Eupnoos

Chronic respiratory diseases (CRDs), including asthma, chronic obstructive pulmonary disease (COPD), and lung fibrosis, pose a significant health burden globally, especially in low- to middle-income countries (LMICs). Despite being largely preventable and treatable, CRDs lead to considerable global morbidity and mortality, highlighting substantial gaps in healthcare such as inadequate early screening, under diagnosis, and poor management due to lack of diagnostic equipment, healthcare infrastructure, community based screening tools. This is further compounded by a shortage of trained technicians and qualified clinicians in both primary and community care settings.

Size of the problem:
- CRDs cause 4 million deaths annually, with asthma affecting an estimated 262 million people and causing 455,000 deaths in 2019. COPD, the third leading cause of death worldwide, resulted in 3.23 million deaths in the same year.
- About 2 billion individuals are exposed to harmful indoor air pollution from biomass fuels.
- Roughly 1 billion people are affected by outdoor air pollution, and a similar number are impacted by smoking and second-hand smoke exposure.
- CRDs rank as a leading cause of death and disability, yet they receive less attention compared to other non-communicable diseases (NCDs) like heart disease, diabetes, and cancer.

These figures underscore the urgent need for widespread early intervention focused on disease prevention strategies as a means for addressing long term institutional problems such as funding for infrastructure, training of personnel, subsidising medication etc . 

Projections for 2050 indicate that sub-Saharan Africa will experience the highest prevalence of COPD, at 15.1%, representing 160 million cases. Notably, the number of COPD cases among females in sub-Saharan Africa is expected to nearly triple from 30 million in 2020 to 80 million by 2050. This gender disparity is also anticipated in other LMICs.

To compound the problem there is considerable variability in diagnostic criteria across different regions, leading to inconsistent disease management. The reliance on patient-reported symptoms and physician diagnoses for conditions like asthma introduces subjectivity and potential for errors such as recall bias. The underrepresentation of women and various ethnic groups in global reference equations , the absence  of standardized, universally accepted diagnostic criteria for diseases like asthma further complicates routine lung function assessments and accurate disease identification.

Finally, it is crucial to diagnose and manage comorbid respiratory conditions due to their potential to exacerbate outcomes. For instance, obstructive sleep apnea, which often coexists with asthma, shows a bidirectional relationship affecting each other's severity. Additionally, Type 2 Diabetes is associated with significant respiratory comorbidities: 16% of diabetic patients also suffer from asthma, and 10% have concurrent COPD. There is also notable evidence that an increase in baseline A1C levels significantly raises the risk of COPD and pneumonia. Moreover, heart failure, which is comorbid in over 80% of COPD cases, further underscores the importance of comprehensive management of these interconnected health issues.

There is an urgent necessity to channel investments towards digital tools that are not point solutions, require minimal resources, and are adaptable to evolving global demographics and increasing income disparities. 

A useful analogy for understanding our technology is the music identification app, Shazam. Similar to how Shazam identifies a song, artist, and album from just a few seconds of music, Eupnoos operates by 'listening' to a few seconds of expiratory breath sound. Our sophisticated algorithms analyze the audio to determine the type and severity of respiratory diseases without being influenced by the patient’s ethnicity, height, weight, or sex. Our technology is designed to be highly scalable, functioning with any smartphone model from 2012 onwards. Once downloaded from an app store, the app transforms the device into a personalized lung health monitoring and disease screening system.

Ease of use is central to the design; the user simply blows into the phone’s microphone. A computer vision algorithm utilizes the camera to turn the screen into a 'magic mirror' that guides users in real time to ensure the test is performed correctly. This removes the need for trained technicians to perform the test and to subsequently translate the results into reports. Testing can be performed by patients remotely or by any community worker in the field.  If conducted properly, the app evaluates the recorded audio to analyze baseline lung function and patterns indicative of conditions like asthma, COPD, or fibrosis. 

For patients unable to perform the blowing test due to severe illness, an alternative method involves making vowel sounds like /a/, /o/, and /u/. These sounds help assess lung capacity and identify biomarkers of airway diseases.

Additionally, the app can detect sounds typically identified through a stethoscope, such as monophonic and polyphonic wheezes. It also includes a series of symptom questionnaires based on clinical templates to gather subjective data about symptoms. Location based data from the phone is aggregated and attached to test results so that population health surveillance and trends can be monitored.

Data from the app is transffered to a clinical dashboard when there is wifi or mobile connectivity for further analysis. 

Eupnoos is a modular system that can be connected via API's into other applications, data bases or service .

By combining clinically objective breath measurements with evidence based patient reported symptom data, the Eupnoos app is the next generation in comprehensive screening and diagnostics.

