Remote patient monitoring in the management of chronic obstructive pulmonary disease

Correspondence to Dr Brooks T Kuhn, Division of Pulmonary and Critical Care Medicine, University of California Davis School of Medicine, Sacramento, California, USA; [email protected]

Introduction

Chronic obstructive pulmonary disease (COPD) is prevalent and detrimental to quality of life (QoL) and survival, though tools to monitor and prevent disease progression are limited and often ineffective.^{1 2} For many patients with COPD, their course is marked by acute exacerbations (AECOPD), defined as a paroxysmal increase in symptoms requiring escalation of therapy. These acute events have lasting effects (accelerated loss of lung function, decreased QoL, and higher rates of subsequent exacerbations), making prevention a top goal of care.³ Similar chronic diseases like heart failure and cancer have been improved through targeted interventions in terms of healthcare delivery, mortality, hospitalization, and readmission rates; unfortunately, COPD outcomes have not had the same benefit.^{4 5} Remote patient monitoring (RPM) offers an expanding number of technologies and approaches to monitor high-risk patients, offering the ability to identify and treat COPD exacerbations early.

Frequent exacerbations come at a cost to both the individual and healthcare system: while individuals with frequent exacerbations have greater mortality,^{6 7} poorer QoL⁸ and substantial economic burden, COPD also presents high societal healthcare expenditures and resource utilization.⁹ Hospital care drives most of the cost in COPD,¹⁰ and while the direct cost increases with increasing severity of disease, hospitalization remains the most important cost variable across stages.¹¹ In addition, COPD is related to high rates of readmission, as described in an evaluation of fee-for-service Medicare beneficiaries admitted for COPD which found 19.6% of these patients were readmitted within 30 days.¹² Cost also comes in the form of decreased productivity and increased absenteeism at work because of frequent exacerbations.^{13 14} This will likely only worsen as disease prevalence is projected to continue to increase (in addition to the aging population).¹

RPM is a technology solution that measures patient-generated data outside traditional healthcare systems to augment care. When applied to COPD, RPM offers many potential benefits: early detection of exacerbation, prompt access to therapy and clinical services, a possible decrease in emergency services and hospitalizations, and ideally decreased healthcare costs.¹⁵ There is a rapidly increasing number of patient-generated data...