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Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial
Paul P Walker1,2, Pasquale P Pompilio3, Paolo Zanaboni4
11 University Hospital Aintree, Liverpool, United Kingdom.
American Journal of Respiratory and Critical Care Medicine
|March 21, 2018
Summary
Remote monitoring for chronic obstructive pulmonary disease (COPD) exacerbations did not reduce hospitalizations but showed promise in reducing repeat hospitalizations in older adults with comorbidities.
Area of Science:
- Pulmonary Medicine
- Geriatrics
- Health Informatics
Background:
- Chronic obstructive pulmonary disease (COPD) exacerbations frequently lead to hospitalizations, particularly in older patients with comorbidities.
- Early detection of exacerbations via telemonitoring may offer a strategy to reduce hospital admissions.
Purpose of the Study:
- To assess the efficacy of home-based telemonitoring of lung mechanics (using the forced oscillation technique) and cardiac parameters in managing older COPD patients with comorbidities.
- To determine if telemonitoring impacts time to first hospitalization (TTFH) and health-related quality of life.
Main Methods:
- A multicenter randomized clinical trial involving 312 patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades II-IV COPD and comorbidities.
- Patients were randomized to either usual care or a telemonitoring group, which included daily self-assessment of lung mechanics and, for a subgroup with heart failure, cardiac parameter monitoring.
- An algorithm alerted healthcare providers to potential deteriorations, prompting interventions.
Main Results:
- Telemonitoring did not significantly alter the time to first hospitalization (TTFH) or the EuroQoL EQ-5D utility index score compared to usual care.
- No significant differences were observed in the rates of antibiotic/corticosteroid prescriptions, overall hospitalizations, or various quality-of-life questionnaire scores.
- Exploratory analysis indicated a significant reduction in repeat hospitalizations among patients in the telemonitoring group (-54%; P=0.017).
Conclusions:
- Remote monitoring of lung function and cardiac parameters using telemonitoring did not improve primary outcomes like TTFH or EQ-5D in older COPD patients with comorbidities.
- While not impacting initial hospitalizations, telemonitoring showed potential in reducing recurrent hospital admissions, warranting further investigation.
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