- Please check and comment entries here.
Asthma and Chronic Obstructive Pulmonary Diseases
Asthma and chronic obstructive pulmonary disease (COPD) are prevalent chronic pulmonary diseases requiring ongoing self-management. According to the World Health Organization, approximately 339 million people worldwide have asthma, and over 65 million suffer from moderate-to-severe COPD, making it the third leading cause of death worldwide. Asthma typically starts early in life and is related to an allergy, whereas COPD is typically caused by air pollutants such as cigarette smoke or biomass fuel.
Assessments by healthcare providers typically only offer a relatively static status of a patient at a given point in time and may not reflect their full range of symptoms and fluctuations. For example, in patients with asthma, it is not uncommon to have a normal lung function and no symptoms during the assessment, while being symptomatic at home . Furthermore, patients may fail to recognize early signs of an exacerbation, leading to delays in consultation, diagnosis and treatment . The early detection and intervention of an exacerbation can reduce recovery times and the need for hospitalization, while also improving quality of life (QoL) . Frequent evaluations of symptoms and clinical parameters also facilitate personalized care, helping to enhance diagnostic accuracy, improve disease management and prevent exacerbations. However, healthcare providers already have a high workload , and increasing the number of clinical visits and assessments is undesirable.
Technological advancements have produced convenient and affordable tools for monitoring symptoms, including Bluetooth ® blood pressure devices, oximeters and mini spirometers. In addition, patients are increasingly able to access the internet, and healthcare providers and organizations are increasingly able to exchange medical data safely within specific digital environments. These developments have led to innovative possibilities for diagnosing, monitoring and treating patients with asthma or COPD. An example of this is telemonitoring. It allows patients to monitor their symptoms and physical parameters at home, share the data with healthcare providers and receive tailored treatment strategies based on that information. In this way, technology can support healthcare providers to deliver personalized disease management and more frequent symptom monitoring without the need for clinical visits or physical on-site assessments .
Telemonitoring can empower patients to become more actively involved in managing their asthma or COPD . Numerous studies have shown that self-management is difficult and often poor in these groups, with an estimated 22–78% of patients having poor adherence to medical therapies . Furthermore, incorrect inhaler technique is common , and 30–50% of symptomatic patients continue to smoke despite moderate-to-severe COPD . Education can improve self-management skills and enhance disease control . Thus, telemonitoring enables patients to be actively involved in their disease management and provides time-efficient education and feedback.
International asthma and COPD guidelines, such as the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) , acknowledge the potential of telemonitoring in disease management. Telemonitoring may offer benefits to disease status , health-related QoL (HR-QoL) , exacerbations , hospital admissions , exercise capacity  and healthcare utilization (including emergency room visits) . To date, the considerable heterogeneity in the research methodology, monitoring devices, outcome variables and patient populations in studies of telemonitoring make it difficult to draw firm conclusions regarding its effectiveness  and feasibility  for these diseases. Implementing telemonitoring in healthcare can also be complicated by organizational limitations, technical matters and resistance from potential users . Acceptance by stakeholders, integration in electronic health records and cost-effectiveness in comparison to current treatment are key to successful implementation. Many promising eHealth technologies have failed to realize their potential to improve outcomes due to resistance from healthcare providers or patients .
2. Current Insights
2.1. Main Results
2.2. Comparison with Current Literature
2.2.1. Telemonitoring and Patient Education
2.2.2. Accetability, Feasibility and Adherence
Telemonitoring is effective, feasible and safe compared to care as usual for patients with COPD. There was an insufficient number of studies to draw conclusions regarding asthma telemonitoring. Telemonitoring can improve several clinical outcomes in COPD patients, including the need for hospitalization, length of hospitalization, number of clinical visits, QoL and number of exacerbations. Adding an educational element to a telemonitoring intervention seems to increase the prospect of a positive effect. However, there is a lack of research on the behavioral and process factors related to telemonitoring. Future research should focus on the effects of telemonitoring in patients with asthma, the full telemonitoring process for the patient and the healthcare provider and its implementation in the healthcare organization, as well as the impact of patient and healthcare provider characteristics.
This entry is adapted from 10.3390/life11111215
- Kavanagh, J.; Jackson, D.J.; Kent, B.D. Over- and under-diagnosis in asthma. Breathe 2019, 15, e20–e27.
- Langsetmo, L.; Platt, R.W.; Ernst, P.; Bourbeau, J. Underreporting Exacerbation of Chronic Obstructive Pulmonary Disease in a Longitudinal Cohort. Am. J. Respir. Crit. Care Med. 2008, 177, 396–401.
- Seemungal, T.A.R.; Donaldson, G.C.; Bhowmik, A.; Jeffries, D.J.; Wedzicha, J.A. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2000, 161, 1608–1613.
- Wilkinson, T.M.A.; Donaldson, G.C.; Hurst, J.R.; Seemungal, T.A.R.; Wedzicha, J.A. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 2004, 169, 1298–1303.
- Marchetti, N.; Criner, G.J.; Albert, R.K. Preventing Acute Exacerbations and Hospital Admissions in COPD. Chest 2013, 143, 1444–1454.
- Doosty, F.; Maleki, M.R.; Yarmohammadian, M.H. An investigation on workload indicator of staffing need: A scoping review. J. Educ. Health Promot. 2019, 8, 22.
