Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial.

RATIONALE: Early detection of chronic obstructive pulmonary disease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization. OBJECTIVES: To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities. METHODS: This multicenter, randomized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grades II to IV COPD (median age, 71 yr [interquartile range, 66-76 yr]; 49.6% grade II, 50.4% grades III-IV), with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity. Patients were randomized to usual care (n = 158) or telemonitoring (n = 154) and followed for 9 months. All telemonitoring patients self-assessed lung mechanics daily, and in a subgroup with congestive heart failure (n = 37) cardiac parameters were also monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were time to first hospitalization (TTFH) and change in the EuroQoL EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescription; hospitalization; the COPD Assessment Tool, Patient Health Questionnaire-9, and Minnesota Living with Heart Failure questionnaire scores; quality-adjusted life years; and healthcare costs. Telemonitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate, or questionnaire scores. In an exploratory analysis, telemedicine was associated with fewer repeat hospitalizations (-54%; P = 0.017). CONCLUSIONS: In older patients with COPD and comorbidities, remote monitoring of lung function by forced oscillation technique and cardiac parameters did not change TTFH and EQ-5D. Clinical trial registered with www.clinicaltrials.gov (NCT 01960907).

Spirometric testing on World COPD Day.

BACKGROUND: To determine the importance of spirometric testing for early detection of chronic obstructive pulmonary disease (COPD). METHODS: Spirometric testing has been performed annually on World COPD Day in Sezana from 2003. Sezana is in a semiurban region of Slovenia, with 12,000 inhabitants. The investigation was performed between January 2003 and December 2008. In total, 770 persons were enrolled (414 females and 356 males). The participants were recruited by mass media appeals. Smokers aged ≥ 40 years with a smoking history of ≥ 10 pack-years were invited to visit the local chest clinic. The participants completed a questionnaire and had spirometry performed. Subjects with a postbronchodilator forced expiratory volume in one second/forced vital capacity <0.70 were defined as having COPD, according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. RESULTS: We identified that 16.2% of subjects had impaired lung function. Of these, 10.2% had an obstructive pattern of ventilatory impairment and 6% had a restrictive pattern. We identified 79 individuals with COPD. Subjects with COPD were >70 years in 40.5% in cases. The majority of individuals with COPD were men (74.6%), and 90% were smokers. COPD was mild in 52% of subjects, moderate in 34%, and severe in 14%. The majority of subjects had a milder stage of the disease, and 92% of those with COPD (72/79) had not been recognized to have COPD previously. CONCLUSION: These results suggest that spirometry testing could detect patients with COPD in the earlier stages of the disease.