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Jones P, Alzaabi A, Casas Herrera A, Polatli M, Rabahi MF, Cortes Telles A, Aggarwal B, Acharya S, Hasnaoui AE, Compton C. Understanding the Gaps in the Reporting of COPD Exacerbations by Patients: A Review. COPD 2024; 21:2316594. [PMID: 38421013 DOI: 10.1080/15412555.2024.2316594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function, poor quality of life, loss of exercise capacity, risk of serious cardiovascular events, hospitalization, and death. However, patients underreport exacerbations, and evidence suggests that unreported exacerbations have similar negative health implications for patients as those that are reported. Whilst there is guidance for physicians to identify patients who are at risk of exacerbations, they do not help patients recognise and report them. Newly developed tools, such as the COPD Exacerbation Recognition Tool (CERT) have been designed to achieve this objective. This review focuses on the underreporting of COPD exacerbations by patients, the factors associated with this, the consequences of underreporting, and potential solutions.
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Affiliation(s)
- Paul Jones
- Global Medical, Regulatory and Quality, GSK plc, Brentford, UK
| | - Ashraf Alzaabi
- Internal Medicine Department, College of Medicine and Health Sciences, UAE University, Al Ain, UAE
- Respirology Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Alejandro Casas Herrera
- AIREPOC (Integrated care and rehabilitation program of COPD), Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Mehmet Polatli
- School of Medicine, Chest Disease Department, Aydin Adnan Menderes University, Aydin, Turkey
| | | | - Arturo Cortes Telles
- Clínica de Enfermedades Respiratorias Hospital Regional de Alta Especialidad de la Península de Yucatán, Yucatán, México
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Glynn L, Mc Cann M, Mc Cabe C. Smartphone applications supporting self-management programme for adults with Chronic Obstructive Pulmonary Disease: A Scoping Review. PLOS DIGITAL HEALTH 2024; 3:e0000532. [PMID: 38870123 PMCID: PMC11175531 DOI: 10.1371/journal.pdig.0000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) significantly impacts on both the quality and quantity of life for patients due to frequent exacerbations requiring hospital admissions resulting in increased morbidity and mortality. A self-management programme purpose is to increase one's knowledge, confidence, and skills to self-manage their chronic illness such as COPD. OBJECTIVE The objective of this review will therefore answer the following research question: What is the current literature pertaining to the use of a smartphone app in supporting a comprehensive self-management programme among COPD patients? A preliminary search was conducted in, Medline, Embase and CINAHL databases to ascertain index terms and keywords. Following this a rigorous search was carried out on Medline, Embase, CINAHL, Web of Science and ASSIA. The findings from this search are presented in tabular form using the PRSIMA flow diagram. RESULTS In this review, fifteen studies met the inclusion criteria. Across all studies participants engaged with the app and developed self-management skills and knowledge to manage their chronic illness. However, engagement with the app without third party involvement declined over time. Technical issues did not cause harm to participants but in some cases contributed to reduced engagement. Smartphone self-management apps empowered a cohort of COPD participants to engage in managing their chronic illness which proved useful in detecting exacerbations earlier resulting in reducing the need for hospitalisations over a three-to-six-month period. By reducing hospitalisations incurred a cost savings for health care and an improved quality and quantity of life for these participants. CONCLUSION It is evident from the literature that smartphone self-management apps may positively influence participants self-management decisions in terms of knowledge, increase physical activity, self-efficacy that may result in reduced hospitalisation and improved quality of life. It is clear that technical issues and sustained engagement over longer periods of time remains a challenge.
