like a smoke alarm that sounds before the fire takes hold
For half a century, asthma care has followed a familiar rhythm: wait for the crisis, then respond. Researchers at the University of Auckland are now challenging that logic, developing a smartwatch system capable of detecting the physiological signs of an impending attack up to seven days before it arrives — offering, for the first time, a genuine window for prevention. The work carries particular weight in a country where Māori and Pacific communities bear a disproportionate share of asthma's harm, and where the standard treatments themselves carry serious long-term risks.
- One in seven New Zealand children lives with asthma, yet the condition has been managed reactively for fifty years — a system built to respond to crises rather than prevent them.
- A smartwatch algorithm that outperforms traditional clinical tools can now calculate a person's attack risk for the coming week, sounding an alert before the crisis takes hold.
- Māori and Pacific New Zealanders are hospitalised at two to three times the rate of other groups, and are often prescribed a lifetime's worth of steroids in a single year — raising their risk of diabetes, stroke, and cardiovascular disease.
- A 250-person randomised controlled trial will test the single variable of information: whether receiving a real-time risk score actually changes health outcomes compared to standard care.
- A parallel $1.4 million study will use blood and breath tests to match steroid treatment to the specific cause of each attack, replacing blanket prescribing with precision medicine centred on the communities most affected.
At the University of Auckland, researchers have been watching smartwatch data stream in from more than 200 people with asthma, searching for patterns invisible to the naked eye. What they found could reshape how the condition is managed: a digital fingerprint that appears roughly a week before an attack strikes — a discovery timed to Asthma Week, when the scale of the problem comes into focus across a country where asthma has been handled the same reactive way for fifty years.
Associate Professor Amy Chan, who leads the School of Pharmacy, describes the shift in simple terms. Rather than waiting for a crisis, a smartwatch monitors heart rate, breathing patterns, and other physiological signals, feeding data to an algorithm that calculates attack likelihood in the coming week. When risk rises, the wearer receives an alert — a prompt to consult their personalised asthma action plan. Chan likens it to a smoke alarm that sounds before the fire takes hold. The algorithm has already outperformed the self-reporting and peak flow measurements doctors have long relied upon.
The disparity in who suffers most shaped the research from the start. Māori and Pacific populations face hospitalisation rates two to three times higher than other groups, and the team ensured strong representation of those communities in both the trial population and the research itself. The next step is a randomised controlled trial involving 250 participants over twelve months: half will receive a real-time risk score alongside standard care, half will not. The only variable is information — what Chan calls the secret sauce.
A parallel project, funded with $1.4 million from the Health Research Council, addresses a different but connected problem. Many New Zealanders — particularly Māori and Pacific people — receive far more steroid medication than their condition requires. Some attacks are driven by eosinophils and respond well to steroids; others stem from viral infections and may not benefit at all. Yet steroids are routinely prescribed regardless, and the risks accumulate: diabetes, stroke, cardiovascular disease, obesity. Chan's research found many patients receive in a single year what guidelines recommend as a lifetime maximum.
The new trial, run with the National Hauora Coalition and co-led by Associate Professor Anneka Anderson from Te Kupenga Hauora Māori, will use a finger-prick blood test and a breath test to identify the type of attack a patient is experiencing, then tailor treatment accordingly. Together, the two projects represent a meaningful shift — one offering early warning, the other offering precision — both centred on the communities carrying the heaviest burden.
At the University of Auckland, researchers have spent months watching smartwatch data stream in from more than 200 people with asthma, looking for patterns invisible to the naked eye. What they found could reshape how asthma is managed: a digital fingerprint that appears roughly a week before an attack strikes. The discovery arrives during Asthma Week, when the scale of the problem comes into focus—one in seven children and one in eight adults in New Zealand live with asthma, a condition that has been managed the same reactive way for half a century.
Associate Professor Amy Chan, who leads the School of Pharmacy at the university's Faculty of Medical and Health Sciences, frames the breakthrough in simple terms. Asthma care has always waited for the crisis to arrive, then responded. This new approach flips that logic. A smartwatch monitoring heart rate, breathing patterns, and other physiological signals feeds data to an algorithm that calculates the likelihood of an attack in the coming week. When risk climbs, the wearer gets an alert—a prompt to consult their asthma action plan, the personalized instructions their doctor or nurse has prepared for exactly this moment. It works, Chan explains, like a smoke alarm that sounds before the fire takes hold.
