Health apps beneficial to help prevent COPD exacerbation

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Sep 15, 2015       Rachael Zimlich, RN

Early intervention is key to managing chronic obstructive pulmonary disease (COPD), and a new report out of Temple Lung Center in Philadelphia details the successes of telemedicine in heading off acute exacerbations.

COPD is the third leading cause of death in the United States, causing more than 130,000 deaths each year, according to the American Lung Association. Roughly 12.7 million Americans have been diagnosed with the chronic respiratory disease, which presents with increasing coughing, sputum, and dyspnea. Acute exacerbations of the disease often result in hospitalization, adding to the already high costs to manage the condition. COPD costs about $49.9 billion annually, including $29.5 billion in direct healthcare costs.

But in the two-year clinical study led by Gerard J. Criner, MD, FACP, FACCP, founding chair of the new department of thoracic medicine and surgery at Temple University School of Medicine, and director of the Temple Lung Center, researchers found that patients that used a digital health application to report their daily symptoms and received same-day treatment recommendations from their health care provider experienced fewer and less severe COPD exacerbation symptoms, leading to an improvement in daily symptom control, lung function, and activity levels.

The study enrolled patients who were hospitalized for a COPD exacerbation over the last 12 months or who were using supplemental oxygen therapy. They were given a telecommunications device to report their symptoms, which were scored according to their baseline and assessed by a computer algorithm. Scores one or more points above the patient’s baseline generated an alert, and those patients were contact by a nurse or referred to a physician for intervention. Although the study revealed no differences in hospitalization or mortality rates between the intervention and control group, the intervention group did report improved daily peak flow and dyspnea scores.

Through the use of the reporting technology, researchers were able to detect patients’ worsening symptoms, as well as identify specific symptoms that generated an alert for care providers. Treatment approaches following an alert ranged from intensification of bronchodilator therapy, to the addition of steroids or antibiotics. Patients submitted additional symptom reports following the intervention so that caregivers could assess the efficacy of the response.

Researchers noted that none of the interventions used in the study were novel, but digital symptom reporting allowed healthcare providers to initiate patient-specific treatments on the same day COPD symptoms worsened.

“We believe that timely, focused intervention was the primary reason for improvements in patient outcomes. Early intervention decreased the frequency and magnitude of subsequent exacerbation symptoms, decreased dyspnea, and improved peak flow and daily activity status,” the report states. “Long-term electronic daily monitoring of respiratory symptoms was well accepted by moderate to severe COPD patients as evidenced by the high rate of reporting compliance in both the control and intervention groups.”

Although the study didn’t enroll a large enough cohort to determine the application’s impacts on mortality and hospitalization rates, it illustrated that earlier intervention means better outcomes, and ways physicians to triage their daily patients more effectively.

“You can keep a close eye on these patients as their symptoms escalate or they don’t respond to medication. You can triage a patient group, and those that might be getting sicker at home might come in to an outpatient center earlier rather than going to the ER and maybe get directly admitted to the hospital,” Dr. Criner says.

He says the digital health applications are also promising for the treatment of other chronic conditions like diabetes, hypertension, and even heart failure.

“I think telemedicine—no matter what format—will have a much greater role to play in the future,” Dr. Criner says.