Community Health Workers (CHWs) play a pivotal role in extending primary health care (PHC) to underserved and unserved communities. CHWs deliver a broad spectrum of PHC services including preventive care, curative care, and health education, directly within homes, community institutions, or peripheral health posts. They are deeply integrated into the communities they serve, often coming from these same locales, which positions them uniquely to understand and address local health needs effectively.

Given the existing pressures on CHWs, with a growing scope of responsibilities and often limited resources, innovative solutions like Eupnoos are essential to enhance their efficiency and effectiveness. Eupnoos, by leveraging mobile technology, offers a significant opportunity to support these overburdened workers in several impactful ways:

1. Integration with Existing mHealth Apps: Following the COVID-19 pandemic, numerous digital health surveillance programs have been launched in LMICs, with mobile apps playing a pivotal role in these initiatives and significantly enhancing digital literacy. Eupnoos is crafted to integrate effortlessly into the mobile tools that Community Health Workers (CHWs) are already utilizing. This seamless integration reduces the learning curve and minimizes disruption, enabling a smooth and rapid adoption. By complementing platforms already familiar to CHWs, Eupnoos enhances their toolkit without adding complexity to their existing workflows.

2. Enhanced Diagnostic Capabilities: Eupnoos transforms any smartphone into a sophisticated diagnostic tool for respiratory conditions, which are significant but often under-addressed aspects of community health. This capability allows CHWs to perform respiratory screenings and monitor conditions like asthma, COPD, and other respiratory diseases on-site, reducing the need for patients to travel to distant health facilities for initial screenings.

3. Real-time Data and Guidance: With Eupnoos, CHWs can receive real-time data and guidance on patient health metrics. This immediate feedback enables timely decision-making and interventions, which is crucial for managing chronic conditions effectively and preventing complications.

4. Training and Support: While Eupnoos enhances CHWs' capabilities, it also supports their ongoing education and training through interactive guides and continual updates within the app. This feature helps CHWs stay abreast of the latest health care practices and improves their confidence in handling diverse health issues.

5. Reduction in Workload: By automating and simplifying the diagnostic process for respiratory diseases, Eupnoos can significantly reduce the workload on CHWs. This efficiency allows them to allocate more time to other critical tasks, including community education, follow-up visits, and care for more patients.

6. Data Collection and Monitoring: Eupnoos aids in systematic data collection and health monitoring, which are essential for understanding health trends, planning public health interventions, and advocating for resources. Better data enables health systems to respond more effectively to community health needs and supports the case for continued investment in CHW programs.

Eupnoos supports the expansion and effectiveness of CHW programs in line with WHO recommendations. This integration not only bolsters the capacity of CHWs to manage health care needs but also aligns with broader goals to enhance global health outcomes.

Our team, led by founder Arshia Gratiot, is well-equipped to deliver Eupnoos, a significant innovation for respiratory health monitoring. Arshia's strong connection to the communities we target is rooted in her 25+ years living in both a heavily polluted major city and a smaller Tier B town in India. Her personal battle with asthma and COPD, worsened by late diagnosis and long-term exposure to pollution, has given her first-hand experience of the shortcomings in healthcare and environmental challenges.

This personal experience gives Arshia a deep understanding of the respiratory issues common in similar environments. This isn't just theoretical knowledge; it's real-life experience that motivates her to develop preventive health solutions. Eupnoos is focused on helping individuals recognize early symptoms of respiratory diseases, allowing them to act quickly to prevent the disease from worsening.

An important part of our strategy is the availability of low-cost generic medications for asthma and COPD in LMICs. Unlike the costly treatments required for diseases like cancer or heart disease, managing asthma and COPD can be cost-effective if the conditions are diagnosed early. This is where Eupnoos can make a significant difference by improving early disease management when it's most effective.

Our approach to design and implementation deeply involves the community. We work closely with local organizations like the Lung Care Foundation in Delhi, which helps us understand the needs, ideas, and priorities of the communities we aim to serve. This collaboration ensures that Eupnoos is not only technically robust but also culturally tailored and sensitive to the specific needs and preferences of local populations.

Eupnoos has collaborated with the Government of Singapore to pilot a project aimed at improving lung health monitoring in the marine and offshore industry. This industry is known for exposing workers to harmful conditions like fumes and pollutants, which can lead to respiratory diseases. The project, supported by the Association of Maritime Industries and the Workplace Health and Safety Institute (part of the Ministry of Manpower), focuses on developing cost-effective technology for early detection and management of lung health issues.

