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- Title
Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial.
- Authors
Walker, Paul P; Pompilio, Pasquale P; Zanaboni, Paolo; Bergmo, Trine S; Prikk, Kaiu; Malinovschi, Andrei; Montserrat, Josep M; Middlemass, Jo; Šonc, Silvana; Munaro, Giulia; Marušič, Dorjan; Sepper, Ruth; Rosso, Roberto; Siriwardena, A Niroshan; Janson, Christer; Farré, Ramon; Calverley, Peter M A; Dellaca', Raffaele L
- Abstract
<bold>Rationale: </bold>Early detection of chronic obstructive pulmonary disease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization.<bold>Objectives: </bold>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.<bold>Methods: </bold>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.<bold>Measurements and Main Results: </bold>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).<bold>Conclusions: </bold>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).
- Subjects
OBSTRUCTIVE lung disease diagnosis; RESEARCH; LUNGS; RESEARCH methodology; EVALUATION research; MEDICAL cooperation; PATIENT monitoring; COMPARATIVE studies; OBSTRUCTIVE lung diseases; QUESTIONNAIRES; TELEMEDICINE
- Publication
American Journal of Respiratory & Critical Care Medicine, 2018, Vol 198, Issue 5, p620
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201712-2404OC