Back in September, probably sometime between campaigns, I sent a note to the team at Atmotube, asking if I could review their product. They quickly said yes, and within a couple weeks I had an Atmotube Pro device clipped near-constantly to my belt loop, where it’s been most days for the last 2 months. 

Atmotube is a personal air quality monitor—it tracks humidity, temperature, barometric pressure, particulate matter (10 and 2.5) and volatile organic compounds (VOCs). We’ve had a lot of time to get acquainted, as when after a month of use I’d planned to write this, I got a lung infection and blah blah blah. Not why we are here (but it will come up).

There are two models of the Atmotube, the tube-looking one and the Pro, which is the version they sent me. There are some functional differences between the two, but for me, I was most happy with the battery life on the Pro. I have mine set to test the air quality every 10 minutes, since I’m usually at home. As I understand it, it also does on-demand tests when you hit the button, so when I’m curious, that’s a good option too. 

Pressing the button illuminates the multicoloured LED present just above the button—the colour displayed corresponds to the colour the monitor associates with the air quality, from blue [great] to red [poor] with green, yellow and orange in the middle. It also does an on-demand air quality test. Opening the app gives you a greater sense of what your environmental air “looks like” at a given moment in time. Here’s one from as I’m editing this article:

I should really move the air purifier to the kitchen. More on that shortly.

First days with the Atmotube Pro
I sent a lot of messages to friends during the first few days with the Atmotube—this thing is COOL. I wore it out the first night I got it, but was outside most of the evening in great air quality, so my results were as expected. The next day, though, is clear in my mind. Here’s what my day looked like:
Noon – Left home to go to Staples and Shoppers Drug Mart.
12:45 – Shoppers drug mart asked I come back in an hour and a half for my flu shot.
1 PM – Arrived at a nearby apartment building to canvass for the federal election.
2 PM – Completed canvassing 2 floors, walked back to the mall.
2:10 – Went to the food court for a root beer
2:15 – Arrived back at the pharmacy
2:45ish – Returned to the apartment building, chatted with seniors, finally began canvassing again.
4:40 PM – Left apartment to walk to meet my parents for my mom’s birthday dinner. Immediately upon opening door (my hand was still on it!), the Atmotube app IMMEDIATELY alerted the humidity had dropped past the set threshold. My mind was BLOWN how fast it was.
5:05 PM – Finally get to near restaurant but we are not going there anymore. Get in the car.
5:15 PM – Arrive at Mongo’s Grill, an open-grill Mongolian-style stir-fry restaurant if you couldn’t guess.
5:20 PM – Atmotube continues to freak out about high particulate matter for the duration of the meal.
6:30 PM – Arrive home, where the air quality is consistently decent-but-not-great. 

Here’s what the graphs look like from that day:
 

Beyond everyday use
Within a week of getting the Atmotube, I headed off to Philadelphia. The device itself stores data while not connected to a smartphone, so being on the plane didn’t hinder my data collection (although I think it was still connected). The air quality was surprisingly good on all 4 of my flights, which I found interesting—and shocking! The hotel also didn’t cause me any asthma issues as they sometimes do, and the air quality there was also consistently good! 

My friend John also has an Atmotube, and he noted the air quality in the hospital he works in isn’t great – when I went to Urgent Care a couple months ago, I forgot to take the Atmotube with me, which is disappointing because I was sort of looking forward to that experiment! 

What I’ve learned from the Atmotube
I’ve learned a few things from using Atmotube. Here’s the most interesting one:

I very quickly noted sharp drops in air quality when cooking. I checked out a Government of Canada document that notes running the stove exhaust fan when cooking to be helpful for promoting indoor air quality (by drawing the particulate matter out of the house) – I’d love to speak to how the data from Atmotube Pro actually changes but I assume there are many variables involved that would make this complicated for my non-scientist brain to wrap around—ie. duration of cooking, what is being cooked and how, when or whether the exhaust fan was turned on, and device proximity. I can say the effects are a consistent drop in air quality with most stovetop cooking, though (as first noted at Mongo’s). As I wrote this section, my dad was just making food on the stovetop (with the exhaust fan on), some sort of grilled sandwich, as well as making coffee in the percolator. When I opened up the app a minute ago, the air quality score was about 50 – but the sensor is down the hall. Now it’s 66, sensor still down the hall, about 12 steps away.

