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AI app devised and trialled in Cambridge could revolutionise healthcare for cystic fibrosis patients





An app using artificial intelligence that could be “revolutionary” for patients with chronic lung conditions such as cystic fibrosis (CF) is being trialled at Royal Papworth Hospital in Cambridge.

Breathe RM is able to predict when a patient will fall ill up to 10 days in advance and could enable CF patients to be monitored remotely, removing the need for regular checks in clinics.

Prof Andres Floto, a consultant chest physician at Royal Papworth Hospital. Picture: Keith Heppell
Prof Andres Floto, a consultant chest physician at Royal Papworth Hospital. Picture: Keith Heppell

It can also predict when patients are likely to get a major infection – known as an exacerbation – which can lead to weeks in hospital.

Some 50 patients are involved in the year-long project, known as ACE-CF, and researchers are aiming to recruit 400.

The trial is being supported by medical research charity LifeArc and and the National Institute for Health and Care Research (NIHR).

Collecting data that users input daily, Breathe RM is designed like a to-do list.

Lung function is measured through a handheld device called a spirometer, while oxygen in the blood is measured using a peg oximeter on the end of a patient’s finger.

Both devices are connected to the app using bluetooth and data is inputted automatically.

Prof Andres Floto, a Wellcome Trust investigator and professor of respiratory biology in the Molecular Immunity Unit of the University of Cambridge, based at the MRC Laboratory of Molecular Biology. Picture: Keith Heppell
Prof Andres Floto, a Wellcome Trust investigator and professor of respiratory biology in the Molecular Immunity Unit of the University of Cambridge, based at the MRC Laboratory of Molecular Biology. Picture: Keith Heppell

The technology also collects data from the likes of personal smartwatches, with patients also self-reporting how often they cough and how well they are feeling.

Home-monitoring vitals would remove the need for patients to attend clinics for checks every six to eight weeks. Appointments typically last several hours and patients have to be segregated due to some carrying antibiotic resistant infections in their lungs.

Andres Floto, a professor of respiratory biology at the University of Cambridge and a research director of the Cambridge Centre for Lung Infection at Royal Papworth Hospital, created the AI algorithm used in the app.

It looks at subtle differences in data, alerting patients to when they should clear their airways or call their doctor in the hopes they can avoid an exacerbation.

Prof Floto, who is also a practising CF physician, said: “At the moment, we think we’re pretty good at predicting when someone’s going to become ill about 10 days earlier than normal.

“It’s a traffic light system, and really this whole kind of philosophy is about empowering people with CF to take control of their own health.

Prof Andres Floto, a Wellcome Trust investigator and professor of respiratory biology in the Molecular Immunity Unit of the University of Cambridge, based at the MRC Laboratory of Molecular Biology. Picture: Keith Heppell
Prof Andres Floto, a Wellcome Trust investigator and professor of respiratory biology in the Molecular Immunity Unit of the University of Cambridge, based at the MRC Laboratory of Molecular Biology. Picture: Keith Heppell

“So for the purposes of the trial, we’re asking people to keep an eye on the algorithm.

“Green – carry on doing what you’re doing. Amber – do more of what you know you should be doing, perhaps doing more airway clearance, more adherence to medicines.

“And red – get hold of the CF team because red would indicate it’s very likely that you’re going to be unwell in the future.”

During the pandemic, the emerging technology was used to help patients monitor their health at home.

ACE-CF also involves Magic Bullet, a company set up by husband-and-wife team Kirsty Hill, 47, a project manager, and David Hill, 54, who works for Microsoft.

They started looking for solutions for patients with CF after their son George Hill, 19, was diagnosed as a baby.

Mrs Hill said the couple’s “initial concept” was a “virtual nagger”.

She added: “At the time, if I’m honest, what we wanted was something that could help our son help himself and take away the nagging aspect of the parent.

“It can be really fractious in a relationship if all you’re doing is asking somebody to do jobs all the time.”

Mrs Hill said Prof Floto has “always been looking at pioneering real change in this space”.

She added: “If that exacerbation predictor holds up in the trial, that will be a revolutionary feature that we can offer people through the app.

“The thing I know from having a person with CF, and from speaking to others, is that they always want to think about having CF as little as possible.”

The Cystic Fibrosis Trust says about 10,800 people in the UK have the condition.

Mrs Hill describes George as a “tenacious” person with a passion for rollercoasters who is now training to be an engineer at Thorpe Park.

Inspired by his brother’s condition, her other son Sam, 21, is studying medical genetics and hopes to make an impact in genetic diseases.

Steven Tait, senior business manager at LifeArc, said: “People with CF are really aware of their condition.

“Normally they can kind of get an inkling, ‘I’ve had a cold, I’m going to get an exacerbation’. But this should help them quantify that and should help their physician get ahead of the game, essentially.”

It is hoped the same technology in Breathe RM can also be used to help those with bronchiectasis, another chronic lung condition where the airways of the lungs become widened.

A separate study, called Bronch-Ex, is being funded by LifeArc as part of its wider £100million investment in treatments for chronic respiratory infections.

Mr Tait added: “You never hear about bronchiectasis, it’s a kind of silent disease. I think there’s upwards of 200,000 people in the UK [with it] – and increasing.

“It’s often misdiagnosed; in older people it’s misdiagnosed as COPD and in younger people it’s misdiagnosed as asthma.”



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