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Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED): A Randomized Clinical Trial
Aintree Univ Hosp NHS Fdn Trust, Liverpool, Merseyside, England;Univ Liverpool, Sch Ageing & Chron Dis, Liverpool, Merseyside, England.ORCID iD: 0000-0002-5449-9551
Restech Srl, Milan, Italy.
Univ Hosp North Norway, Norwegian Ctr Hlth Res, Tromso, Norway.
Univ Hosp North Norway, Norwegian Ctr Hlth Res, Tromso, Norway.
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2018 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 198, no 5, p. 620-628Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
AMER THORACIC SOC , 2018. Vol. 198, no 5, p. 620-628
Keywords [en]
forced oscillation technique (FOT), COPD exacerbation, chronic obstructive pulmonary disease, home monitoring
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:uu:diva-364381DOI: 10.1164/rccm.201712-2404OCISI: 000443435800016PubMedID: 29557669OAI: oai:DiVA.org:uu-364381DiVA, id: diva2:1261703
Funder
EU, European Research Council, 306093Available from: 2018-11-08 Created: 2018-11-08 Last updated: 2018-11-08Bibliographically approved

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Malinovschi, AndreiJanson, Christer

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