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Affiliation(s)
- Lisa Glynn
- School of Nursing and Midwifery, University of Galway, Ireland
| | - Margaret Mc Cann
- School of Nursing and Midwifery, Trinity College, Dublin 2, Ireland
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Ellis P, Parekh G, Duvoix A, Watson L, Sharp A, Mobeen F, Pye A, Stockley R, Turner A. Characteristics of alpha-1 antitrypsin deficiency related lung disease exacerbations using a daily symptom diary and urinary biomarkers. PLoS One 2024; 19:e0297125. [PMID: 38306339 PMCID: PMC10836691 DOI: 10.1371/journal.pone.0297125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/27/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Pulmonary exacerbations in alpha-1 antitrypsin deficiency (AATD) related lung disease are a significant contributor to disease burden, as with usual COPD. Separating the early stages of an exacerbation from the day-to-day variation in stable COPD is central to the concerns of both clinicians and patients and has been identified as a research priority by NIHR. Clinical tools that distinguish baseline symptoms from those of an exacerbation could allow early and appropriate treatment of AECOPD to reduce the impact and potentially may slow disease progression thereby improving survival and quality of life. Candidate tools include symptom diaries and biomarkers of infection and acute inflammation. Urinary biomarkers of AECOPD have yet to be explored in AATD related COPD. METHODS 55 patients with AATD related lung disease with a history of 2 or more AECOPD in the preceding year were prospectively followed for 18 months. Each patient recorded symptom scores daily via an electronic symptom diary (eDiary) based on Bronkotest. Urinary biomarkers for AAT, NE, CRP, TIMP1 and desmosine were measured weekly using a home urinary lateral flow device. During self-reported AECOPD patients were asked to perform urine analysis on the first 7 consecutive days. RESULTS Type I Anthonisen exacerbations and episodes occurring in autumn/winter lasted longer than Type II/III exacerbations and spring/summer episodes respectively. Median urinary CRP concentration across all study participants increased during Type I AECOPD. eDiary adherence was 68% over a median of 17.8 months (IQR 15.7 to 18.5). CONCLUSIONS Use of an eDiary and urinary biomarkers to detect and characterise AECOPD remotely in AATD related lung disease is feasible over a prolonged period and paves the way for precision detection of exacerbations.
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Affiliation(s)
- Paul Ellis
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Gita Parekh
- Mologic Ltd, Thurleigh, Bedford, United Kingdom
| | | | | | - Alex Sharp
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Farah Mobeen
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Anita Pye
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Robert Stockley
- Institute of Inflammation and Aging, University of Birmingham, Birmingham, United Kingdom
| | - Alice Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Krishnan JK, Ancy KM, Oromendia C, Hoffman KL, Easthausen I, Leidy NK, Han MK, Bowler RP, Christenson SA, Couper DJ, Criner GJ, Curtis JL, Dransfield MT, Hansel NN, Iyer AS, Paine III R, Peters SP, Wedzicha JA, Woodruff PG, Ballman KV, Martinez FJ. Characterizing COPD Symptom Variability in the Stable State Utilizing the Evaluating Respiratory Symptoms in COPD Instrument. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:195-208. [PMID: 35403414 PMCID: PMC9166327 DOI: 10.15326/jcopdf.2021.0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
RATIONALE It has been suggested that patients with chronic obstructive pulmonary disease (COPD) experience considerable daily respiratory symptom fluctuation. A standardized measure is needed to quantify and understand the implications of day-to-day symptom variability. OBJECTIVES To compare standard deviation with other statistical measures of symptom variability and identify characteristics of individuals with higher symptom variability. METHODS Individuals in the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Exacerbations sub-study completed an Evaluating Respiratory Symptoms in COPD (E-RS) daily questionnaire. We calculated within-subject standard deviation (WS-SD) for each patient at week 0 and correlated this with measurements obtained 4 weeks later using Pearson's r and Bland Altman plots. Median WS-SD value dichotomized participants into higher versus lower variability groups. Association between WS-SD and exacerbation risk during 4 follow-up weeks was explored. MEASUREMENTS AND MAIN RESULTS Diary completion rates were sufficient in 140 (68%) of 205 sub-study participants. Reproducibility (r) of the WS-SD metric from baseline to week 4 was 0.32. Higher variability participants had higher St George's Respiratory Questionnaire (SGRQ) scores (47.3 ± 20.3 versus 39.6 ± 21.5, p=.04) than lower variability participants. Exploratory analyses found no relationship between symptom variability and health care resource utilization-defined exacerbations. CONCLUSIONS WS-SD of the E-RS can be used as a measure of symptom variability in studies of patients with COPD. Patients with higher variability have worse health-related quality of life. WS-SD should be further validated as a measure to understand the implications of symptom variability.
