App facilitates early detection, treatment of COPD exacerbation symptoms

COPD is the third leading cause of death in the United States. The chronic lung disease is characterized by reduced airflow, inflammation and flare-ups, called exacerbations, in which the patient may experience increased coughing, mucus, shortness of breath, wheezing, and a feeling of tightness in their chest. If those symptoms are not detected and treated in a timely fashion, they can escalate and lead to repeated trips to the emergency department, hospitalizations, disability and a diminished quality of life.

As part of a continuous quality improvement program, a team at the Temple Lung Center led by Gerard J. Criner, MD, FACP, FACCP, Founding Chair of the new Department of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University, and Director of the Temple Lung Center, conducted a 320-day assessment of patient compliance with daily COPD symptom reporting using a digital health application, as well as the Lung Center's ability to provide timely responses to worsening COPD symptoms, as reported by the digital application.

"Given a general lack of awareness among patients of small day-to-day symptom changes and the pace of symptom worsening in COPD, daily COPD telemonitoring is an attractive approach to facilitate early intervention, provided that the system is used and that the health care provider responds in a timely manner," says Dr. Criner. "Patient adherence to daily symptom reporting system using this application exceeded 90% for more than half of the participants, and 90% of worsening COPD symptom reports were responded to in less than 11 hours with patient-specific treatment recommendations. That's substantially better than response times reported in recent COPD research literature."

The digital health application allows patients to report their respiratory symptoms and peak flow measurements, which are converted to a symptom score by a computer algorithm. That score is then compared to the patients' baseline metrics. A score that exceeds the patients' baseline metrics by a predetermined amount generates an alert that is conveyed to the patient and stored in the system for a nurse to review. Based upon the symptoms reported, the nurse suggests an evidence-based treatment recommendation and forwards it to a pulmonologist for approval. Once the pulmonologist signs off, the nurse transmits the recommendation to the patient via text or email.

Publication of the findings comes on the heels of a Temple-led study published by Telemedicine and eHealth on August 10, which revealed that patients who used the application to report their daily symptoms and received same-day treatment recommendations experienced fewer and less severe COPD exacerbation symptoms, leading to an improvement in daily symptom control, lung function and activity status.

"Early interventions for worsening COPD symptoms shortens their duration and reduces their severity," says Michael R. Jacobs, PharmD, lead author of the analysis, as well as Professor of Clinical Pharmacy at Temple University School of Pharmacy and Director of Clinical Research for the Department of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine. "This digital health application is an example of how emerging technology can help facilitate early intervention and treatment by the health care team."

There were limitations to the findings, including the small number of patients who were enrolled. All of those patients were quite ill and that may have provided greater motivation to make daily symptom reports than if they were less ill. Also, because of the small sample size, lack of a control group and limited follow-up duration, the team is unable to comment on whether health care utilization was impacted.

The technology used in the quality improvement program is a precursor to the solution currently offered by HGE Health Care Solutions, a spin-off company of Temple University. HGE's application is also supported by Temple's recently launched Center for Digital Health.