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Am J Respir Crit Care Med. 2018 Sep 1;198(5):620-628. doi: 10.1164/rccm.201712-2404OC.

Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial.

Author information

1
1 University Hospital Aintree, Liverpool, United Kingdom.
2
2 School of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.
3
3 Restech s.r.l., Milano, Italy.
4
4 Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.
5
5 Technomedicum, Tallinn University of Technology, Tallinn, Estonia.
6
6 Department of Medical Sciences: Clinical Physiology, and.
7
7 Hospital Clinic and.
8
8 Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain.
9
9 Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom.
10
10 Hospital of Sežana, Sežana, Slovenia.
11
11 Elettronica Bio Medicale S.p.a., Foligno, Italy; and.
12
12 Department of Medical Sciences: Respiratory, Sleep, and Allergy Research, Uppsala University, Uppsala, Sweden.
13
13 Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona-Institut Investigacions Biomediques August Pi Sunyer, Barcelona, Spain.
14
14 Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy.

Abstract

RATIONALE:

Early detection of chronic obstructive pulmonary disease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization.

OBJECTIVES:

To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities.

METHODS:

This multicenter, randomized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grades II to IV COPD (median age, 71 yr [interquartile range, 66-76 yr]; 49.6% grade II, 50.4% grades III-IV), with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity. Patients were randomized to usual care (n = 158) or telemonitoring (n = 154) and followed for 9 months. All telemonitoring patients self-assessed lung mechanics daily, and in a subgroup with congestive heart failure (n = 37) cardiac parameters were also monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions.

MEASUREMENTS AND MAIN RESULTS:

Primary outcomes were time to first hospitalization (TTFH) and change in the EuroQoL EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescription; hospitalization; the COPD Assessment Tool, Patient Health Questionnaire-9, and Minnesota Living with Heart Failure questionnaire scores; quality-adjusted life years; and healthcare costs. Telemonitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate, or questionnaire scores. In an exploratory analysis, telemedicine was associated with fewer repeat hospitalizations (-54%; P = 0.017).

CONCLUSIONS:

In older patients with COPD and comorbidities, remote monitoring of lung function by forced oscillation technique and cardiac parameters did not change TTFH and EQ-5D. Clinical trial registered with www.clinicaltrials.gov (NCT 01960907).

KEYWORDS:

COPD exacerbation; chronic obstructive pulmonary disease; forced oscillation technique (FOT); home monitoring

PMID:
29557669
DOI:
10.1164/rccm.201712-2404OC

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