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Affiliation(s)
- Jamuna K. Krishnan
- Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
- *Co-first authors, both authors contributed equally to the work
| | - Kayley M. Ancy
- Department of Medicine, Weill Cornell Medicine, New York, New York, United States
- *Co-first authors, both authors contributed equally to the work
| | - Clara Oromendia
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States
| | - Katherine L. Hoffman
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States
| | - Imaani Easthausen
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States
| | | | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Russell P. Bowler
- Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado, United States
| | - Stephanie A. Christenson
- Pulmonary and Critical Care, University of California San Francisco, San Francisco, California, United States
| | - David J. Couper
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Gerard J. Criner
- Pulmonary and Critical Care Medicine, Temple University Hospital, Philadelphia, Pennsylvania, United States
| | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
- Medical Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Mark T. Dransfield
- Pulmonary, Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore Maryland, United States
| | - Anand S. Iyer
- Pulmonary, Allergy and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Robert Paine III
- Division of Pulmonary and Critical Care Medicine, Department of Veterans Affairs Medical Center, University of Utah, Salt Lake City, Utah, United States
| | - Stephen P. Peters
- Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine Medical Center, Winston-Salem, North Carolina, United States
| | | | - Prescott G. Woodruff
- Pulmonary and Critical Care, University of California San Francisco, San Francisco, California, United States
| | - Karla V. Ballman
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York, United States
| | - Fernando J. Martinez
- Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, New York, United States
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Coll F, Cavalheri V, Gucciardi DF, Wulff S, Hill K. Quantifying the Effect of Monitor Wear Time and Monitor Type on the Estimate of Sedentary Time in People with COPD: Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11071980. [PMID: 35407588 PMCID: PMC8999633 DOI: 10.3390/jcm11071980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 01/25/2023] Open
Abstract
In studies that have reported device-based measures of sedentary time (ST) in people with chronic obstructive pulmonary disease (COPD), we explored if the monitor type and monitor wear time moderated the estimate of this measure. Five electronic databases were searched in January 2021. Studies were included if >70% of participants had stable COPD, and measures of ST (min/day) were collected using wearable technology. Meta-regression was used to examine the influence of moderators on ST, monitor type, and wear time. The studies identified were a total of 1153, and 36 had usable data for meta-analyses. The overall pooled estimate of ST (mean [95% CI]) was 524 min/day [482 to 566] with moderate heterogeneity among effect sizes (I2 = 42%). Monitor wear time, as well as the interaction of monitor wear time and monitor type, were moderators of ST (p < 0.001). The largest difference (−318 min; 95% CI [−212 to −424]) was seen between studies where participants wore a device without a thigh inclinometer for 24 h (and removed sleep during analysis) (675 min, 95% CI [589 to 752]) and studies where participants wore a device with a thigh inclinometer for 12 h only (356 min; 95% CI [284 to 430]). In people with COPD, the monitor wear time and the interaction of the monitor wear time and the monitor type moderated the estimate of ST.
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Affiliation(s)
- Fiona Coll
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia; (F.C.); (V.C.); (D.F.G.)
- Physiotherapy Department, Royal Perth Hospital, Perth, WA 6000, Australia;
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia; (F.C.); (V.C.); (D.F.G.)
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Allied Health, South Metropolitan Health Service, Perth, WA 6150, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA 6027, Australia
| | - Daniel F. Gucciardi
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia; (F.C.); (V.C.); (D.F.G.)
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Sheldon Wulff
- Physiotherapy Department, Royal Perth Hospital, Perth, WA 6000, Australia;
| | - Kylie Hill
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia; (F.C.); (V.C.); (D.F.G.)
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
- Correspondence: ; Tel.: +61-8-9226-2774
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Wang JM, Han MK, Labaki WW. Chronic obstructive pulmonary disease risk assessment tools: is one better than the others? Curr Opin Pulm Med 2022; 28:99-108. [PMID: 34652295 PMCID: PMC8799486 DOI: 10.1097/mcp.0000000000000833] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Risk assessment tools are essential in COPD care to help clinicians identify patients at higher risk of accelerated lung function decline, respiratory exacerbations, hospitalizations, and death. RECENT FINDINGS Conventional methods of assessing risk have focused on spirometry, patient-reported symptoms, functional status, and a combination of these tools in composite indices. More recently, qualitatively and quantitatively assessed chest imaging findings, such as emphysema, large and small airways disease, and pulmonary vascular abnormalities have been associated with poor long-term outcomes in COPD patients. Although several blood and sputum biomarkers have been investigated for risk assessment in COPD, most still warrant further validation. Finally, novel remote digital monitoring technologies may be valuable to predict exacerbations but their large-scale performance, ease of implementation, and cost effectiveness remain to be determined. SUMMARY Given the complex heterogeneity of COPD, any single metric is unlikely to fully capture the risk of poor long-term outcomes. Therefore, clinicians should review all available clinical data, including spirometry, symptom severity, functional status, chest imaging, and bloodwork, to guide personalized preventive care of COPD patients. The potential of machine learning tools and remote monitoring technologies to refine COPD risk assessment is promising but remains largely untapped pending further investigation.