The algorithm outperformed the tools doctors have relied on for years: patient self-reporting and peak flow measurements. That performance matters especially because asthma does not affect all New Zealanders equally. Māori and Pacific populations face hospitalization rates two to three times higher than other groups. The research team built this disparity into their design from the start, ensuring strong Māori and Pacific representation in the trial population and in the research itself.
Now comes the test that matters most. The team is launching a randomized controlled trial—the gold standard in medical research—involving 250 people with asthma over twelve months. Everyone will receive standard asthma care. Half will also receive a risk score generated by their smartwatch data, showing their likelihood of an attack. The other half will not. The only variable is information. Chan calls this the secret sauce: testing whether knowing your risk, in real time, actually changes outcomes. The trial has received partial funding from the Auckland Medical Research Foundation and Return on Science, with the team seeking additional support.
A parallel project, already funded with $1.4 million from the Health Research Council, tackles a different but related problem. Many New Zealanders with asthma—particularly Māori and Pacific people—receive far more steroid medication than they need. Some asthma attacks are driven by immune cells called eosinophils, which respond well to steroids. Others stem from viral infections or different causes entirely and may not benefit from steroid treatment at all. Yet current practice often prescribes steroids as a standard response, regardless of the attack's underlying cause.
This matters because the risks accumulate. Steroids increase the chances of diabetes, stroke, cardiovascular disease, obesity, and mood disorders—conditions already more prevalent in Māori and Pacific communities. Current best practice recommends people receive no more than one gram of corticosteroids over their entire lifetime. Chan's research found many New Zealanders with asthma are prescribed that amount in a single year. The new trial, run with the National Hauora Coalition and co-led by Associate Professor Anneka Anderson from Te Kupenga Hauora Māori, will use a finger-prick blood test and a breath test to identify which type of asthma attack a patient is experiencing, then tailor steroid treatment accordingly. The goal is to move from one-size-fits-all prescribing to medicine shaped to the individual.
Together, these projects represent a shift in how asthma is understood and treated. One offers early warning. The other offers precision. Both center the communities most burdened by the disease.
Notable Quotes
Asthma care has always been reactive, but this could be like a smoke alarm in your house. You want the alarm to go off before the fire starts.— Associate Professor Amy Chan, University of Auckland
Many New Zealanders with asthma are prescribed the lifetime recommended dose of corticosteroids within a single year, yet steroid risks—including diabetes, stroke, and cardiovascular disease—are already higher in Māori and Pacific populations.— Associate Professor Amy Chan
The Hearth Conversation Another angle on the story
Why does a smartwatch work better than what doctors have been using?
A smartwatch captures continuous data—heart rate, breathing patterns, movement, sleep—all the small signals your body sends before it breaks down. A peak flow meter gives you one number once a day. A patient's memory of symptoms is filtered through what they remember and how they describe it. The algorithm sees patterns humans can't.
But doesn't everyone's body work differently? How can one algorithm predict attacks for all asthma sufferers?
That's exactly why they're testing it on 250 people over a year. The algorithm learns from patterns, but it also needs to account for individual variation. That's why half the trial group gets the risk score and half doesn't—to see if the information itself changes behavior and outcomes.
You mentioned Māori and Pacific people are two to three times more likely to be hospitalized. Why is that disparity built into the research?
Because if you design a trial without centering the communities most affected, you end up with a tool that works well for some people and not others. They made sure from the beginning that Māori and Pacific researchers and participants shaped the work.
The steroid study seems separate. Are they connected?
They're parallel efforts addressing different parts of the same problem. One prevents attacks before they happen. The other makes sure that when attacks do happen, people get the right treatment for their specific type of attack, not just the standard dose everyone gets.
What happens if the smartwatch trial works? What's next?
That's the question everyone's asking. If it works, you're looking at a tool that could be scaled across the health system. But first they need to prove it actually changes how people manage their asthma and whether it reduces hospitalizations and attacks.