NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

In high-income countries, asthma is usually a nuisance, but among the rural BOP, asthma can be a costly and deadly disease for victims who are unable to access treatment locally.

Eric Green, a medical student at Stanford University, traveled to Mexico last year as part of a group from his ?Entrepreneurial Design for Extreme Affordability? class. In Mexico, he found inspiration for the invention of a very low-cost asthma inhaler spacer, an apparatus that attaches to the medicine canister and enables young children to take the medicine. He named the apparatus ?Respira!,? Spanish for ?Breathe!? He explains the motivation behind Respira!:

?This project began with a trip to the Higueras Health Center in Nuevo Leon, Mexico. There I met Jose Antonio, a young physician working and living in this center. He told me the story of Jesus, a child arriving with his mother in the middle of the night and gasping for breath [from an asthma attack]. Jose Antonio knew the right treatment immediately but had no way to deliver it. Although he had a refurbished nebulizer sitting in the corner of the room, it had not worked for years.

He then took me to a side room with a humidifier and explained how he desperately tried to get medication to Jesus? lungs by pouring it into the humidifier, closing the door and hoping. It was the combination of his own feeling of frustration, the powerlessness and anxiety of the child’s mother, and the suffering and fear of the child that compelled me to address this need [for more affordable asthma treatment]? (excerpt from Respira’s Changemakers Competition entry, written by Eric Green).

Respira! is one of ten finalists in the Changemakers Disruptive Innovations in Health Competition and is in the running for a $5000 prize. Below are notes from my recent conversation with Eric.

Could you tell me a little bit about your background?
I’ve just finished my fifth year in a combined MD/PhD program at Stanford, where I?m focusing mostly on research into high-tech medical devices for developed markets. Last winter and spring, I took the course ?Entrepreneurial Design for Extreme Affordability,? offered by the Stanford Institute of Design.

How did asthma become the focus of your project for that class?
A group of classmates from the course and I visited rural clinics in Mexico to learn about the obstacles they face and areas where simple devices could make a big difference. These are small clinics, each staffed by a single physician, usually a recent graduate from medical school who lives and works at the clinic 24/7. We heard from physicians that patients were making long trips to cities for diseases that could easily be treated by clinics but that the clinics were missing a few critical tools. Asthma was an example–clinics had asthma inhalers but young children had difficulty using them because they couldn?t synchronize their breathing. We did more research to see how people deal with this in the US and learned that here, they use a spacer. The cost of a spacer is prohibitively high for most Mexican clinics. In the US, spacers cost $50. So, we made it our goal to design a spacer that could be produced at a fraction of that cost.

Who are some of your partners in this effort?
Respira! began through a partnership between Stanford and Instituto Tecnol?gico y de Estudios Superiores de Monterrey (ITESM). Five students developed the prototype as a class project, and Santiago Ocejo, a student at ITESM, and I are continuing the project independently of the universities.

The Ministry of Health helped us form partnerships with 10 clinics and a hospital which will participate in our pilot. We’ve also developed a partnership with Nektar Therapeutics, a US-based company that has offered the use of its facility for pre-clinical tests.

Could you describe the design of the spacer?
The spacer is made from paperboard that’s rigid enough that it won?t collapse with use, but that is malleable enough to fold. Factories that are able to manufacture paper to-go boxes would be able to manufacture the spacer. The paperboard needs only to be folded in an easy 4-step process to be ready for use.

How much does it cost to produce the spacer?
For now, it costs about $0.15 each to make them by hand, but the price should decrease as they go into production.

What stage is the project in?
We have a working prototype, and we?re now writing the protocol for its first pilot and clinical trial, which should happen before the end of 2007. We?re also exploring different manufacturing options for larger scale production.

What are the main challenges that you face at this point?
Getting funding is a main challenge, and also the engineering of the prototype. We?re experimenting with the design in several respects?we?re working on simplifying the folding process and instructions, ensuring that users will be comfortable with the design, and thinking about ways to make the spacer reusable. It’s currently designed for the treatment of a single attack.

How much of a need is there for this product?
In Mexico, about 11 million people suffer from asthma, and 8-9 million are in our target population of kids under the age of 8. Maybe 4-5 million receive health care from the government and would seek treatment through clinics that would be stocked with the product. This is not counting those with non-governmental insurance who might get the product in hospitals or pharmacies.

Do you see opportunities beyond the Mexican market?
We envisioned the product as one that would answer a specific problem in Mexico but have no doubt it could serve well in other parts of the developing world and potentially offer an alternative to expensive spacers in developed countries.

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As Ana mentions below, voting in the Changemakers competition closes next Wednesday, Aug 29. Cast your vote and help decide the winners.