Global use, utility, and methods of tele-health in COPD: a health care provider survey

Limited Use and Potential Implementation Hurdles of Telemedicine Tools for the Remote Management of Patients With Chronic Obstructive Pulmonary Disease Among Members of SEPAR

Introduction

Telemedicine (TM) can help in the management of chronic obstructive pulmonary disease (COPD). This study examines knowledge, current use and potential limitations for practical implementation of TM for the remoted management of COPD patients among members of the COPD area of SEPAR (n = 3118).

Methods

An electronic survey was circulated three times to these 3118 health-care professionals. Their knowledge, current use and potential limitations for implementation of different forms of TM, including tele-monitoring, tele-education and self-care, tele-rehabilitation and mobile health, for the remote management of COPD patients were tabulated and described.

Results

Only 120 health-care professionals responded to the survey (3.9%). The rate of response varied greatly across different Autonomous Communities (AACC); 99.2% of responders declared being aware of TM, but only 60.5% knew about the different TM alternatives investigated here, and only 40.3% actually used some form of TM for their current management of patients with COPD. Of those using TM, 47.1% referred being satisfied with its use. Main identified barriers for implementation of TM in their institutions were technological limitations and data security.

Conclusions

The potential of TM for the clinical management of COPD is well known among interviewed health-care professionals, but only less than half used it currently. The potential for growth is therefore clear. We propose that SEPAR analyze critically this potential and promotes measures to achieve it for the benefit of COPD patients.

Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review

Telemedicine is defined as the use of electronic technology for information and communication by healthcare professionals with patients (or care givers) aiming at providing and supporting healthcare to patients away from healthcare institutions. This systematic review over the last decade (2013-2022) investigates the use of telemedicine in patients with chronic obstructive pulmonary disease (COPD). We identified 53 publications related to: (1) home tele-monitorization; (2) tele-education and self-management; (3) telerehabilitation; and (4) mobile health (mHealth). Results showed that, although evidence is still weak in many of these domains, results are positive in terms of improvement of health-status, use of health-care resources, feasibility, and patient satisfaction. Importantly, no safety issues were identified. Thus, telemedicine can be considered today as a potential complement to usual healthcare.

Pulmonary rehabilitation for COPD: A narrative review and call for further implementation in Saudi Arabia

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable condition, in which outcomes can be improved with careful management. Pulmonary rehabilitation (PR) comprises exercise and education, delivered by multidisciplinary teams. PR is a cost-effective management strategy in COPD patients which improves exercise performance, reduces dyspnea, reduces the risk of exacerbation, and improves health-related quality of life. All COPD patients appear to benefit irrespective of their baseline function, and PR has also been shown to be a clinically and cost-effective management approach following an acute exacerbation. COPD patients with greater disability and those recovering postexacerbation should be specifically targeted for PR. Due to limited current capacity, the latter group may not currently be able to benefit from PR. Therefore, there is a need for the wider implementation of PR services in Saudi Arabia, requiring us to address challenges including capacity and workforce competency.

Key toolkits of non-pharmacological management in COPD: during and beyond COVID-19

Individuals with COPD are at higher risk of severe disease and mortality if they contract COVID-19. Shielding and social distancing have negatively impacted the delivery of routine care for COPD patients, which should be maintained to avoid further deterioration. We aimed to review the literature about the key toolkits of non-pharmacological treatments of COPD patients before and during the COVID-19 pandemic. In particular, we focused on smoking cessation, pulmonary rehabilitation, and telehealth delivery approaches during the COVID-19 crisis. Smoking cessation services are important to mitigate the spread of the virus, especially in people with chronic lung disease; the pandemic, in one way or another, has helped to enhance people's motivation to quit smoking. Also, tele-rehabilitation is considered as effective as conventional pulmonary rehabilitation in controlling symptoms of disease, promoting physical activity, and enhancing self-management of COPD. Tele-rehabilitation offers flexibility and it could be the dominant mode for providing a pulmonary rehabilitation programme. Finally, the use of telehealth (TH) modes has trended during the pandemic. Consensus about the effectiveness of TH in reducing exacerbation events is still inconclusive. In the context of COPD, further clinical research must concentrate on understanding attitudes, behaviours, and motivations towards smoking cessation. Further recommendations include gauging the feasibility of a long-term tele-rehabilitation programme in large COPD populations, designing more COPD-related mobile apps, and evaluating the feasibility of tele-rehabilitation in clinical practice.

