Helping Everyone Breathe Easier

Dr. Jonathan Feldman
Dr. Jonathan Feldman

Dr. Jonathan Feldman is a professor of psychology at Ferkauf Graduate School of Psychology and an associate professor in the Department of Pediatrics at Albert Einstein College of Medicine. For most of his professional career, he has worked to alleviate the psychological and physical damage done by asthma, including his most recent project, an app called ASTHMAXcel Perception that will help its users “recognize the onset of asthma symptoms so that they don’t escalate into flare-ups or full-blown attacks,” he explained.

He is working on the app, which is being tested for children between the ages of 15 to 21, with two Einstein/Montefiore colleagues. Dr. Sunit Jariwala is an associate professor in the Department of Medicine, with a focus on allergy and immunology and an interest in developing patient-facing mobile health applications for chronic conditions. Dr. Marina Reznik is a professor in the Department of Pediatrics focused on promoting guideline-based care for asthma. Together, they applied for funding from the Price Family Foundation, receiving $500,000 ($250,000 per year for two years) for the app’s development and distribution.

“The Price family has a longstanding relationship with Einstein,” explained Dr. Feldman, pointing out the Michael F. Price Center for Genetic and Translational Medicine and the recent challenge grant by Michael F. Price and the Price Family Foundation to support COVID-19 research, matching donations to Einstein for research on the novel coronavirus, dollar-for-dollar, up to $1 million.

For the past 25 years, Dr. Feldman has been studying asthma and how to get people to comply with medical regimens that keep them healthy, “to improve their medication adherence,” he explained. “This is especially true with asthma, which relies entirely on compliance to prevent the condition. But it’s still hard to convince people to do what’s good for themselves,” noting as evidence the resistance by many today to following social distancing and mask-wearing guidelines in the midst of a pandemic. His hope is that the app will improve adherence by making it easier to manage symptoms without it also feeling like a burden to follow the rules. “These screenshots give you a general sense as to what the user sees when they guess their peak flow, receive the feedback message, and play the perception game.”

Images from the ASTHMAXcel Perception app
Images from the ASTHMAXcel Perception app

Why asthma, especially since, as Dr. Feldman admitted, there is no incidence of it in his family? “In graduate school at Rutgers, in my work on chronic diseases, I became interested in studying anxiety and the ways that anxiety and chronic medical conditions can be confused and lead to mistaken decisions,” he observed. Asthma is a chronic disease that is an excellent model for studying adherence, symptom perception, and information feedback loops influenced by anxiety.

He came to Ferkauf in 2004 in part because its Bronx location was also an “asthma hot spot with enormous disparities in the incidence and treatment of the condition.” Over the years, he has built an impressive résumé of research and projects, many of which can be read about on “Dr. Jonathan Feldman’s Psychology of Asthma Lab.” The focus of the lab’s work is on “psychosocial factors in both adult and pediatric asthma” and investigations into “comorbidity between panic disorder and asthma, symptom perception, asthma disparities and Latino mental health.” Absolutely crucial to the lab’s success “is the work of the graduate students—their dedication and intelligence is absolutely amazing.” There is also a close collaboration with the Parnes Clinic, directed by Dr. William Salton, where patients can receive treatment for the emotional and psychological challenges brought on by their asthma.

The app should be ready for download mid-January 2021, and the three creators are cautiously optimistic that its rollout will be a success. “Compared to previous iterations, we have developed better graphics, character models and scripts to improve the aesthetics of the application to suit our older adolescent audience. Newer features also allow for participants to input different variables and goals, for example, the types of medications they are on, the triggers that most affect their asthma, the types of activities they participate in and goals for how active they wish to be in a given week.”

Other improvements include an in-app asthma perception tool that participants can use in conjunction with a peak flow meter.  This tool allows participants to guess their peak expiratory flow (PEF, or how much air they can breathe out using the greatest effort) before blowing into the peak flow meter and then typing in their actual PEF. A message about their asthma symptom perception then appears.

“We have also a patient portal,” he added, “where patients can log in to view how well they are answering questions, view their peak flow data, and make individualized adjustments to the content and timing of push notifications they receive.”

If all goes as planned, the young adults using the app will have a chance to manage their conditions in ways that help them, and the friends and family concerned about their health, all breathe a little easier.