Digital Technology in COPD Therapy: Current Options and Future Prospects
This year, digital technologies have demonstrated their advantages in interpersonal communication, administrative processes, and in the field of medicine. The global crisis triggered by the coronavirus pandemic revealed the need to implement telemedicine into everyday medical practice. What are its options and future prospects in the therapy of patients with chronic obstructive pulmonary disease? These questions are thoroughly addressed in an article published in the Journal of Thoracic Disease last fall.
Introduction
Chronic obstructive pulmonary disease (COPD) is a serious chronic disease of the lung tissue that affects more than 170 million people worldwide and causes 3 million deaths annually. An important part of therapy is the regular monitoring of patients to maintain the highest possible compliance and adherence to therapy and to monitor patients to prevent frequent exacerbations and rehospitalizations. Telemedicine is a promising modality in this context, enabling improved collaboration with patients through computers, 'smart' mobile phones, and other technologies.
Study Results
One of the goals of telemedicine is to improve self-care among individuals with stable COPD. A recently published review article evaluated the incidence of COPD exacerbations in patients using various health applications for mobile phones. Patients using these applications demonstrated an 80% reduction in the risk of exacerbations (3 randomized controlled clinical trials, odds ratio [OR] 0.20; p = 0.005). Another large randomized cluster study evaluated telemedicine in patients with COPD (48.3%) and other chronic diseases. The study involved 1584 patients using telemedicine and 1570 on usual care over 12 months. Patients using telemedicine showed an 18% reduction in the risk of hospitalization (OR 0.82; p = 0.017) and a 46% reduction in mortality (OR 0.54; p < 0.001).
Several other studies have confirmed the positive effect of telemedicine on reducing the risk of hospitalization. However, clinical evidence regarding the reduction in mortality with the use of telemedicine is limited and inconsistent. Regarding electronic health records for hospitalized persons, studies are also limited. For electronic health records, there was an 18% weekly reduction in the risk of duplicate tests, a reduction in the length of hospitalization by 0.11 days, and a reduction in 30-day mortality by 0.182%.
Inconsistent results also relate to the outcomes of patient care after hospital discharge. One study evaluated 50 patients using remote assistance via a computer with a camera and microphone, with care provided by trained healthcare professionals who helped prevent exacerbations and medication management. Compared to 50 patients on usual care, the telemedicine group showed a significant reduction in the risk of rehospitalization within 30 days of discharge (hazard ratio [HR] 0.25; 95% CI 0.09–0.69). Rehabilitation in the form of breathing exercises conducted via Skype also had a significant effect on patients with COPD.
An interesting and no less important area of telemedicine is monitoring environmental factors. For example, in a study published by Qiu et al., an association was found between 54,966 hospitalizations for COPD and the amount of environmental pollutants and cold weather. Similar results were proven in another large study evaluating 950,000 hospitalizations for COPD. However, the application of these analyses in clinical practice is not yet entirely clear.
Conclusion
Due to the digital transformation of healthcare, many promising applications and models for the care of patients with COPD have emerged. The potential of these applications has been demonstrated in numerous clinical studies, although clinical evidence is often limited and inconsistent. This year has undoubtedly proven that telemedicine is appropriate to some extent in the care of patients suffering from COPD and other chronic diseases. The definitive capabilities and limitations of telemedicine technologies certainly need to be demonstrated through further clinical research; current data do not allow for definitive conclusions.
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Sources:
1. Ding H., Fatehi F., Maiorana A. et al. Digital health for COPD care: the current state of play. J Thorac Dis 2019; 11 (Suppl. 17): S2210–S2220, doi: 10.21037/jtd.2019.10.17.
2. Qiu H., Tan K., Long F. et al. The burden of COPD morbidity attributable to the interaction between ambient air pollution and temperature in Chengdu, China. Int J Environ Res Public Health 2018; 15 (3): 492.
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