a balloon with the caption “One in four children can’t inflate this.”

While the reasons for our high rate of prevalence haven’t been fully determined, living with this chronic condition can be debilitating for sufferers.

Hospitalisation rates for asthma have more than doubled in the last 30 years, up to 8 percent of teenagers report wheeze limiting speech and on average one person a week in NZ dies from the condition.

Research breakthrough

Based on the findings of a large clinical trial undertaken by the NZ Medical Research Institute, the study has provided new evidence that using two types of common asthma medications combined in one inhaler for both preventive and rescue treatment is more effective at reducing severe attacks of asthma than conventional asthma management, and has a favourable safety profile. 

The breakthrough is a significant development for Nexus6, one of the early graduates from Auckland based incubator The Icehouse.

What makes the story all the more significant is that Nexus6 founder and executive director Garth Sutherland is himself a chronic asthmatic.

He says that in the year 2000, after seeing little progress in the management of the condition for sufferers, he decided to use his background in science and technology to develop a solution for himself.

Home-grown approach

“I had just come back from my OE. I'd been working around the world in the technology sector for about six years and when I returned home I was looking to enter a different stage in my life.”

“One of the key issues for me personally was that I hadn't grown out of my own asthma as I'd hoped to do in my early teens and I realised then that I was going to be on asthma medications for the rest of my life.”

“So I was really looking for ways to change my lifestyle to minimize the amount of medication I was taking, while retaining very good levels of asthma control so that I could enjoy my life; enjoy my sports and my relationships. It was then that I started looking at different ways of improving my asthma, such as getting super fit, changing my diet, all these sorts of things. As part of that I was starting to record my medication usage as really one of the metrics around wellness.”

Patient Management

Much like diabetes, management of the condition by patients is vital for achieving positive outcomes for asthma sufferers.

“What I soon realized is that it was actually really difficult to consistently track usage of the different asthma medications. For example, there are multiple medications from the controller or preventative medications that are taken twice daily, through to the relief medications which are used as needed. Just keeping track of that was very difficult.”

“But I also realised that was really the key indicator to asthma control as well. So, I started applying the skills that I had been learning through my career in the technology sector, to automating that process for myself as a patient. That was the real driver for me.”

Innovation

Trying to develop a back room solution was one thing, but taking on the big pharmaceutical companies at their own game with their deep pockets and huge R&D capability was a risk all in itself; not that Sutherland was concerned about that prospect in the early days.

“I always saw myself as a service provider to industry. If I got the technology right for myself, then other people would ultimately benefit from that as well. So rather than going up against them I was really trying to solve these problems from a patient perspective and then provide them to industry, because my goal was really to sort out my own condition and make the same tools available to other people.”

“Industry is a way to get those tools to other patients. So from early on we've been seeking partnerships with industry to help deliver our innovation into the hands of patients. But innovation is hard, and it can be a real challenge for these big companies to innovate easily. So there is a need for innovation and often that comes from smaller, agile companies like ours.’

How it works

Get Sutherland talking about the technology, particularly how it works, and the excitement really kicks in.

“We came up with the idea for real time monitoring of the medication usage first using one of our very early devices that had a serial port before moving on to USB when that option became available. However, I didn't have access to the information I wanted on a daily basis, simply because of the adherence issue with uploading data.”

“What I noticed when I worked for Microsoft in the late 90s was the PDA technology was extremely useful as a phone etc. But even when you could upload your email to your Smartphone, through a USB connection - this is before email came online through the cellular connection – your email was never really up to date.”

“However, all that changed once email started updating in real time through the cellular connection. So when I sat down and really analysed the problem including why there was friction in terms of getting to the data and the reality I decided was that things just needed to be made simpler for patients.

That was one of those real light bulb moments for me and I realised then what needed to happen.”

The simplicity came in actually putting the cell phone technology into the inhaler embracing a rapidly growing concept in medical circles called telemedicine where information is able to be communicated between doctor and patient using cellular technology. The result is the new high tech SMART inhaler (Single inhaler Maintenance And Reliever Therapy.)

“So every time you use your inhaler several things are happening. Firstly, it’s going to dial up and load the information on my usage to my personal secure database online, which I can access from anywhere, and secondly it’s going to send that information to anyone else I’ve authorised to access it.”

“Essentially we came at the issue from the perspective of trying to solve the problems, knowing that there’s value in the data, but trying to remove the friction towards accessing it.”

“As I said earlier, dealing with asthma is all about the way the patient manages the condition. In fact, the global guidelines – or the global initiative for asthma require patients to monitor medication use, in particular the use of reliever medication, as the key indicator to disease control.”

What about the decision to remain in NZ and develop the technology from here rather than basing the company in the US?

“There are pros and cons. It wasn't necessarily a conscious decision to remain in NZ. But the challenges came early on. The infrastructure for new technology companies was still being developed at a public level. Certainly there was private infrastructure for companies such as Fisher and Paykel Healthcare and access funding from their founders.”

“But in terms of public infrastructure, Nexus was actually just the second company to raise capital from the formal angel network here in New Zealand. So those pieces of infrastructure were still being created, where's in Silicon Valley they were already very well established.”

“Our first sale was to one of the finest respiratory research groups in New Zealand, The Medical Research Institute of New Zealand and in particular Professor Richard Beasley, who I was introduced to through NZTE.

“I showed him what I'd developed for my asthma management and he said straight away the technology could be used in clinical trials and shortly thereafter that’s exactly what happened and we’re still publishing with that group today."

What the trials concluded was that with the help of electronic monitoring of medication use, it was observed that the number of days of high use, marked overuse and extreme overuse were about 40% lower in the group using the new SMART inhalers compared with the group given standard treatment. 

Protecting its hard won IP has been important for Nexus6.

“In terms of registered rights, I guess our focus has been on the international patenting system. There are some advantages to the New Zealand patenting system. Typically we file both here and abroad but protecting our IP has been really important.”

Icehouse CEO Andy Hamilton agrees, saying it’s been a vital aspect of the company’s success.

“Its decision to recognise and then focus on protecting its IP has been critical to allow it to get to this point. Nexus is a great example of one of the early technology businesses we supported in its infancy going on to achieve the recognition that it has today.”

In the future Nexus6 founder Garth Sutherland says he hopes children in particular will be better able to manage their condition than he was able to do as a child.

“I’d love to see kids globally using smart inhalers and experiencing great health as a result of it. That’s really our founding principle and that of the research community who are now beginning to see really promising results.”