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Affiliation(s)
- Jennifer M Wang
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
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A Systematic Review of Published Algorithms for Selecting an Inhaled Delivery System in COPD. Ann Am Thorac Soc 2021; 19:1213-1220. [PMID: 34856108 DOI: 10.1513/annalsats.202108-930oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Medication for treatment of COPD is available in many different delivery systems; however, national and international guidelines do not provide recommendations on how to select the optimal system for an individual patient. OBJECTIVES To perform a systematic review of published algorithms for inhaler selection in out-patients with COPD. METHODS PubMed, EMBASE, PsycINFO, Cochrane, and Google Scholar were search for articles on inhaler selection published between January 1, 1990 and March 10, 2021. The results were reviewed for articles containing an algorithm for inhaler selection. The quality of publications containing an algorithm was assessed using the JBI SUMARI text and opinion critical appraisal checklist. Individual steps recommended in the algorithms and the order in which they were considered were extracted independently by the two authors using the JBI text and opinion data extraction tool. Textual syntheses and a table of factors included were used to appraise and compare algorithms. RESULTS The search identified 1016 publications. After removing duplicate studies (n = 409), 607 abstracts were examined. Nine different algorithms or hierarchical recommendations for device selection were identified. All nine publications were considered of good quality. Most algorithms contain only a few decision steps. There were significant differences between the algorithms. None of the algorithms have been validated. Three domains for factors included in the algorithms were identified: patient factors, device attributes, and HCP factors. Patient factors were considered most frequently (19 times) compared with device attributes (10 times) and HCP factors (7 times). Five specific attribute/factors with at least three rankings in different algorithms, were identified as key factors for device selection. CONCLUSION Although the algorithms generally provide step-by-step approaches based on a literature review and/or the experiences of the different authors, none were developed using item generation/reduction methodology nor included input from patients with COPD. There were considerable differences between the algorithms; however, the review identified key factors that should be considered by HCPs when selecting therapy. Registration: PROSPERO (CRD42021244475).
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Kohlbrenner D, Kuhn M, Stüssi-Helbling M, Nordmann Y, Spielmanns M, Clarenbach CF. Longitudinal Smartphone-Based Post-hospitalisation Symptom Monitoring in SARS-CoV-2 Associated Respiratory Failure: A Multi-Centre Observational Study. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:777396. [PMID: 36188784 PMCID: PMC9397765 DOI: 10.3389/fresc.2021.777396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022]
Abstract
Background: We aimed to longitudinally monitor the recovery in breathlessness, symptom burden, health-related quality-of-life, and mental health status in individuals hospitalised due to SARS-CoV-2 associated respiratory failure. Methods: Individuals hospitalised due to SARS-CoV-2 associated respiratory failure were recruited at hospital discharge in three participating centres. During the 90 day follow-up, European Quality of Life−5 Dimensions−5 Levels Instrument (EQ-5D-5L), modified Medical Research Council (mMRC) Dyspnoea Scale, COPD Assessment Test (CAT), and weekly Hospital Anxiety and Depression Scale (HADS) questionnaires were assessed using a smartphone application. The results were presented using descriptive statistics and graphics. Linear mixed models with random intercept were fitted to analyse differences of intensive-care unit status on the recovery course in each outcome. Results: We included 58 participants, 40 completed the study. From hospital discharge until 90 days post-discharge, EQ-5D-5L index changed from 0.83 (0.66, 0.92) to 0.96 (0.82, 1.0), VAS rating on general health status changed from 62 (50, 75) % to 80 (74, 94) %, CAT changed from 13 (10, 21) to 7 (3, 11) points, mMRC changed from 1 (0, 2) to 0 (0, 1) points, HADS depression subscale changed from 6 (4, 9) to 5 (1, 6) points, HADS anxiety subscale changed from 7 (3, 9) to 2 (1, 8) points. Differences in the recovery courses were observed between intensive-care and ward participants. Participants that were admitted to an intensive-care unit during their hospitalisation (n = 16) showed increases in CAT, mMRC, HADS scores, and decreases in EQ-5D-5L 30 days after hospital discharge. Conclusion: Being admitted to an ICU led to statistically significant reductions in recovery in the EQ-5D-5L and the CAT. Furthermore, the flare-up in symptom burden and depression scores, accompanied by an attenuated recovery in HrQoL and general health status in the ICU-group suggests that a clinical follow-up 1 month after hospital discharge can be recommended, evaluating further treatments. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04365595].
