Assessing the Usefulness of the Prevexair Smartphone Application in the Follow-Up High-Risk Patients with COPD

Abstract

Juan Luis Rodríguez Hermosa,1,2 Antonia Fuster Gomila,3 Luis Puente Maestu,4 Carlos Antonio Amado Diago,5,6 Francisco Javier Callejas González,7 Rosa Malo De Molina Ruiz,8 Manuel E Fuentes Ferrer,9,10 Jose Luis Alvarez-Sala,1,2 Myriam Calle Rubio1,2 1Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain; 2Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain; 3Pulmonology Department, Hospital U. Son Llátzer, Palma De Mallorca, Balearic Islands, Spain; 4Pulmonology Department, Hospital U. Gregorio Marañón, Madrid, Spain; 5Pulmonology Department, Hospital U. Marqués de Valdecilla, Santander, Cantabria, Spain; 6Department of Medicine, Universidad de Cantabria, Santander, Spain; 7Pulmonology Department, Complejo Hospitalario U. de Albacete, Albacete, Spain; 8Pulmonology Department, Hospital U. Puerta de Hierro de Majadahonda, Madrid, Spain; 9Department of Medicine Preventive, San Carlos Health Research Institute (IdISSC), Madrid, Spain; 10Department of Medicine, Universidad Alfonso X El Sabio, Madrid, SpainCorrespondence: Myriam Calle RubioPulmonology Department Hospital Clínico San Carlos, C/Martin Lagos s/n., Madrid 28040, SpainTel [phone]Fax [phone]Email [email protected]: This manuscript analyzes the exacerbations recorded by the Prevexair application through the daily analysis of symptoms in high-risk patients with COPD and explores its usefulness in assessing clinical stability with respect to that reported in visits.Patients and Methods: This study is a multi-centre cohort of COPD patients with the exacerbator phenotype who were monitored over 6 months. The Prevexair application was installed on the patients’ smartphones. Patients used the app to record symptom changes, use of medication and use of healthcare resources. It is not established a recommended action plan when worsening of symptoms. At their clinical visit during the follow-up period, patients were asked about exacerbations suffered during these 6 months of monitoring. The investigators who conducted the visit were blinded about the Prevexair app records.Results: The patients experienced a total of 185 exacerbations according to daily records in the app whereas only 64 exacerbations were recalled during medical visits. Perception became more accurate for severe exacerbations (kappa 0.6577), although we found no factors that predicted poor recall. The proportion of 72.5% patients were classified as unstable if the exacerbations captured by Prevexair were used to define stability, versus 47.8% if the exacerbations recall in visit was used. Two-thirds of the exacerbations recorded in the Prevexair application were not reported to doctors during their clinical visits. Almost half were treated with oral corticosteroids and/or antibiotics and more than one-quarter of the exacerbations treated did not seek medical attention.Conclusion: The findings of this cohort study confirm that patients do not always remember the exacerbations suffered during their medical visit. The prevexair application is useful in monitoring COPD patients at high risk, in order to a better assessment of exacerbations of COPD during medical visits. Further research must be carried out to evaluate this strategy in clinical practice.Keywords: chronic obstructive pulmonary disease, telemonitoring, mobile health, exacerbations, clinical prediction, management, electronic patient record

Keywords

• chronic obstructive pulmonary disease
• telemonitoring
• mobile health
• exacerbations
• clinical prediction
• management
• electronic patient record