The next is that some buses appear to have worse air quality than others, even when riding on the same route. I am curious if this is bus-model specific, but haven’t yet been able to determine reliably. It’s fascinating (but also sucky?). 

Oh, and this will surprise no one: It’s true – hockey arenas have poor air quality.
So do food courts. 

Changes I’ve made
Related to the stove exhaust, we try to run it more frequently when cooking on the stovetop.  I have purchased a “pluggable” “air sanitizer” (mostly because it was on sale for $30) made by Germ Guardian that is apparently good for minimizing cooking odours—it wasn’t running when the above food related numbers were cited. Of course, it’s really difficult to tell how well it works because “food odours” are pretty subjective, and I’m going to assume, the particles released are perhaps not super uniform.
But check it out—here’s a small peak in particulate matter during food prep time:
 

Though generally our house air quality scores are quite good overall, I also ordered an air purifier on Boxing Day (a JS FLO). And damn, I can tell you, the Atmotube says that thing actually works—here are the graphs. The first 2 are from the first time I turned the air purifier on. The third is from the day where I heard you should run the air purifier for a couple hours before you go to bed (makes sense, no?) so I left the Atmotube in my room with it.

If it isn’t clear, air quality score (AQS) should go up, VOCs (and particulate matter) should go down. 

Problems I’ve had with Atmotube
The problems I’ve experienced with Atmotube are pretty minimal.

The first, with the LED, you have to hold the device at a very particular angle to see the actual corresponding colour to the current air quality—if you move the device around, you see different colours. For this (and for the greater amount of data), I prefer to use the app.

The device also comes pre-calibrated, and states it does not require regular calibration as it will continue to calibrate as it works. In mid-November (coincidentally, just as I was getting sick with that lung infection), I was getting consistently lower readings. This is also right when it got colder, and I assumed, when the furnace was running more—so, having asthma, I attributed this to why I was feeling cruddy. (As determined later, it was a lung infection leading to the asthma issues.) I did hit the recalibrate button. The change in results (which improved), of course, lead to questioning on my part of the accuracy of the device—it’s generally been consistent . I’d love to do side-by-side comparisons between two devices, such as with another Atmotube Pro, or a different personal air quality monitor (I think there’s maybe one other on the market right now), to see if results are consistent. I still think given my experiences—ie. poor air quality on buses with doors constantly opening and closing in traffic, realistic responses to humid environments and temperature changes, and so on—that the device is reliable.

There’s also a barometer function that I really don’t use—the scale goes from “stormy” to “very dry”, and it’s always apparently “stormy” with low pressure. I don’t know much about this, but I certainly know it’s currently cold but calm outside! 

Oh and this isn’t really a problem, but more of a funny: the Atmotube always alerts me to poor air quality when I do a nebulizer treatment. The particles are likely 5-7 micrometres, which is near certainly registering in the atmotube as an influx of PM10 (which is particulate matter 10 micrometres or less in diameter. I will maintain that the Ventolin I am inhaling is good for my lungs and not a pollutant!

What I’d like to see
While the Atmotube has already given me so much more data and insight than I’d have expected possible—seriously, this thing is cool—the main thing I’d really like to see from the Atmotube app is actually a bit more different information. It does a good job of really concisely saying what you can do in general to improve indoor air quality, but it’d be nice to see, for instance, some information tailored to what you’re experiencing. “Hey. Your PM2.5 is increasing. If you’re cooking, try running the hood fan.” “Hey, your house seems pretty dry. Here’s what can help right now and over time.” (My house is apparently too dry all the time. Other than buying a humidifier, which I don’t want to do, I still don’t know what to do about that.” While I will say it has told me to get plants to increase my household humidity, I’ll say I’ve only been successful at keeping my cactus alive for several years… and it’s a cactus.
More actionable alerts rather than generalized articles would perhaps actually encourage people to do things to alter their indoor air quality, humidity, or so-forth. Like right now, I’d like to know where the heck the elevated VOCs are coming from causing the app to “alarm”!