Project Details: The pilot was conducted over eight months at a SembCorp Marine site, where Eupnoos tested a prototype of their lung health application. The project involved screening over 700 shipyard workers to identify those at risk of respiratory diseases and to evaluate the general lung health within this workforce.

Outcomes: The main objective was to integrate a system that could alert workers about potential lung health risks and encourage preventive actions. This is expected to improve health outcomes and increase productivity by reducing the impact of respiratory issues.

 Eupnoos also carried out a usability study in Brazil in collaboration with AstraZeneca. This study included 30 patients—15 with severe asthma and 15 with COPD—and 30 physicians, comprising pulmonologists, clinicians, and cardiologists, who evaluated the app's effectiveness for remote and community screening of patients.

In the UK, Eupnoos has conducted a study focusing on asthma and COPD screening involving 40 patients in partnership with CareAshore, a charity and old age home. This study is part of our commitment to enhancing respiratory health monitoring and management within community settings, especially for populations that may be at increased risk due to age and environmental factors.

Our ambition with Eupnoos is to create a significant positive impact on global health but these intentions intersect with the practicalities of building a sustainable impact business. Our primary barriers lie in the lack of experience in navigating the impact sector, securing financing, and understanding market dynamics in countries where we dont have lived experience but where we are keen to do business, an example of this is Sub Saharan Africa, North Africa and Indonesia .

Through Solve, we aim to acquire the knowledge and skills necessary to build a resilient but global impact business. We seek to connect with a network of mentors who can provide guidance on establishing and scaling our operations in a way that aligns with our mission to improve health outcomes in respiratory diseases. Regulatory challenges around medical devices and sensitive patient data are also an area of support we would seek. These mentors, with their wealth of experience and expertise, could offer invaluable advice on business modeling, strategic partnerships, and long-term sustainability.

Furthermore, forming connections with foundations and charities is essential for piloting our product , where the need for innovative healthcare solutions is great, yet the market is complex and challenging to navigate. Collaborating with organizations that have an established presence and understanding of local health ecosystems could facilitate more effective pilot studies and community engagement, ultimately leading to a more impactful deployment of our technology.

Creating a robust network in the impact world is another crucial step for us. Being part of a community that is dedicated to social entrepreneurship and innovation in healthcare would not only provide support and collaboration opportunities but also enhance our credibility and visibility in the sector.

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Eupnoos tackles the problem of respiratory screening and diagnosis by using smartphones to interpret breath sounds, innovating beyond the traditional spirometry used in most healthcare settings. This method has the potential to transform the current landscape by providing an immediate, non-invasive, and cost-effective diagnostic tool that could be particularly beneficial in low- and middle-income countries (LMICs) where access to traditional healthcare resources is limited.

Spirometry, while effective, is not universally accessible due to its cost and the need for specialized training to both administer the tests and interpret the results. Eupnoos eliminates these barriers, enabling rapid on-site assessments without the need for specialized equipment or extensive medical training. This could lead to a market shift where mobile-based diagnostics become the norm, particularly for conditions like asthma, which currently lacks a definitive standalone diagnostic test and relies on a combination of assessments that may not be readily available in LMICs.

Moreover, Eupnoos can extend its capabilities to screen for comorbid conditions, addressing a significant gap in healthcare delivery. Respiratory comorbidities often complicate the management of primary conditions, leading to deteriorating health outcomes. Early detection and integrated care for these comorbidities are crucial, especially in regions where such conditions are prevalent and underdiagnosed.

Eupnoos's ability to provide instant assessments can change the broader healthcare ecosystem by enabling remote care with objective testing, a feat previously challenging due to the need for physical assessments like auscultation. It allows Community Health Workers (CHWs) to provide more comprehensive evaluations of patients' respiratory health without the need to master complex equipment or result interpretation. This capability not only improves the quality of care delivered by CHWs but also increases the efficiency and reach of healthcare services.

The introduction of Eupnoos could usher in an era of personalized precision digital health accessible to all, regardless of geographic location. It empowers a broader range of healthcare providers, including those in remote areas, to deliver quality care. The data collected by Eupnoos can also inform public health strategies, provide insights into epidemiological trends, and improve resource allocation in healthcare systems.

Overall, Eupnoos presents a substantial leap forward for respiratory healthcare, especially in underserved areas. Its scalability, ease of use, and diagnostic precision offer a promising future where quality healthcare is not determined by proximity to advanced medical facilities but is available to anyone with a smartphone.

Eupnoos is built on a straightforward theory of change. Here’s how we map our activities to expected outcomes:

Activities:
- Development and deployment of the Eupnoos app, which utilizes smartphone technology for respiratory screening and diagnosis.