A Systematic Review and Meta-Analysis of Telemonitoring Interventions on Severe COPD Exacerbations

This systematic review and meta-analysis aimed to provide current evidence regarding the effectiveness of telemonitoring for preventing COPD exacerbations, focusing on severe exacerbations requiring hospitalisation or emergency room (ER) visits. We systematically searched for randomised controlled trials using nine databases from August to September 2020 following the Cochrane Collaboration Guidelines. Of 2159 records identified, 22 studies involving 2906 participants met the inclusion criteria. The participants in 55% and 59% of studies had severe airflow limitations and severe exacerbation histories in the preceding year, respectively. The most commonly telemonitored data were oxygen saturation (91%) and symptoms (73%). A meta-analysis showed that telemonitoring did not reduce the number of admissions (12 studies) but decreased the number of ER visits due to severe exacerbations [7 studies combined, standardised mean difference (SMD) = −0.14; 95% confidence interval (CI): −0.28, −0.01]. Most studies reported no benefit in mortality, quality of life, or cost-effectiveness. All eight studies that surveyed participant satisfaction reported high satisfaction levels. Our review suggested that adding telemonitoring to usual care reduced unnecessary ER visits but was unlikely to prevent hospitalisations due to COPD exacerbations and that telemonitoring was well-accepted by patients with COPD and could be easily integrated into their existing care.

Chronic Obstructive Pulmonary Disease Patients' Acceptance in E-Health Clinical Trials

INTRODUCTION

Telehealth (TH) interventions with Chronic Obstructive Pulmonary Disease (COPD) management were introduced in the literature more than 20 years ago with different labeling, but there was no summary for the overall acceptance and dropout rates as well as associated variables.

OBJECTIVE

This review aims to summarize the acceptance and dropout rates used in TH interventions and identify to what extent clinical settings, sociodemographic factors, and intervention factors might impact the overall acceptance and completion rates of TH interventions.

METHODS

We conducted a systematic search up to April 2021 on CINAHL, PubMed, MEDLINE (Ovid), Cochrane, Web of Sciences, and Embase to retrieve randomized and non-randomized control trials that provide TH interventions alone or accompanied with other interventions to individuals with COPD.

RESULTS

Twenty-seven studies met the inclusion criteria. Overall, the unweighted average of acceptance and dropout rates for all included studies were 80% and 19%, respectively. A meta-analysis on the pooled difference between the acceptance rates and dropout rates (weighted by the sample size) revealed a significant difference in acceptance and dropout rates among all TH interventions 51% (95% CI 49% to 52; p < 0.001) and 63% (95% CI 60% to 67; p < 0.001), respectively. Analysis revealed that acceptance and dropout rates can be impacted by trial-related, sociodemographic, and intervention-related variables. The most common reasons for dropouts were technical difficulties (33%), followed by complicated system (31%).

CONCLUSIONS

Current TH COPD interventions have a pooled acceptance rate of 51%, but this is accompanied by a high dropout rate of 63%. Acceptance and dropout levels in TH clinical trials can be affected by sociodemographic and intervention-related factors. This knowledge enlightens designs for well-accepted future TH clinical trials. PROSPERO registration number CRD4201707854.

Telemedicine in the management of patients with chronic respiratory failure

Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure.

Educational aims

To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.

Periodontal Status, Its Treatment Needs, and Its Relationship with Airflow Limitation and Quality of Life in COPD Patients

Objective

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent respiratory diseases in the world. There is an impressive relationship between periodontal status and airflow limitation in patients with COPD. Therefore, in this study, we aimed to investigate the periodontal status, its treatment needs, and its relationship with the severity of airway obstruction and quality of life in patients with COPD.

Materials and Methods

In this case-control study, 36 healthy men (control group) and 35 men afflicted with COPD (case group) were investigated. On the basis of spirometry results and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, patients with COPD were further divided into 4 groups. The participants' quality of life was evaluated using COPD Assessment Test (CAT) questionnaire. Thereafter, both groups of participants were referred to a dentistry clinic so that the related specialist could investigate their periodontal health status. The relationship between the periodontal indices and the variables under study including GOLD stage, CAT score, Forced Expiratory Volume in first second and Forced Vital Capacity (FEV1/FVC) ratio, Forced Expiratory Volume in first second (FEV1), and the exacerbation rate were statistically analyzed using independent t-test, one-way analysis of variance, Tukey's test, and Pearson correlation coefficient.

