29 Mar Real-world use of rescue inhaler sensors, electronic symptom questionnaires and physical activity monitors in COPD
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to identify several sub-groups of respiratory disorders that can include emphysema, bronchitis and refractory asthma (Bowler et. Al., 2019). This study investigated the efficiency and accuracy of real-time monitoring patients’ self-healthcare in subjects with COPD. The authors clearly outlined the current methods of clinical monitoring in patients with COPD; these primarily include subjective patient reports when they return to their consulting physician or GP (Bowler et. Al., 2019). The validity and reliability of subjective patient reports on their symptoms is understandably questionable given the highly circumstantial nature of these reports. This proves to be the basis for the study conducted; by using recent advances in technology, the authors conducted real-time monitoring of rescue inhaler use, received daily symptom diaries and tracked step counts across all subjects.
The 180 subjects involved in the study were all educated in the use of the EXAcerbations of Chronic pulmonary disease Tool (EXACT); they were instructed to complete EXACT daily; if they did not complete it, a research coordinator was informed and they were instructed to complete within 24 hours (Bowler et. Al., 2019). Of those 180 subjects, 58 participants of this cohort also used MDI rescue inhalers equipped with real-time sensors that monitored time and delivery of puffs each day.
The results of this study yielded several correlations between measures: typically, between subjective patient reported symptoms and clinical indications of lung function. Daily respiratory symptoms were positively associated with more frequent daily rescue inhaler usage (p<0.001) and steps per day (p<0.001) among all participants when assessed day-by-day (over 24 hours). Median step counts were not correlated with mean respiratory symptoms (E-RS:COPD score) over 3 weeks (p=0.646). Also, more difficulty with performing physical activity (higher PROactive Rasch Difficulty Score) was associated with more rescue inhaler use and E-RS:COPD score (p<0.001) (Bowler at. Al., 2019).
This study served to prove that daily real-time monitoring of patients’ self-healthcare is a viable method of COPD treatment and care. Trends that display a mean daily diary adherence of 91% and mean daily activity monitor adherence (≥8 hours) of 96% over the duration of this 3-week study, show the validity of the approach taken (Bowler et. Al., 2019). In particular, the daily monitoring questionnaire provided a highly applicable insight in to the patients’ symptom recognition because it included 14 specific questions to their daily respiratory symptoms. Furthermore, the convenience of remotely monitoring daily lifestyle data proves to be very important, given that any deviation from regular inhaler delivery times or from regular questionnaire answers, could highlight the potential for an exacerbation of COPD symptoms and lead to early intervention by the patients’ healthcare professionals.
Whilst this study was successful in obtaining results that seem applicable to future practices of medicine, the cohort used was small. In order to prove further the successfulness of this approach, a larger population is needed for this study; in turn, this increases the data that needs to be quantified which highlights a future need for development in algorithms and data collection software to appropriately and succinctly minimize and extrapolate the relevant information.