科技

　　Medical devices

　　医疗设备

　　Inhaling information

　　有关吸入器的吸入信息

　　How to collect data on asthma while, at the same time, treating it

　　在处置哮喘的同时如何收集哮喘数据

　　IN 1985 and 1986 an epidemic of asthma hit Barcelona. The city's researchers first turned to the usual suspects, such as air pollution, pollen and mould. But a series of telephone interviews with the sufferers pointed to a much more precise cause. All the attacks had occurred by the harbour, and at times when ships were unloading soya beans. The cause was clear: soya-bean dust. So was the solution: the installation of filters on the harbour's silos.

　　1985年和1986年巴塞罗那哮喘病流行。这个城市的研究人员首先调查了一般的怀疑对象，如空气污染、花粉和霉菌等。但从一连串对患者的电话随访中得出了一个更为确切原因。所有的哮喘发作都发生在港口，且都在货船卸大豆的时候。原因很清楚：大豆灰尘。所以解决办法就是：在港口的筒仓上安装过滤器。

　　Asthma is one of the world's most common chronic diseases. It affects about 300m people (almost 5% of the population). Yet what triggers any given asthma attack is often unclear and, as a consequence, most asthmatics are not properly treated. Stories of success, like that of Barcelona, are rare.

　　哮喘是世界上最常见的慢性病之一。大约有3亿人（接近人口的5％）患有哮喘。然而，人们往往并不清楚是什么诱发了任何特定哮喘的发作，其结果，大多数哮喘患者得不到妥善处置。象巴塞罗那这样成功的故事是很罕见的。

　　Part of the reason for that lack of clarity is inadequate data on where and when attacks happen. But David Van Sickle, an epidemiologist and medical anthropologist who once worked for America's Centres for Disease Control and Prevention (CDC), has come up with a solution. This is to use the asthma inhalers carried around routinely by patients to record the time and location of symptoms as they happen.

　　缺乏确切了解的部分原因在于对哮喘在何时何地发作没有足够的数据。但是曾在美国疾病控制和预防中心（CDC）工作过的流行病学家和医学人类学家大卫?凡?西科勒想出了一个解决方案。这个解决方案就是利用患者例行性随身携带的哮喘吸入器来记录他们的哮喘症状出现时的时间和位置。

　　To develop his idea, Dr Van Sickle left CDC and founded a company, Asthmapolis, which is based in Madison, Wisconsin. The result is Spiroscout, an inhaler with a built-in Global Positioning System locator and (in advanced models) a wireless link to the internet. Whenever someone uses the inhaler, it broadcasts the location and time to a central computer. Asthmapolis plots and analyses the data, and sends weekly reports to participating patients and their doctors summarising the observations and making recommendations.

　　为了开发他的想法，凡?西克尔博士离开美国疾病控制和预防中心并成立了一家公司，公司名为Asthmapolis，总部设在威斯康星州的麦迪逊市。其结果就是一款名为肺量测定法侦察员的吸入器问世，这款吸入器带有内置的全球定位系统定位和（高级型）联到互联网的无线连接。每当有人使用吸入器时，吸入器就把位置和时间播报到中央计算机。Asthmapolis公司把播报来的数据绘制成图并加以分析，每周向参与播报的患者以及他们的医生发送报告，以便他们的医生总结观察并提出建议。

　　That is useful for the individuals involved, since it may illuminate patterns of which they were unaware (the proximity of a particular kind of crop, for example). It could also help doctors identify those patients whose asthma is not under proper control. Use of the inhaler more than a couple of times a month suggests there is something wrong, and that the patient's medication may need to be changed. Patients do not, however, always report such problems, and so do not get the right drugs. The big public gain, though, will come from pooling all the data from the inhalers, once they have been suitably anonymised. That will open the way for a much more detailed analysis of what is going on, and may allow the triggers to be identified and ranked in order of importance.

　　这对有关个人很有用，因为它可以阐释未明的诱发哮喘模式（例如接近特定种类的农作物）。它还可以帮助医生确定那些哮喘无法适当控制的病人。每月使用吸入器超过了一两次的情况说明有问题存在，而病人的药物可能需要更换了。然而，如果患者一直不报告这种问题，那么就无法得到正确的药物。不过，最大公共收益将出自汇集所有吸入器播报的数据，这些数据从前被适当地隐藏了。这将开辟一种对发生的事情进行更详细分析的方法，而且也可能让哮喘的诱因得以识别并按照重要性的顺序加以排列。

　　Over the past three years Dr Van Sickle has run two pilot studies to test the new tool. Both of these showed useful improvements in patients' management and understanding of their disease. They have also resulted in him questioning some longstanding theories about asthma, including the ideas that symptoms occur primarily at home and that the affliction is more prevalent in urban areas than rural ones. If those insights are confirmed, they will change the way asthma is managed.

　　过去三年来，凡?西克尔博士已经完成了两次试点研究，以测试新的工具。两次试点研究都显示了对患者管理及疾病认识的有益改进。这两次试点研究也让凡?西克尔博士质疑一些长期存在的哮喘理论，包括症状主要发生在家里以及在城市地区比农村地区感染更盛行这样的观念。如果这些质疑结果得到证实，它们将改变控制哮喘的方法。

　　The next step, commercialisation, is planned for the autumn. With nearly 500,000 asthma-related hospital admissions every year in America alone (often involving cases where the disease could have been properly controlled by drugs, but was not), the market could be large. Alternatively, Dr Van Sickle's old friends at the CDC or some other medical-research agency might think the data sufficiently valuable to buy and distribute the things themselves. Either way, the upshot would be better lives for patients in the short term and, if all went well, a true understanding of the triggers of this debilitating and occasionally life-threatening condition.

　　下一步的商业化计划在秋季进行。鉴于仅在美国每年就有近50万与哮喘有关的病人入院治疗（通常涉及的病例是该病可用药物进行适当的控制，但不是所有病例），市场可能很大。另外，在美国疾病控制和预防中心或其它医疗研究机构工作的凡?西克尔博士的老朋友们可能会觉得这些数据有足够的购买价值，并把它们用到自身的研究上。无论哪种方式，其结果都将会在短期内让患者的生活更好，且一切顺利的话，人们就会真正了解这种令人衰弱、有时危及生命的病症的诱因。