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Makani Science

Makani Science

Continuous Respiration Monitor

Andrew Kuzemczak
May 27, 2025

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Hi friend,

Welcome back to Future Human! I hope you enjoyed last week’s edition (#14) on Mirvie. Collaborating with their senior leadership was an incredible experience—and it’s only made us more excited to connect with more founders and startup teams. After all the research, the Future Human team has become something of a mini–preeclampsia task force. The timing couldn’t be better: tomorrow, I start our medical school unit on reproduction. Let’s see how much the newsletter prepped me!

On a different note, today we’re shifting gears back into hardware. If I remember correctly, this next startup was the final team I profiled during my 2024 Healthtech 30in30 writing challenge. The company is still in its earliest stages—a period I find especially exciting. Nick, one of our fantastic research associates, helped me dig into a trove of data to create a deep dive that’s both comprehensive and easy to absorb.

So with that, let me ask you:

If you knew that respiratory rate is the most inaccurately measured vital sign in medicine, would you push providers to improve their technique—or turn to wearables to monitor it more reliably across all patients?

The Story

As with some of our greatest startups covered thus far, we begin with 10 years of academic research from one lab itching to break out and revolutionize a market. Dr. Michelle Khine is a biomedical engineering professor and Associate Dean for Undergraduate Education at UC Irvine. Like any normal person, she also has 5-6 side hustles. She is the co-founder of numerous medtech startups including Novoheart (biotech casually dedicated to engineering bioartificial human heart surrogates), 100 Tiny Hands (educational toy company), Vena Vitals (new way to non-invasively track beat to beat blood pressure), and Fluxion Biosciences (provides analytical, live cell analysis tools to researchers). She was also the Director of BioENGINE (BioEngineering Innovation and Entrepreneurship) at UC Irvine until 2022. What do you do with your free time?

Okay, back to Makani.

Dr. Khine’s vision for Makani came as a result of an event that involved her baby son who had a collapsed lung. With all the monitors he had on him, nothing was monitoring his breathing sufficiently to detect the issue. With co-founder and CTO, Dr. Michael Chu, the Makani Respiratory Sensor was born in 2018.¹^,²

To further underscore the value of academic research to society: Dr. Chu was a graduate student in the Khine Lab, and Makani’s development was only possible because of his PhD work under Dr. Khine’s mentorship.³

Makani Science is developing the world’s first Continuous Respiration Monitor to be used on patients regardless of age. This small, wearable, wireless respiratory monitor uses a unique stretch sensor that continuously measures important parameters of breathing (rate, volume, and waveform).

A few years after founding, the team took their sensor to YCombinator, where they participated in the S21 (Summer 2021) batch. In reading their YC description, it is clear they applied first with the aim of improving monitoring safety in patients being sedated for medical procedures. As with most YC startups, they morphed their long-term goal to combine machine learning with their growing database. They are now more broadly working to identify and predict respiratory complications for different patient populations from the data collected.

Makani is now under the leadership of Dr. Greg Buchert. He is a successful C-Suite leader in the health insurance and care delivery systems space. Dr. Buchert became involved with Makani through his involvement in angel investment groups TCA Venture Group and MEDA Angels.⁴^,⁵^,⁶

The Tech

The Makani Science Respiratory Monitoring System is a wearable, wireless patch. See below if you are still confused.

Makani Respiratory Monitor

The sensor measures respirations (shocking), but then pairs with a mobile platform for long term data monitoring. Thanks to the magic of Bluetooth (which I just learned this weekend was named after a 10th-century Viking king, Harald Bluetooth), the patient environment is free of wires and easy to navigate.

The core tech here is their proprietary, postage sized, stretchable sensor for respiratory rate monitoring.

“Stretchable sensor?” you ask.

As the #2 thing I learned recently, this time thanks to my cardiac engineering lab here at Weill Cornell, stretchable sensors (or flexible electronics) are devices built on bendable substrates, allowing them to conform to non-flat surfaces or dynamic movement. Think:

Substrates like plastic (PET) or polyimide (PI)
Flexible semiconductors, either organic (carbon-based) or special inorganic compounds
Conductive materials like silver nanowires, graphene, or conductive polymers

So what does Makani use from this list of advanced, research-grade materials? Wait for it…

Shrinky Dinks.

Shrinky Dinks are sheets of thin, flexible plastic that shrink and harden when heated in an oven. Dr. Chu says that for Makani, they combine soft electronics with Shrinky Dink prototyping for device fabrication. Shrinky Dinks, originally a children's craft material made from polystyrene plastic, have found applications in scientific research due to their predictable shrinkage properties when heated. By using the shrinking plastic, Makani can make tiny, super-smart stickers that stick to your skin while being comfortable to wear.¹^,⁵

Just last month, Makani Science announced that it achieved 510(k) clearance from the U.S. FDA to market and distribute its Makani Respiratory Monitor. After a decade of lab research and seven years as a startup, Makani is moving forward with manufacturing, early clinical deployment, and research collaborations. The device is poised to support applications in hospitals, outpatient clinics, athletic performance monitoring, and early disease detection—frankly anywhere continuous, non-invasive respiratory monitoring can make a meaningful difference.

