Remote Patient Monitoring for the Detection of COPD Exacerbations
Christopher B Cooper,1 Worawan Sirichana,1,2 Michael T Arnold,1 Eric V Neufeld,1 Michael Taylor,3 Xiaoyan Wang,4 Brett A Dolezal1 1Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 2Divisi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2020-08-01
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| Series: | International Journal of COPD |
| Subjects: | |
| Online Access: | https://www.dovepress.com/remote-patient-monitoring-for-the-detection-of-copd-exacerbations-peer-reviewed-article-COPD |
| _version_ | 1811331660407373824 |
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| author | Cooper CB Sirichana W Arnold MT Neufeld EV Taylor M Wang X Dolezal BA |
| author_facet | Cooper CB Sirichana W Arnold MT Neufeld EV Taylor M Wang X Dolezal BA |
| author_sort | Cooper CB |
| collection | DOAJ |
| description | Christopher B Cooper,1 Worawan Sirichana,1,2 Michael T Arnold,1 Eric V Neufeld,1 Michael Taylor,3 Xiaoyan Wang,4 Brett A Dolezal1 1Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand; 3eResearch Technology Inc., Philadelphia, PA, USA; 4Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USACorrespondence: Christopher B CooperDavid Geffen School of Medicine, University of California 10833, Le Conte Avenue, 37-131 CHS Building, Los Angeles, CA 90095-1690, USATel +1 310 470 3983Fax +1 310 206 8211Email ccooper@mednet.ucla.eduBackground: COPD exacerbations occur more frequently with disease progression and are associated with worse prognosis and higher healthcare expenditure.Purpose: To utilize a networked system, optimized with statistical process control (SPC), for remote patient monitoring (RPM) and to identify potential predictors of COPD exacerbations.Methods: Seventeen subjects, mean (SD) age of 69.7 (7.2) years, with moderate to severe COPD received RPM. Over 2618 patient-days (7.17 patient-years) of monitoring, we obtained daily symptom scores, treatment adherence, self-reported activity levels, daily spirometry (SVC, FEV1, FVC, PEF), inspiratory capacity (IC), and oxygenation (SpO2). These data were used to identify predictors of exacerbations defined using Anthonisen and other criteria.Results: After implementation of SPC, concordance analysis showed substantial agreement between FVC (decrease below the 7-day rolling average minus 1.645 SD) and self-reported healthcare utilization events (κ=0.747, P< 0.001) as well as between increased use of inhaled short-acting bronchodilators and exacerbations defined by two Anthonisen criteria (κ=0.611, P< 0.001) or modified Anthonisen criteria (κ=0.622, P< 0.001). There was a moderate agreement between FEV1 (decrease > 1.645 SD below the 7-day rolling average) and self-reported healthcare utilization events (κ=0.475, P< 0.001) and between SpO2 less than 90% and exacerbations defined by two Anthonisen criteria (κ=0.474, P< 0.001) or modified Anthonisen criteria (κ=0.564, P< 0.001).Conclusion: Exacerbations were best predicted by FVC and FEV1 below the one-sided 95% confidence interval derived from SPC but also by increased use of inhaled short-acting bronchodilators and fall in oxygen saturation. An RPM program that captures these parameters may be used to guide appropriate interventions aimed at reducing healthcare utilization in COPD patients.Keywords: chronic obstructive pulmonary disease, exacerbations, early detection, home monitoring, telemedicine |
| first_indexed | 2024-04-13T16:24:02Z |
| format | Article |
| id | doaj.art-815627d276d44ed6a42ece8851c80439 |
| institution | Directory Open Access Journal |
| issn | 1178-2005 |
| language | English |
| last_indexed | 2024-04-13T16:24:02Z |
| publishDate | 2020-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of COPD |
