Early detection of chronic obstructive pulmonary disease (COPD) exacerbations by remote patient monitoring (RPM) can enable patients to seek treatment sooner, alleviating their symptoms and likely improving patient outcomes.
COPD is a lung disease in which airflow is restricted that can be classified as chronic bronchitis or emphysema. Exacerbations are “flare-ups” or a marked worsening of symptoms associated with COPD, and increased frequency of these events indicates progression of the disease. The need for improved management and treatment of COPD is clear. It is the fourth leading cause of death globally and affects at least 15.7 million American adults, although many cases are likely undiagnosed.
In a recent study from UCLA, researchers followed 17 subjects with moderate to severe COPD for a total of about seven patient-years, evaluating key metrics related to COPD to match them with exacerbation events. Specifically, they tracked daily spirometry, inspiratory capacity, oxygenation (SpO2), treatment adherence, daily symptom scores, and self-reported activity levels. From spirometry data, they assessed forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow, and slow vital capacity. Exacerbations were self-reported or based on Anthonisen criteria or modified Anthonisen criteria.
Of the data collected, the study found the strongest correlation between decreases in FVC and exacerbations, suggesting a benefit to using regular collection of spirometry data to identify exacerbations earlier.
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).Cooper CB, Sirichana W, Arnold MT, Neufeld EV, Taylor M, Wang X, Dolezal BA. Remote Patient Monitoring for the Detection of COPD Exacerbations. Int J Chron Obstruct Pulmon Dis. 2020;15:2005-2013.
These data indicate that RPM using spirometers and pulse oximeters can be applied to detect exacerbations early and advance the timeline for patients to get the care they need. The authors note that future work could evaluate how daily tracking of COPD exacerbation predictors affects the long-term outcomes of patients with the disease.