- Barbosa, M.T.; Sousa, C.S.; Morais-Almeida, M.; Simões, M.J.; Mendes, P. Telemedicine in COPD: An Overview by Topics. COPD: J. Chronic Obstr. Pulm. Dis. 2020, 17, 601–617.
- Doshi, H.; Hsia, B.; Shahani, J.; Mowrey, W.; Jariwala, S.P. Impact of Technology-Based Interventions on Patient-Reported Outcomes in Asthma: A Systematic Review. J. Allergy Clin. Immunol. Pract. 2021, 9, 2336–2341.
- Ding, H.; Jayasena, R.; Chen, S.H.; Maiorana, A.; Dowling, A.; Layland, J.; Good, N.; Karunanithi, M.; Edwards, I. The Effects of Telemonitoring on Patient Compliance With Self-Management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial. J. Med. Internet Res. 2020, 22, e17559.
- Aikens, J.E.; Rosland, A.-M.; Piette, J.D. Improvements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes. Prim. Care Diabetes 2015, 9, 127–134.
- Mäkelä, M.J.; Backer, V.; Hedegaard, M.; Larsson, K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir. Med. 2013, 107, 1481–1490.
- Lavorini, F.; Magnan, A.; Dubus, J.C.; Voshaar, T.; Corbetta, L.; Broeders, M.; Dekhuijzen, R.; Sanchis, J.; Viejo, J.L.; Barnes, P.; et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir. Med. 2008, 102, 593–604.
- Tashkin, D.P.; Celli, B.; Senn, S.; Burkhart, D.; Kesten, S.; Menjoge, S.; Decramer, M. A 4-Year Trial of Tiotropium in Chronic Obstructive Pulmonary Disease. N. Engl. J. Med. 2009, 58, 848–849.
- Lorig, K.R.; Holman, H.R. Self-management education: History, definition, outcomes, and mechanisms. Ann. Behav. Med. 2003, 26, 1–7.
- Warsi, A.; Wang, P.S.; LaValley, M.P.; Avorn, J.; Solomon, D.H. Self-management education programs in chronic disease: A systematic review and methodological critique of the literature. Arch. Intern. Med. 2004, 164, 1641–1649.
- 2021 GINA Main Report—Global Initiative for Asthma—GINA. Available online: https://ginasthma.org/gina-reports/ (accessed on 10 September 2021).
- 2021 GOLD Reports—Global Initiative for Chronic Obstructive Lung Disease—GOLD. Available online: https://goldcopd.org/2021-gold-reports/ (accessed on 10 September 2021).
- Bonnevie, T.; Smondack, P.; Elkins, M.; Gouel, B.; Medrinal, C.; Combret, Y.; Muir, J. Cuvelier, A.; Prieur, G.; Gravier, F. Advanced telehealth technology improves home-based exercise therapy for people with stable chronic obstructive pulmonary disease: A systematic review. J. Physiother. 2021, 67, 27–40.
- Hong, Y.; Lee, S.H. Effectiveness of tele-monitoring by patient severity and intervention type in chronic obstructive pulmonary disease patients: A systematic review and meta-analysis. Int. J. Nurs. Stud. 2019, 92, 1–15.
- Alghamdi, S.M.; Alqahtani, J.S.; Aldhahir, A.M.; Alrajeh, A.M.; Aldabayan, Y.S. Effectiveness of telehealth-based interventions with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Am. J. Respir. Crit. Care Med. 2020, 201, A4308. Available online: https://www.embase.com/search/results?subaction=viewrecord&id=L632377796&from=export (accessed on 1 September 2021).
- Jang, S.; Kim, Y.; Cho, W.K. A Systematic Review and Meta-Analysis of Telemonitoring Interventions on Severe COPD Exacerbations. Int. J. Environ. Res. Public Health 2021, 18, 6757.
- Kruse, C.; Pesek, B.; Anderson, M.; Brennan, K.; Comfort, H. Telemonitoring to Manage Chronic Obstructive Pulmonary Disease: Systematic Literature Review. JMIR Med. Inform. 2019, 7, e11496.
- Paré, G.; Moqadem, K.; Pineau, G.; St-Hilaire, C. Clinical effects of home telemonitoring in the context of diabetes, asthma, heart failure and hypertension: A systematic review. J. Med. Internet Res. 2010, 12, e21. Available online: https://www.embase.com/search/results?subaction=viewrecord&id=L359408353&from=export (accessed on 1 September 2021).
- Almojaibel, A. Delivering pulmonary rehabilitation for patients with chronic obstructive pulmonary disease at home using telehealth: A review of the literature. Saudi J. Med. Med. Sci. 2016, 4, 164–171.
- Damschroder, L.J.; Aron, D.C.; Keith, R.E.; Kirsh, S.R.; Alexander, J.A.; Lowery, J.C. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement. Sci. 2009, 4, 50.
- Gemert-Pijnen, L.v.; Kelders, S.; Kip, H.; Sanderman, R. (Eds.) eHealth Research, Theory and Development. A Multidisciplinary Approach, 1st ed.; Routledge, Taylor & Francis Group: Abingdon, UK, 2018.
- Hanlon, P.; Daines, L.; Campbell, C.; McKinstry, B.; Weller, D.; Pinnock, H. Telehealth interventions to support self-management of long-term conditions: A systematic metareview of diabetes, heart failure, asthma, chronic obstructive pulmonary disease, and cancer. J. Med. Internet Res. 2017, 19, e172.
- Porter, M.E. What is value in health care? N. Engl. J. Med. 2010, 363, 2477–2481.