Current methods for continuous respiration monitoring such as respiratory inductive or optoelectronic plethysmography are limited to clinical or research settings. Makani’s disposable sensor can measure both respiration rate and volume by simply measuring the local strain of the ribcage and abdomen during breathing. They have also shown in their 2019 Nature paper that the detection accuracy does not diminish in ambulatory or non-research conditions, making the low-powered sensor useful for monitoring those with chronic respiratory disease in everyday life.⁷^,⁸

Although I have not found pricing written in stone anywhere, it appears they are developing three revenue streams with the tech. The disposable sensor will be available for $75-100 each. Thanks to its similarity to sensors for other vital signs, coverage by national payers is already established. The app will be subscription based, charging $100/user. Finally, I noted CEO, Dr. Buchert, spoke a few times about selling de-identified data in the future as the database matures.

Well there you have it. I bet some of you never thought your electronics could be “soft” and “flexible” before this.

The Market

Breathing is a big market (wow). How Makani makes its way through the market will be interesting to see given its massive size.

In our research, we find that they will begin by deploying tech in hospitals and research institutions for patients with COPD, asthma, and sleep apnea. They appear poised to also target the pediatric market early. Later on, they will expand beyond disease and cover wellness. Ultimately, they are considering a direct-to-consumer option for those who just want to monitor their breathing daily, even without a respiratory pathology.

Let’s take a look at some of these markets.

The global COPD and asthma diagnostic and monitoring device market accounted for $5.0 billion in 2019, and is expected to reach $8.2 billion by 2027. That CAGR clocks in at 6.3% for those wondering. The market can be segmented into diagnostic devices, monitoring devices, and consumables and accessories. The diagnostic devices segment includes spirometers, FeNo test analyzer, peak flow meter, and arterial blood gas analyzer (ABG). The monitoring devices segment includes pulse oximeters, capnography, wearables, and infrared spectroscopy (FTIR).

If I were to pin down Makani Science’s course, it would be first monitoring device —> then diagnostic device —> finally consumable.

In COPD and asthma, they will be coming up against market leaders including Becton Dickinson and Company, Dragerwerk, Masimo Corporation, and Medtronic.⁹

Next, the global sleep apnea devices market was valued at $6.0 billion in 2023, is forecasted to grow 7.3%, reaching $9.3 billion by 2029. With telehealth making its stand post-COVID, sleep apnea and other sleep disorders are classic frontiers where telemedicine will continue to propel growth and open up room for more tech innovation. There has been an increasing trend of health agencies expanding the reimbursement coverage of remote patient monitoring and other connected health services. Just sending along the data and avoiding in-person visits is not always the ideal solution in healthcare, but it can certainly be the cheapest for payers. Makani is well placed to capitalize on such a market shift.¹⁰

As often as the Makani team touts COPD, asthma, and sleep apnea as their beachhead markets, they also mention pediatrics as a parallel path. Unsurprisingly, the pediatric medical devices market is ginormous, valued at $28 billion in 2022 and growing 7.8% annually. Rising chronic diseases among children, namely respiratory disorders (asthma), is accelerating growth.¹¹^,¹²

Finally, as their last frontier, we arrive at health and wellness. The global fitness tracker market was valued at $62 billion in 2024. Alongside that overall value, the growth rate would make any market self-conscious, coming in with a CAGR of 22.1%.¹³

If you sum that up and add general respiratory devices, Makani Science is looking down range at a total addressable market (TAM) of $116 billion.

Although incumbents are large and anti-competitive, Makani carries a serious advantage as the tech disruptor. Respiratory technology has not kept pace with the need for innovation. Pulse oximetry remains the ‘gold standard’ but it is a lagging indicator with no ability to measure respiratory rate and known inaccuracy with motion. Capnography (technique that measures the concentration of CO2 in exhaled breath) can infer breaths but cannot monitor breathing effort and is best used on intubated patients in hospital settings.

If breathing is one of the most vital signs of life, why has it been the most overlooked in innovation?

The Sick

In 2017, according to the WHO, respiratory diseases were considered to be the leading causes of death and disability in the world. Approximately 65 million people suffer from COPD and 3 million are expected to die from it each year, making it the third leading cause of death across the globe. Although younger generations may be smoking and drinking less, the overall trend shows that the aging population is smoking and drinking more. This is all fuel for COPD rates.⁹

The term COPD (chronic obstructive pulmonary disease) refers to two main conditions:¹⁴

Emphysema develops when there is damage to the walls between the air sacs in the lungs
Chronic bronchitis is caused by repeated or constant irritation and inflammation in the lining of the airways (thick mucus forms in the airways, making it hard to breathe)

There is no cure, treatments and lifestyle changes such as quitting smoking can help you feel better, stay more active, and slow the progress of the disease.