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Affiliation(s)
- Dario Kohlbrenner
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Manuel Kuhn
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Melina Stüssi-Helbling
- Clinic of Internal Medicine, Department of Internal Medicine, Triemli Hospital, Zurich, Switzerland
| | | | - Marc Spielmanns
- Department of Pulmonary Rehabilitation, Zürcher Rehazentren Klinik Wald, Wald, Switzerland
- Department of Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - Christian F. Clarenbach
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- *Correspondence: Christian F. Clarenbach
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Criner GJ, Cole T, Hahn KA, Kastango K, Eudicone JM, Gilbert I. Use of a Digital Chronic Obstructive Pulmonary Disease Respiratory Tracker in a Primary Care Setting: A Feasibility Study. Pulm Ther 2021; 7:533-547. [PMID: 34463947 PMCID: PMC8589940 DOI: 10.1007/s41030-021-00168-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Telemonitoring is a promising self-management strategy to improve health care outcomes. This study evaluated real-world adoption of the chronic obstructive pulmonary disease (COPD) Co-Pilot daily symptom monitoring tool by patients and primary care providers (PCPs). Methods An open-label, 6-month, single-arm, multicenter, noninterventional feasibility study enrolled 97 patients aged ≥ 40 years with symptomatic or poorly controlled COPD and ≥ 10 pack-year smoking history. Patients received smartphones and training to use the COPD Co-Pilot application. During the study, patients tracked symptoms daily; an increase in symptom score of ≥ 1.0 point from baseline (symptom alert) prompted patients to contact their PCP via toll-free number. The primary endpoint was time to clinical recommendation (TTCR) from a symptom alert; adherence to completing daily symptom reports through the COPD Co-Pilot application and patient satisfaction were also measured. Results Overall, 87 of 96 patients (90.6%) received 2142 symptom alerts; 42 alerts (equivalent to 2% of all symptom alerts) resulted in 23 patients contacting their PCP. Median TTCR was 7.1 h (interquartile range [IQR]: 4.0–29.9). Among 15 patients using the toll-free number, median TTCR was 2.1 h (IQR 0.0–7.2) versus 19.6 h (IQR 4.5–45.2) for eight patients using other contact methods. Average COPD Co-Pilot adherence overall was 75.2% (95% CI 74.6–75.9). Patients responded favorably regarding the application’s ease of use, functionality, and information provided. Conclusions The COPD Co-Pilot tool was associated with relatively high levels of adherence, suggesting patients’ willingness to monitor symptoms daily. Although a limited number of patients initiated PCP contact, patients who used the study-provided toll-free number had substantially shorter median TTCR, suggesting that this tool could help empower patients to better manage their COPD. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-021-00168-3.
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Affiliation(s)
- Gerard J Criner
- Temple University Hospital, Philadelphia, PA, USA. .,Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine At Temple University, 3500 North Broad Street, Philadelphia, PA, 19140, USA.
