• Paul P Walker, Pasquale P Pompilio, Paolo Zanaboni, Trine S Bergmo, Kaiu Prikk, Andrei Malinovschi, Josep M Montserrat, Jo Middlemass, Silvana Šonc, Giulia Munaro, Dorjan Marušič, Ruth Sepper, Roberto Rosso, A Niroshan Siriwardena, Christer Janson, Ramon Farré, Calverley Peter M A PMA 2 School of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom., and Raffaele L Dellaca'.
• 1 University Hospital Aintree, Liverpool, United Kingdom.
• Am. J. Respir. Crit. Care Med. 2018 Sep 1; 198 (5): 620-628.

RationaleEarly detection of chronic obstructive pulmonary disease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization.ObjectivesTo evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities.MethodsThis 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 ResultsPrimary 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).ConclusionsIn 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).

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