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High-tech approaches to chronic care can help COPD patients avoid hospital visits through better management of their condition.
Technology has the power to link physicians and chronic obstructive pulmonary disease (COPD) patients to accelerate collection of valuable information and improve patient care.
Smartphone applications are now available to empower COPD patients to better monitor and manage their condition, allowing a clinical care team to track patients in real time and respond immediately. A smartphone can be used to track daily symptoms and detect exacerbations early on, with symptom changes, missed diary transmissions or medical care for a respiratory problem triggering alerts to clinicians at the time of suspected COPD exacerbations.
Web-based applications can facilitate patient access to information and subsequently lead to appropriate interactions with clinicians, Valentin Prieto-Centurion, MD, instructor of medicine at the University of Illinois in Chicago, recently told Medical Economics.
Web-based COPD self-management applications can be integrated into the primary care disease-management process. These remote healthcare technologies have been shown to reduce the number of emergency admissions to hospitals in patients with long-term conditions, including COPD, he said.
Perhaps the easiest way for primary-care physicians to employ technology is to track their COPD patients’ physical activity with a pedometer. “COPD patients who limit physical activity have worse outcomes, more hospitalization and worse mortality. Physicians can collect information from pedometers and, based on a patient’s physical activity, provide feedback to help the patient overcome barriers in day-to-day life,” said Prieto-Centurion.
In a 2015 study published in the European Respiratory Journal, 97 COPD patients took part in a three-month individualized program to promote an increase in their daily physical activity. They were randomized to either a standard program of physical activity encouragement alone or a pedometer-based program. The 50 patients in the pedometer group had significantly greater improvements in physical activity (as measured by daily steps), six-minute walking distance and scores on the COPD assessment test than the 47 patients receiving activity encouragement only.
A 2015 Chest study, an Internet-mediated, pedometer-based walking program improved the health-related quality of life (HRQOL) and daily step counts in COPD patients. The 239 COPD patients were randomized to either use a pedometer along with an Internet-mediated program or just a pedometer for four months. A significantly greater proportion in the intervention group showed an improvement in HRQOL than did the controls. Although there was no significant difference in activities score between the two groups, the intervention group walked 779 more steps per day than controls did.
“These studies from small numbers of patients show that pedometers provide accurate information and can help track and measure physical activity,” said Prieto-Centurion. “Putting this intervention into a larger framework, pedometers help motivate people to meet activity goals and should be integrated into COPD care.”
Other studies with stable COPD patients show they walk more and improve their physical activity using pedometers along with a health coach to interpret the data. The coach helps in motivation and in ensuring the patients exercise in a safe way, he said.
Prieto-Centurion is leading a clinical trial that uses pedometers with COPD patients recently discharged from the hospital. “Only 10% of COPD patients complete pulmonary rehabilitation programs for a variety of reasons. For those patients, we will monitor their symptoms in real-time at home and use pedometers to track their physical activity,” said Prieto-Centurion. The pilot study has recruited 85 COPD patients so far, with results expected in a few years, he said.
“Technology is out there. Now we have to learn more about how to use it and respond to the information we gather,” said Prieto-Centurion.