Results

The results revealed that probing pocket depth (PDD), bleeding on probing (BOP), and loss of attachment (LOA) are negatively correlated with FEV1% (r=-0.53, p=0.001), (r=-0.62, p=0.001), and (r=-0.72, p=0.001) as well as FEV1/FVC ratio (r=-0.45, p=0.007), (r=-0.47, p=0.004), and (r=-0.61, p=0.001), respectively. The results showed that PDD, BOP, and LOA are positively correlated with CAT score (r=0.51, p=0.002), (r=0.47, p=0.004), and (r=0.71, p=0.001), respectively.

Conclusion

Periodontal problems are positively associated with COPD severity as determined by GOLD criteria and negatively associated with quality of life of patients with COPD.

Impact of a Home Telehealth Program After a Hospitalized COPD Exacerbation: A Propensity Score Analysis

INTRODUCTION

Currently there is lack of data regarding the impact of a home telehealth program on readmissions and mortality rate after a COPD exacerbation-related hospitalization.

OBJECTIVE

To demonstrate if a tele-monitoring system after a COPD exacerbation admission could have a favorable effect in 1-year readmissions and mortality in a real-world setting.

METHODS

This is an observational study where we compared an intervention group of COPD patients treated after hospitalization that conveyed a telehealth program with a followance period of 1 year with a control group of patients evaluated during one year before the intervention began. A propensity-score analyses was developed to control for confounders. The main clinical outcome was 1-year all-cause mortality or COPD-related readmission.

RESULTS

The analysis comprised 351 telemonitoring patients and 495 patients in the control group. The intervention resulted in less mortality or readmission after 12 months (35.2% vs. 45.2%; hazard ratio [HR] 0.71 [95% CI=0.56-0.91]; p=0.007). This benefit was maintained after the propensity score analysis (HR=0.66 [95% CI=0.51-0.84]). This benefit, which was seen from the first month of the study and during its whole duration, is maintained when mortality (HR=0.54; 95% CI=[0.36-0.82]) or readmission (subdistribution hazard ratio [SHR] 0.66; 95% CI=[0.50-0.86]) are analyzed separately.

CONCLUSION

Telemonitoring after a severe COPD exacerbation is associated with less mortality or readmissions at 12 months in a real world clinical setting.

Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis

BACKGROUND

Coronavirus disease 2019 (COVID-19) is an evolving infectious disease that dramatically spread all over the world in the early part of 2020. No studies have yet summarized the potential severity and mortality risks caused by COVID-19 in patients with chronic obstructive pulmonary disease (COPD), and we update information in smokers.

METHODS

We systematically searched electronic databases from inception to March 24, 2020. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesized a narrative from eligible studies and conducted a meta-analysis using a random-effects model to calculate pooled prevalence rates and 95% confidence intervals (95%CI).

RESULTS

In total, 123 abstracts were screened and 61 full-text manuscripts were reviewed. A total of 15 studies met the inclusion criteria, which included a total of 2473 confirmed COVID-19 patients. All studies were included in the meta-analysis. The crude case fatality rate of COVID-19 was 7.4%. The pooled prevalence rates of COPD patients and smokers in COVID-19 cases were 2% (95% CI, 1%-3%) and 9% (95% CI, 4%-14%) respectively. COPD patients were at a higher risk of more severe disease (risk of severity = 63%, (22/35) compared to patients without COPD 33.4% (409/1224) [calculated RR, 1.88 (95% CI, 1.4-2.4)]. This was associated with higher mortality (60%). Our results showed that 22% (31/139) of current smokers and 46% (13/28) of ex-smokers had severe complications. The calculated RR showed that current smokers were 1.45 times more likely [95% CI: 1.03-2.04] to have severe complications compared to former and never smokers. Current smokers also had a higher mortality rate of 38.5%.

CONCLUSION

Although COPD prevalence in COVID-19 cases was low in current reports, COVID-19 infection was associated with substantial severity and mortality rates in COPD. Compared to former and never smokers, current smokers were at greater risk of severe complications and higher mortality rate. Effective preventive measures are required to reduce COVID-19 risk in COPD patients and current smokers.