The science behind HCO Respiratory

A decade of research. A clear through line.

Every element of our program is grounded in peer-reviewed evidence. This page walks through the science, from the gap that causes avoidable attacks, to the device that closes it, to the education model that makes the difference stick.

Section 1

The body is always signaling. Most people can't hear it.

More than half of people with asthma or COPD have poor outcomes despite taking their medication. For years, this was attributed to non-compliance. The research tells a more nuanced and more important story.

A qualitative study published in the European Respiratory Journal (Bidad et al., 2018) found that people with asthma consistently set their personal “tolerance threshold” for symptoms far higher than clinical guidelines recommend. They adapt to feeling unwell and stop recognizing it as a warning sign. The body is signaling distress. The person simply cannot hear it.

“Symptoms indicative of poor control were often tolerated as part of living with asthma. Participants appeared to have an internal barometer, but for many the level indicating poor control was set much higher than clinical criteria.”

Bidad et al., European Respiratory Journal, 2018
50M+
Americans living with asthma or COPD, more than half with poor outcomes despite medication adherence
71%
of study participants scored below the threshold for good asthma control, while many believed their condition was well managed
Bidad et al., 2018
Section 2

The device that listens when you can't.

The ADAMM-RSM wearable was developed at the University of Rochester through a rigorous three-phase research program. The foundational work, published in JMIR mHealth and uHealth (Rhee et al., 2014), established the device's ability to objectively capture cough frequency, type, and respiratory patterns continuously, in real life.

The 2015 validity study (Rhee et al., 2015, JMIR) showed that device data was a statistically significant predictor of asthma control, quality of life, and healthcare utilization at three months follow-up.

3 months
Device data predicted healthcare utilization up to 3 months in advance
Rhee et al., 2015
r = 0.61
Correlation between cough counts and healthcare utilization (p<0.001)
Concurrent validity
β = 0.74
Predictive validity for healthcare utilization at 3 months (p=0.004)
Predictive validity

An independent peer-reviewed review (Fan et al., 2020, UCSD) evaluated every commercially available remote monitoring device for COPD. ADAMM-RSM was the only device to achieve the highest rating across forecasting ability, ease of use, and appearance.

Forecasting ability
Highest rated for its ability to signal a developing exacerbation based on key biomarkers
Ease of use
Passive, hidden under clothing. No effort required from the wearer to capture data
Appearance
Discreet, lightweight design rated highest for user acceptability and comfort
Section 3

Knowing isn't enough. Learning changes everything.

The research is unambiguous: devices and apps alone do not produce lasting behavior change. What works is structured, hyper-personalized self-management education, delivered at the point of experience by a trusted clinician over time.

The CDC identified intensive self-management education as one of only four evidence-based interventions for asthma. Following evidence-based guidelines reduced asthma-related ED visits by 45% and hospitalizations by 56%. Return on investment: up to $4.00 for every $1.00 spent.

45%
reduction in asthma-related ED visits with evidence-based self-management education
CDC, National Asthma Education and Prevention Program
56%
reduction in hospitalizations with self-management education programs
CDC

“To achieve full behavioral change, specific human-to-human interaction is necessary. Apps and devices are necessary, but they are not sufficient.”

HCO Whitepaper, December 2023, citing Omada Health, 2022 and supporting literature
The shift from reacting to crises to staying ahead of them

Before

  1. Warning signs go unnoticed day to day.

  2. Recognizes the problem only once it's serious, with no plan to act on.

  3. Ends up at the clinic or ER, sometimes admitted to hospital.

After

  1. Reads their own symptoms while living, working and playing.

  2. Spots trouble well ahead of a crisis, and knows exactly what to do then.

  3. The crisis never happens.

Section 4

Education at the point of experience. That is what makes it stick.

Most self-management education is delivered in a clinic, once, at diagnosis. HCO delivers education differently. When a member's data begins to shift from their personal norm, their care team responds. The education is tied directly to what the member is experiencing in that moment.

HCO approach
Bite-size, contextual, compounding
Small pieces of education, delivered at the moment of lived experience, tied to the member's own data. Habits that compound over time.
The result
Self-sufficiency, not dependency
Members learn to recognize their own patterns, act before a crisis, and manage their condition independently. Most graduate within 2 years.

The science is the foundation. The program is the proof.

Read the independent research or talk to our clinical team.