I can also think of a number of great quantified self projects when I decide to dig into playing with the CSV files a bit more. But that is a nerdy pursuit for another day!

Who Atmotube is for
Are you a nerd who likes checking a device you’re wearing all the time? Do you have a health condition, like asthma or heart disease that makes it more important for you to know what you’re breathing? Are you willing to put some time in to devise patterns, do some research, and make your own inferences from the data the Atmotube is getting you? If yes to any or all of these (all = me), and you can make the financial investment, I’d say yes. I’ve found using the Atmotube the last several months fascinating and illuminating to what, exactly, is in the air I’m breathing. 
Even if that happens to be Ventolin and it tells me its pollution. We can’t be totally perfect. 😉 

Disclosure: I reached out to the makers of Atmotube, who sent me an Atmotube Pro device to review honestly (and keep) with no strings attached beyond just writing this article. They were fabulous answering my many questions, sending a reviewers guide, and being patient in all my delays getting this article out—thanks, Ariuna and Daria!

I posted this on Facebook earlier today, after I left the pharmacy. After a few requests to make it public so friends could share, I did—and it seemed reasonable, 12 shares, 45 reactions and 59 comments later—many shocked that this happens in Canada—to post it on my blog, too.

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Do you know why Canada needs true national Pharmacare?
I do every day, but especially on days like today where I leave $642.01 behind at the pharmacy counter just to function for a month, for just 4 of my 7 meds. 

Did you know that despite being self employed and having two part time jobs, I can’t get insurance in Canada that covers medication for my preexisting conditions? Okay, actually I can, but it would cover $500 in medication: less than one tenth of my annual medication costs. Less than I just paid today. 

  • I can survive without Vyvanse for my severe ADHD, but I can’t thrive. That’s the expensive one, and it’s not an enhancer, just a sort-of equalizer. 
  • I require four different inhalers to manage my moderate-to-severe asthma. (One of those I’m on right now isn’t covered for asthma under Manitoba Pharmacare, so I pay out of pocket. Despite how well it works, I’ll switch it for another drug in not-winter to save money.) This is to BREATHE, which is not exactly optional.
  • Barring other radical intervention for my fibroids, I’ll need to stay on oral contraceptives for another several decades–and this is the only drug I may have a forseeable end date on. Despite my persistence, this is not optional. (And also, even if I were using them for contraception, does the province not realize paying for the pill for a decade is cheaper than probably just getting a baby born? Never mind making them a good human?)
  • Oh, and on top of the asthma medicine, I have allergic rhinitis, for which I consider the drugs “the optional ones”, but only because my sinuses aren’t super impairing–note, my doctors disagree with the optional-ness of daily nasal steroids, and support the use of singulair as an add on. 

I am productive and mostly healthy because I have these medicines. I’m lucky I can afford the deductible which is thrown at people like me in a lump sum at the beginning of the fiscal year. I will have another pharmacy trip or two where I leave a not-insignificant amount of money behind. Just because I can afford this now–with minimal expenses, living with my parents–doesn’t mean I’ll always be able to. 

Am I happy to have some provincial coverage? Yes. 
Do we need to do better? Unquestionably yes.

We need this for every person who needs to choose between food and medicine. For every person who cant financially handle a $500 emergency—40% of Canadians. For the parents who forgo their meds to let their kids play soccer–and for the ones who can’t play soccer because their parents need medicine. For every would be enterpreneur who could change the world but is stuck at a job because of benefits.

We need this to be a better Canada–that place where healthcare is a right because we take care of each other and we take pride in that. Except we stopped short, leaving patients who are still patients after they leave the doctors office often fighting to survive. We need more than “gap filling” solutions, we need Pharmacare for everyone, all the time. 

Canada, we can do better.

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Do you have a story about inadequate access to medication or medication coverage in Canada? Please SHARE IT so others know why this issue matters. One way you can share your story is to reach out to my friend Bill at FacesOfPharmacare.ca. You can also send your story to your Member of Parliament (find them here), and most importantly, VOTE in October for a candidate who supports a true national Pharmacare strategy for all Canadians.

