Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial
- 1 September 2018
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 198 (5), 620-628
- https://doi.org/10.1164/rccm.201712-2404oc
Abstract
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.This publication has 40 references indexed in Scilit:
- Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohortRespiratory Medicine, 2013
- Use of mortality within 30 days of a COPD hospitalisation as a measure of COPD care in UK hospitalsThorax, 2013
- Domiciliary pulse-oximetry at exacerbation of chronic obstructive pulmonary disease: prospective pilot studyBMC Pulmonary Medicine, 2010
- Development and first validation of the COPD Assessment TestEuropean Respiratory Journal, 2009
- Effect of bronchodilation on expiratory flow limitation and resting lung mechanics in COPDEuropean Respiratory Journal, 2009
- Statistical analysis of exacerbation rates in COPD: TRISTAN and ISOLDE revisitedEuropean Respiratory Journal, 2008
- Measurement of physiological recovery from exacerbation of chronic obstructive pulmonary disease using within-breath forced oscillometryThorax, 2007
- Expiratory flow limitation detected by forced oscillation and negative expiratory pressureEuropean Respiratory Journal, 2006
- The PHQ-9Journal of General Internal Medicine, 2001
- Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendanAmerican Heart Journal, 1992