Remote Patient Monitoring for the Detection of COPD Exacerbations

Abstract

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 [phone]Fax [phone]Email [email protected]: 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

Keywords

• chronic obstructive pulmonary disease
• exacerbations
• early detection
• home monitoring
• telemedicine