- Training community health workers (CHWs) and individuals to use the app effectively.

- Establishing a new standard of lung function assessment through the Eupnoos app that addresses the shortcomings of traditional spirometry indices and reference standards, drawing on findings from the European Respiratory Journal.

Immediate Outputs:

- Increased accessibility to respiratory health diagnostics in underserved communities.
- More frequent and earlier detection of respiratory conditions.
- Enhanced ability of CHWs to provide immediate, on-site health assessments.

Short-Term Outcomes:
- Reduction in the time taken to diagnose respiratory conditions.
- Improvement in the management of chronic respiratory diseases through earlier intervention.
- Decreased need for patients to travel to distant health facilities for initial screenings, saving time and resources.

Long-Term Outcomes:
- Better overall management of respiratory health within communities, leading to reduced morbidity and mortality rates associated with respiratory diseases.
- More efficient allocation of healthcare resources as CHWs are able to handle routine screenings independently, freeing up healthcare professionals to focus on more complex cases.
- Creation of a data repository for respiratory health, facilitating public health research and the design of targeted interventions.

Evidence Supporting the Links:

1. **Accessibility & Early Detection:**
   - Research shows that mobile health interventions can significantly increase access to healthcare services in LMICs (Source: WHO mHealth assessment).
   - Studies indicate that early detection of diseases like COPD and asthma leads to better management and outcomes (Source: Journal of Thoracic Disease).

- Research shows underrepresentation of multiple ethnicities and female sex within the Global Lung Index Reference Standard for spirometry (Source : European Respiratory Society)

2. Efficiency & Time Savings:
   - Data from similar mHealth initiatives demonstrate reduced diagnosis times and increased efficiency in health service delivery (Source: mHealth Alliance).
   -  Reports from observational studies and interviews with CHWs report that these tools save time and allow for broader community coverage (Source: Nature).

Eupnoos’s impact is rooted in these logical linkages, backed by evidence from global health research. 

Our impact goals for Eupnoos focus on transforming respiratory health screening, especially in low- and middle-income countries (LMICs). Our vision is to make routine lung health testing accessible, efficient, equitable, and inclusive. Below are our impact goals and the indicators we use to measure progress:

Impact Goals:

1. Increase Access to Routine lung health screening
   - To provide at least 100,000 individuals in LMICs with access to mobile-based lung function assessments by the end of year three.
   - To train and equip 6,500 community health workers (CHWs) with Eupnoos technology for on-site lung health screening.

2. Improve Early Detection  Respiratory Diseases:**
   - To achieve a 5% increase in early detection rates of respiratory conditions such as asthma and COPD in deployed regions within two years.

3. Promote Health Equity:
   - To ensure that at least 39% of the beneficiaries of Eupnoos are women within the target regions.
   - To achieve equitable health outcomes in respiratory care across different demographic groups, including gender, economic status, and rural versus urban populations.

Indicators to Measure Progress:

1.*For Increased Access:
   - Number of individuals using the Eupnoos app for lung health assessment.
   - Number of CHWs trained and actively using Eupnoos in their health practice.

2. For Early Detection and Management:
   - Increase in the number of respiratory conditions diagnosed at an early stage, as recorded by the app.

3. For Promoting Health Equity:
   - Proportion of female app users 

These goals are tracked through app's data analytics, feedback from health workers, and health outcomes shared by regional health authorities. We also align our goals with relevant UN Sustainable Development Goals to ensure comprehensive tracking and impact measurement.

There are 2 full time employees and 6 contractors working on Eupnoos's technology platform

The Eupnoos platform has taken two years to build. However, the research behind the tech began in 2019 based on studies from the University of Washington from 2012. 

The Eupnoos team is composed of over 5 different nationalities. Our leadership team reflects a broad spectrum of backgrounds, including varied ethnicities, genders, and national origins, with significant representation from the communities we target in our projects. For instance, our founder's deep personal and professional roots in India provide valuable insights into the challenges faced in LMICs. Additionally, we strive to include members with lived experiences of the health challenges we address, enriching our understanding and approach to solutions.

Goals for Diversity, Equity, and Inclusion (DEI):

• Recruitment: We are committed to equitable recruitment practices that prioritize diversity at all levels of the organization. This includes partnerships with organizations that support underrepresented groups in tech and health industries.

Actions Taken:

• Bias-Free Hiring Practices: We utilize structured interviews and standardized evaluation criteria to minimize unconscious bias in our hiring processes.
• Flexible Working Conditions: Recognizing the different needs of our diverse team, we offer flexible working hours and the possibility to work remotely, which is particularly supportive of team members with caregiving responsibilities or those living with disabilities.