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I got an e-mail Monday about a secret flu shot clinic for employees of my health region, including Disability Support Providers (me). It was a ten minute walk from my house (where I got led into an Authorized Personnel Only room), convenient as I am also high risk because of my asthma. Also it is basically next door to 7-Eleven. And a lovely morning for a walk.

While I often update my disclosures page without a whole post about it, this one needs attention called to it. Because, transparency.

Last week, I signed a contract with AstraZeneca Global, to participate in the Global Asthma Patient Partnership Program, after engaging in an initial webinar to get a feel for the experience, and receiving an invitation to join the Program for a year. I will receive financial compensation for my involvement on projects that I can opt-in-and-out of on a project by project basis. The initial webinar was also compensated by AstraZeneca.

I had hesitations. I thought long and hard. I asked questions about the contract. I deliberated alongside others in the same position; others aware of and sharing in the concerns I have about being involved as a patient with a pharmaceutical company. (You can also see this post from 2015 about going on a trip to Denver to learn about a GSK sponsored school asthma program on GSK’s tab, and my thoughts.)

AstraZeneca and its products are no longer a player in my own asthma management (I do have a Turdoza inhaler at home, although that’s a long story and is not actually one of my meds). I switched out Pulmicort for Qvar and then Symbicort for Zenhale close to five years ago. Had I been on AstraZeneca meds, this would actually be much harder, if that even makes sense, as their product(s) would be the ones keeping me healthy.

Do I think I am “partnering” with AstraZeneca? 

No, not exactly—more accurately I’d call it consulting. AstraZeneca can take or leave my feedback. I receive compensation either way. Just like I do and will write honestly, I’ll give them feedback honestly, too. Compensation won’t change that (unlike physician prescribing practices—see: Who Pays For the Pizza). I won’t be switching my meds out anytime soon. It’s likely that I won’t discuss AstraZeneca at all, which has been the case with GSK (considering I even get embargoed press releases since Denver).

Learn more about the AZ Patient Partnership Program by checking out the FAQ

Know that this is a trial run for me, too. I’m still getting a feel for this and how exactly I want to move forward. I can terminate my agreement at any time, but I am hoping that this is a positive experience—while it probably (almost certainly) won’t change how I see pharma, hopefully it changes how AstraZeneca sees asthma patients, which is maybe even more important.

Have questions? I cannot disclose anything discussed in the projects I consult on with AstraZeneca. (Nor, you know, their products/drugs, because I am not a doctor.) Otherwise, please let me know if you have questions or concerns and I will do my absolute best to address them.

Disclosure: As I have signed a contract with AstraZeneca, I provided this post for review by the Patient Engagement Director prior to publication (the only edits requested and made were referring to AstraZeneca by its full name). AstraZeneca did not ask me to write this post (rather, the opposite per the contract, although the Patient Engagement Director was encouraging). Transparency, however, is extremely important to me. I want you to know these things, so that we—as patients—can be more critical. 

Today my friend Sara asked me about my favourite asthma tracker app. If you’ve read my post, Technology, Self-Tracking and Asthma on Asthma.Net you’ll know that answer. (Disclosure: they pay me money but don’t influence my views, which is a sweet gig).

Pretend spoiler alert: I don’t like any asthma apps out there. (If you’re looking for one, though, read the article. I tried to look at a variety of aspects from price to what data was collected to design/user friendliness.)

So, with no coding skills what-so-ever, I set out to build my own solution. (I seem to do that.) I’m still working on it, and it’s far from perfect, but here’s what I’ve got so far. Keep in mind, I’ve got dozens of hours of trial and error behind this, and once I got it down, I used it (in the fragments created to that point) for maybe about six weeks before I hit a lapse, or burned out on it. I think, also, it will be easier (maybe not as effective, but easier) when I’m not at the cabin every weekend.