| spelling | doaj.art-815627d276d44ed6a42ece8851c804392022-12-22T02:39:48ZengDove Medical PressInternational Journal of COPD1178-20052020-08-01Volume 152005201356529Remote Patient Monitoring for the Detection of COPD ExacerbationsCooper CBSirichana WArnold MTNeufeld EVTaylor MWang XDolezal BAChristopher B Cooper,1 Worawan Sirichana,1,2 Michael T Arnold,1 Eric V Neufeld,1 Michael Taylor,3 Xiaoyan Wang,4 Brett A Dolezal1 1Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand; 3eResearch Technology Inc., Philadelphia, PA, USA; 4Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USACorrespondence: Christopher B CooperDavid Geffen School of Medicine, University of California 10833, Le Conte Avenue, 37-131 CHS Building, Los Angeles, CA 90095-1690, USATel +1 310 470 3983Fax +1 310 206 8211Email ccooper@mednet.ucla.eduBackground: COPD exacerbations occur more frequently with disease progression and are associated with worse prognosis and higher healthcare expenditure.Purpose: To utilize a networked system, optimized with statistical process control (SPC), for remote patient monitoring (RPM) and to identify potential predictors of COPD exacerbations.Methods: Seventeen subjects, mean (SD) age of 69.7 (7.2) years, with moderate to severe COPD received RPM. Over 2618 patient-days (7.17 patient-years) of monitoring, we obtained daily symptom scores, treatment adherence, self-reported activity levels, daily spirometry (SVC, FEV1, FVC, PEF), inspiratory capacity (IC), and oxygenation (SpO2). These data were used to identify predictors of exacerbations defined using Anthonisen and other criteria.Results: After implementation of SPC, concordance analysis showed substantial agreement between FVC (decrease below the 7-day rolling average minus 1.645 SD) and self-reported healthcare utilization events (κ=0.747, P< 0.001) as well as between increased use of inhaled short-acting bronchodilators and exacerbations defined by two Anthonisen criteria (κ=0.611, P< 0.001) or modified Anthonisen criteria (κ=0.622, P< 0.001). There was a moderate agreement between FEV1 (decrease > 1.645 SD below the 7-day rolling average) and self-reported healthcare utilization events (κ=0.475, P< 0.001) and between SpO2 less than 90% and exacerbations defined by two Anthonisen criteria (κ=0.474, P< 0.001) or modified Anthonisen criteria (κ=0.564, P< 0.001).Conclusion: Exacerbations were best predicted by FVC and FEV1 below the one-sided 95% confidence interval derived from SPC but also by increased use of inhaled short-acting bronchodilators and fall in oxygen saturation. An RPM program that captures these parameters may be used to guide appropriate interventions aimed at reducing healthcare utilization in COPD patients.Keywords: chronic obstructive pulmonary disease, exacerbations, early detection, home monitoring, telemedicinehttps://www.dovepress.com/remote-patient-monitoring-for-the-detection-of-copd-exacerbations-peer-reviewed-article-COPDchronic obstructive pulmonary diseaseexacerbationsearly detectionhome monitoringtelemedicine |
| spellingShingle | Cooper CB Sirichana W Arnold MT Neufeld EV Taylor M Wang X Dolezal BA Remote Patient Monitoring for the Detection of COPD Exacerbations International Journal of COPD chronic obstructive pulmonary disease exacerbations early detection home monitoring telemedicine |
| title | Remote Patient Monitoring for the Detection of COPD Exacerbations |
| title_full | Remote Patient Monitoring for the Detection of COPD Exacerbations |
| title_fullStr | Remote Patient Monitoring for the Detection of COPD Exacerbations |
| title_full_unstemmed | Remote Patient Monitoring for the Detection of COPD Exacerbations |
| title_short | Remote Patient Monitoring for the Detection of COPD Exacerbations |
| title_sort | remote patient monitoring for the detection of copd exacerbations |
| topic | chronic obstructive pulmonary disease exacerbations early detection home monitoring telemedicine |
| url | https://www.dovepress.com/remote-patient-monitoring-for-the-detection-of-copd-exacerbations-peer-reviewed-article-COPD |
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