As for asthma, approximately 334 million people suffer from it, and it is the most common chronic disease of childhood, affecting 14% of all children globally.⁹

Asthma causes wheezing, breathlessness, chest tightness, and coughing at night or early in the morning. If you have asthma, you have it all the time, but you will have asthma attacks only when something bothers your lungs. During an asthma attack, the sides of the airways in your lungs swell and the airways shrink.¹⁵

Finally, sleep apnea can be divided into two types like COPD:¹⁶

Obstructive sleep apnea (OSA) happens when your upper airway becomes blocked many times while you sleep—factors such as obesity, large tonsils, or changes in your hormone levels can narrow your airway
Central sleep apnea occurs when your brain does not send the signals needed to breathe

Untreated sleep apnea increases the risk for stroke and heart attack.

Let us for a moment step away from the traditionally ‘sick’ patients and look at another category of patients Makani will support. Remember when I said the Makani Science team applied to YCombinator looking to monitor patients during surgical procedures?

Well that remains a key patient group, so let us take a look at anesthesia.

In the US, approximately 21 million patients receive general anesthesia annually for surgical procedures. This includes both adults and children, with about six million pediatric patients undergoing general anesthesia each year. Globally, over 300 million people receive anesthesia and surgery every year. The primary goal of general anesthesia is to render a patient unconscious and unable to feel painful stimuli while controlling autonomic reflexes. General anesthesia requires an anesthetic machine that contains a ventilator, gas supply, reducing valves, vaporizers, flow meters, breathing circuits, and suction canisters. The anesthesia machine also contains a monitor to display vital signs. Certainly a lot of moving parts.¹⁷

Whether during the procedure or during recovery, monitoring respiratory function is essential but often lags in early detection of apnea or hypoventilation, non-invasive solutions for non-intubated patients, and reliable data creation in presence of movement or poor patient compliance.

Makani could finally provide a continuous, comfortable, and high-fidelity respiratory monitor for surgical patients, as well as those with COPD, asthma, or sleep apnea.

The Economy

As the leading beachhead market, COPD will be our economic test subject. COPD costs the US $24 billion each year among adults 45 years of age and older. For context, cancer costs $200 billion and cardiovascular disease about $250 billion annually. Although it is smaller, keep in mind this is against the #1 and #2 source of healthcare expenditure nationally.

The $24 billion for COPD is dominated by prescription drug costs. It breaks down into $11.9 billion for drugs, $6.3 billion in inpatient costs, $2.4 billion in office-based costs, $1.6 billion in home health costs, $900 million in emergency room costs, and $800 million in outpatient costs.¹⁸

American Lung Association: COPD Trends Brief

COPD medical costs are $4,322 per patient each year on average and it is not stabilizing. Average COPD medical costs per year increased 72% from 2000 to 2018, including an increase in prescription drug costs of eight times. So what could reduce costs?

Continuous monitoring has offered among the most robust data.

In a 2021 paper, Khanna et al. compared intermittent pulse oximetry and continuous pulse oximetry + capnography monitoring for patients receiving opioids (not a perfect comparator to Makani, but valuable nonetheless). The model utilized costs and outcomes from the Prediction of Opioid-Induced Respiratory Depression in Patients Monitored by Capnography (PRODIGY) trial, and applied them to a cohort of 2,447 patients.

Continuous pulse oximetry and capnography monitoring of high-risk patients reduced annual hospital cost by $535,531 and cumulative patient length of stay by 103 days.

Just a 1.5% reduction in respiratory depression achieved a break-even investment point and justified the technology cost.¹⁹

Now, imagine building on this foundation with Makani Science’s affordable and user-friendly respiratory monitoring platform. Our improved technology helps reduce hospital emergencies, such as respiratory depression, ultimately lowering healthcare costs worldwide.

Let the Good (economic) Times Roll.

My Thoughts

As compared to diagnostics and therapeutics, patient monitoring is not always the most buzz-worthy space. I think that is a mistake. To support patients early and prevent the need to diagnose and treat a disease in the first place is the ultimate goal. This cannot be achieved without advancement in monitoring tech, especially vital measurement. Makani Science, led by Drs. Buchert, Khine, and Chu, is addressing one of the most critical challenges in healthtech.

In a world where we obsess over heartbeats, steps, and sleep scores, it is striking how little attention we have paid to our most essential function: breathing. Makani Science is changing that—quietly, precisely, and breath by breath. With their sleek respiratory sensor, they are turning every inhale and exhale into real-time, actionable data. When they succeed, the future of respiratory monitoring won’t just be smarter—it might finally catch its breath.

To more lives saved,

Andrew

I always appreciate feedback, questions, and conversation. Feel free to reach out on LinkedIn @andrewkuzemczak.