| | - Therese Cole
- IQVIA, Rockville, MD, USA.,Advanced Clinical, Deerfield, IL, USA
| | | | - Kari Kastango
- IQVIA, Cambridge, MA, USA.,Everest Clinical Research, Little Falls, NJ, USA
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Chan AHY, Pleasants RA, Dhand R, Tilley SL, Schworer SA, Costello RW, Merchant R. Digital Inhalers for Asthma or Chronic Obstructive Pulmonary Disease: A Scientific Perspective. Pulm Ther 2021; 7:345-376. [PMID: 34379316 PMCID: PMC8589868 DOI: 10.1007/s41030-021-00167-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
Impressive advances in inhalation therapy for patients with asthma and chronic obstructive pulmonary disease (COPD) have occurred in recent years. However, important gaps in care remain, particularly relating to poor adherence to inhaled therapies. Digital inhaler health platforms which incorporate digital inhalers to monitor time and date of dosing are an effective disease and medication management tool, promoting collaborative care between clinicians and patients, and providing more in-depth understanding of actual inhaler use. With advances in technology, nearly all inhalers can be digitalized with add-on or embedded sensors to record and transmit data quantitating inhaler actuations, and some have additional capabilities to evaluate inhaler technique. In addition to providing an objective and readily available measure of adherence, they allow patients to interact with the device directly or through their self-management smartphone application such as via alerts and recording of health status. Clinicians can access these data remotely and during patient encounters, to better inform them about disease status and medication adherence and inhaler technique. The ability for remote patient monitoring is accelerating interest in and the use of these devices in clinical practice and research settings. More than 20 clinical studies of digital inhalers in asthma or COPD collectively show improvement in medication adherence, exacerbation risk, and patient outcomes with digital inhalers. These studies support previous findings about patient inhaler use and behaviors, but with greater granularity, and reveal some new findings about patient medication-taking behaviors. Digital devices that record inspiratory flows with inhaler use can guide proper inhaler technique and may prove to be a clinically useful lung function measure. Adoption of digital inhalers into practice is still early, and additional research is needed to determine patient and clinician acceptability, the appropriate place of these devices in the therapeutic regimen, and their cost effectiveness. Video: Digital Inhalers for Asthma or Chronic Obstructive Pulmonary Disease: A Scientific Perspective (MP4 74535 kb)
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Affiliation(s)
- Amy H. Y. Chan
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1023 New Zealand
| | - Roy A. Pleasants
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC USA
| | - Rajiv Dhand
- Division of Pulmonary and Critical Care Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN USA
| | - Stephen L. Tilley
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC USA
| | - Stephen A. Schworer
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC USA
| | - Richard W. Costello
- Royal College of Surgeons Ireland, 123 St Stephen’s Green, Dublin 2, D02 YN77 Ireland
| | - Rajan Merchant
- Dignity Health Woodland Clinic, 632 W Gibson Rd, Woodland, CA USA
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Alcazar-Navarrete B, Fuster A, García Sidro P, García Rivero JL, Abascal-Bolado B, Pallarés-Sanmartín A, Márquez E, Valido-Morales A, Boldova Loscertales A, Callejas-Gonzalez FJ, Palop M, Riesco JA, Golpe R, Soler-Cataluña JJ, Miravitlles M. Relationship Between Clinical Control, Respiratory Symptoms and Quality of Life for Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:2683-2693. [PMID: 33149566 PMCID: PMC7604255 DOI: 10.2147/copd.s265470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background The concept of clinical control has been proposed as an instrument for evaluating patients with COPD. However, the possible association between clinical control, reduced symptom severity and HRQoL has yet to be confirmed. Methods This multicentre, prospective and observational study was carried out in 15 pulmonology clinics in Spain. The patients were followed up for six months, with a baseline visit (V0), followed by visits at three months (V1) and six months (V2). Clinical control was determined at V1, with the application of both clinical criteria and the COPD assessment test (CAT). All patients reported their symptoms by a validated symptom diary (E-RS) using a portable device, and their HRQoL was assessed using the EQ5D questionnaire. The relationship between clinical control and E-RS and HRQoL during follow-up was assessed with t-test. Results A total of 126 patients were screened. After application of the inclusion/exclusion criteria, 93 were finally included (mean age 66 ± 8 years, 84.9% male), with a mean FEV1 predicted of 49.8% ± 16.5%. Of these patients, 44 (47.3%) achieved clinical control at V1, according to CAT criteria, and 50 (53.8%), according to clinical criteria. The E-RS scores differed between controlled and uncontrolled patients at all time points, both according to CAT (mean differences of −4.6, −5.6 and −6.2 units at V0, V1 and V2, respectively, p<0.005 for all comparisons) and to clinical criteria (mean differences of −3.3, −5-6 and −4.99 units, respectively, p<0.005 for all comparisons). The controlled patients also presented a significantly better HRQoL, measured by the EQ5D questionnaire (mean difference 0.13 and 0.10 at V2 by CAT or clinical criteria, respectively, p<0.05). Conclusion Clinical control in patients with COPD, whether measured by CAT or by clinical criteria, is associated with a lower symptom load and a better HRQoL.