Element One: Google Forms/Google Sheets.
I started this whole thing off with a simple form for myself to fill out regarding my asthma symptoms (1-5 scale) and meds, trigger exposure, as well as my peak flow, FEV1, and oxygen saturation (cause why not?). I tried to tie symptom logging to taking my meds, as well as when I felt an increase in symptoms, so that it wasn’t biased by only reporting increased symptoms (which it still is, of course) and attaining a “baseline”. Unfortunately, I started this project when I was having a bit of a struggle with my asthma control (thanks a lot, rain and humidity).

I also used DO Button from IFTTT for a time to log my Ventolin use. Then I realized this was complicating things as I had to log each puff separately. This is where I began using QR codes.

Element Two: QR Codes.
I usually do not like QR Codes for whatever reason. I really would have preferred to use NFC tags, but, the iPhone 6 doesn’t feature a NFC tag reader like Android does (and whatever future iteration does, it’s ApplePay specific). So, QR Codes have to suffice.

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I created individual, colour coded (note the border) QR codes for each of my inhalers (and my Concerta bottle. And the nasal spray I realize I haven’t taken in forever). I made them small enough and simply attached these to my inhalers with tape (I had to scratch the shininess of the tape away but it worked okay after that, and after I learned not to put the codes on curves in the inhalers, which is difficult with Qvar). The QR codes link to individual Google Forms for each medication. I hit the corresponding button for the number of puffs taken (or, in the case of Concerta, one pill), and then hit submit.

My Ventolin (the blue inhaler above) you’ll notice has two QR codes attached. the one on the cap is for the Ventolin itself, the one on the side is for the symptom logging sheet. The peak flow meter has the link to the sheet to log PEF and FEV1. I also have the symptom barcode by my bed (where my peak flow meter usually lives and where I usually stand to take peak flows).

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It’s not perfect, but it’s kind of fun. And fun, in a twisted, nerdy sort of way is the motivator here. If it’s not nerdy fun, on my terms, it’s not happening. I log for myself, and my doctors don’t really pay much attention to my PEF/FEV1 results, nor do they ask I take them. Which I am okay with, since it lets me not get burned out on numbers.

I got Launch Center Pro for iOS for this reason, so I can swipe down from the Today(/Notifications) Panel and hit one button to launch NeoReader (my favourite of the free QR code scanner apps I’ve found), which I outfitted with a cute pink rocket ship icon thanks to Launch Center Pro. Because I have to make it fun, of course. What’s not fun about a pink rocket ship?

NeoReader also has a history option, so if I’m somewhere the code isn’t reading well (like the cabin), or the light is dim (sometimes with the tape the bright iPhone light doesn’t help) I can pop it open from history. Usually the code works and is faster, though. But, like all QR codes, sometimes it just doesn’t scan. I also had to cover the pharmacy provided barcodes with tape because often NeoReader tried to pick up the pharmacy barcodes instead of my QR code.

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I now have all of these QR codes importing data into different pages on the same Google Sheet.

Element Three: IFTTT.
For like, years now, I’ve had weather pushing itself to Google Drive for this reason. I also, I think, have humidity reports going there so I can correlate my asthma symptoms with humidity percentages and temperature.  

What I’d like to add.
A better summary of what I’d like to add next will be in an upcoming Asthma.Net post called “Quantified Asthma”. However, aside from NFC tags (which is kind of impossible unless I get my hands on an Android device—if anybody has one kicking around they want to send my way for Quantified Self purposes, let me know ;)), I’d like to be able to pull pollen counts automagically from somewhere but that looks impossible from Canada (I don’t have pollen/mold allergies per my testing, but it would be interesting to see if these have any impact on my breathing anyways, like particulate matter). 

Finding trends.
Like I said, I had a pretty crappy bout of breathing going on when I started this project. But, I’d like to grab a week or two a month where I log (since I can’t expect myself to do it all the time without burning out) so I can see differences between seasons. I used Datasense, Sheets and Excel to play with my data, but Datasense is hands down my favourite. I haven’t taken a single data analysis course, so, this aspect has got to be pretty user friendly for me, and, Datasense is a lifesaver for that. Thanks, Intel!

So, that’s it for now.