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Affiliation(s)
- Bernardino Alcazar-Navarrete
- AIG De Medicina. Hospital De Alta Resolución De Loja. Agencia Sanitaria Hospital De Poniente, Loja, Granada, Spain.,CIBERES. Instituto De Salud Carlos III, Madrid, Spain
| | - Antonia Fuster
- Servicio De Neumología. Hospital Universitario De Son Llatzer, Palma De Mallorca, Spain
| | | | | | | | | | - Eduardo Márquez
- CIBERES. Instituto De Salud Carlos III, Madrid, Spain.,Unidad Médico-Quirúrgica De Enfermedades Respiratorias. Hospital Virgen Del Rocío, Sevilla, Spain
| | | | | | | | - Marta Palop
- Servicio De Neumología. Hospital De Sagunto, Sagunto, Spain
| | - Juan Antonio Riesco
- CIBERES. Instituto De Salud Carlos III, Madrid, Spain.,Servicio De Neumología. Hospital San Pedro De Alcántara, Cáceres, Spain
| | - Rafael Golpe
- Servicio De Neumología. Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Juan Jose Soler-Cataluña
- CIBERES. Instituto De Salud Carlos III, Madrid, Spain.,Servicio De Neumología. Hospital Arnau De Villanova- Lliria, Valencia, Spain
| | - Marc Miravitlles
- CIBERES. Instituto De Salud Carlos III, Madrid, Spain.,Servicio De Neumología. Hospital Universitari Vall De Hebron/Vall d'Hebron Institut De Recerca, Barcelona, Spain
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Nguyen HQ, Mularski RA, Moy ML, Lee JS, Shen E. Association between self-reported moderate to vigorous physical activity and the rate of outpatient treated COPD exacerbations: retrospective cohort study. BMJ Open Respir Res 2020; 7:7/1/e000590. [PMID: 32467154 PMCID: PMC7264694 DOI: 10.1136/bmjresp-2020-000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Little has been published regarding the relationship between physical activity (PA) and outpatient treated, mild to moderate acute exacerbation of chronic obstructive pulmonary disease exacerbations (AECOPD). The purpose of this study was to determine the association between self-reported PA and outpatient treated AECOPD over 2 years using real-world data obtained from existing electronic medical records (EMRs). Methods We included 44 896 patients with a chronic obstructive pulmonary disease diagnosis from the EMR in this retrospective cohort study. Moderate to vigorous PA was measured via patient self-report, obtained during routine clinical care; patients were classified as inactive (0 min/week), insufficiently active (1–149 min/week) or active (≥150 min/week). AECOPDs were measured using both encounter and prescription fill (antibiotics and/or oral steroids) data. We used Poisson regression models to compare the unadjusted and adjusted rates of outpatient treated AECOPD over 2 years across the PA categories. Results In adjusted models, the 2-year AECOPD incidence rate ratio (IRR) was not different between the inactive and insufficiently inactive groups (IRR 0.98, 95% CI 0.96 to 1.01) and only marginally meaningful lower for the active group (IRR 0.97, 95% CI 0.95 to 0.98). Sensitivity analyses of patients meeting or not meeting obstructive criteria produced similar results with generally weak or non-significant associations. Conclusion The lack of an association between PA and AECOPD contrasts with previous published findings of a strong relationship between moderate to vigorous PA and hospitalisations for severe AECOPD. This difference could partially be attributed to the imprecision of our measurements for both the exposure and outcome.
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Affiliation(s)
- Huong Q Nguyen
- Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California, USA
| | - Richard A Mularski
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Marilyn L Moy
- Pulmonary Division, Harvard Medical School, Boston, Massachusetts, USA.,Pulmonary Division, VA Boston Health Care System West Roxbury Campus, West Roxbury, Massachusetts, USA
| | - Janet S Lee
- Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California, USA
| | - Ernest Shen
- Research and Evaluation, Kaiser Permanente Southern California Research and Evaluation, Pasadena, California, USA
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