Real-world use of rescue inhaler sensors, electronic symptom questionnaires and physical activity monitors in COPD.
Administration, Inhalation
Aged
Aged, 80 and over
Albuterol
/ administration & dosage
Bronchodilator Agents
/ administration & dosage
Exercise
/ physiology
Female
Fitness Trackers
Follow-Up Studies
Humans
Longitudinal Studies
Male
Middle Aged
Monitoring, Ambulatory
/ instrumentation
Nebulizers and Vaporizers
Pulmonary Disease, Chronic Obstructive
/ diagnosis
Quality of Life
Smartphone
Surveys and Questionnaires
COPD
activity monitors
digital health
medication sensors
patient-reported outcomes
Journal
BMJ open respiratory research
ISSN: 2052-4439
Titre abrégé: BMJ Open Respir Res
Pays: England
ID NLM: 101638061
Informations de publication
Date de publication:
2019
2019
Historique:
received:
22
08
2018
revised:
13
12
2018
entrez:
9
4
2019
pubmed:
9
4
2019
medline:
9
4
2019
Statut:
epublish
Résumé
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterised by airflow obstruction and other morbidities such as respiratory symptoms, reduced physical activity and frequent bronchodilator use. Recent advances in personal digital monitoring devices can permit continuous collection of these data in COPD patients, but the relationships among them are not well understood. 184 individuals from a single centre of the COPDGene cohort agreed to participate in this 3-week observational study. Each participant used a smartphone to complete a daily symptom diary (EXAcerbations of Chronic pulmonary disease Tool, EXACT), wore a wrist-worn accelerometer to record continuously physical activity and completed the Clinical Visit PROactive Physical Activity in COPD questionnaire. 58 users of metered dose inhalers for rescue (albuterol) were provided with an inhaler sensor, which time stamped each inhaler actuation. Rescue inhaler use was strongly correlated with E-RS:COPD score, while step counts were correlated with neither rescue use nor E-RS:COPD score. Frequent, unpatterned inhaler use pattern was associated with worse respiratory symptoms and less physical activity compared with frequent inhaler use with a regular daily pattern. There was a strong week-by-week correlation among measurements, suggesting that 1 week of monitoring is sufficient to characterise stable patients with COPD. The study highlights the interaction and relevance of personal real-time monitoring of respiratory symptoms, physical activity and rescue medication in patients with COPD. Additionally, visual displays of longitudinal data may be helpful for disease management to help drive conversations between patients and caregivers and for risk-based monitoring in clinical trials.
Sections du résumé
Background
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterised by airflow obstruction and other morbidities such as respiratory symptoms, reduced physical activity and frequent bronchodilator use. Recent advances in personal digital monitoring devices can permit continuous collection of these data in COPD patients, but the relationships among them are not well understood.
Methods
184 individuals from a single centre of the COPDGene cohort agreed to participate in this 3-week observational study. Each participant used a smartphone to complete a daily symptom diary (EXAcerbations of Chronic pulmonary disease Tool, EXACT), wore a wrist-worn accelerometer to record continuously physical activity and completed the Clinical Visit PROactive Physical Activity in COPD questionnaire. 58 users of metered dose inhalers for rescue (albuterol) were provided with an inhaler sensor, which time stamped each inhaler actuation.
Results
Rescue inhaler use was strongly correlated with E-RS:COPD score, while step counts were correlated with neither rescue use nor E-RS:COPD score. Frequent, unpatterned inhaler use pattern was associated with worse respiratory symptoms and less physical activity compared with frequent inhaler use with a regular daily pattern. There was a strong week-by-week correlation among measurements, suggesting that 1 week of monitoring is sufficient to characterise stable patients with COPD.
Discussion
The study highlights the interaction and relevance of personal real-time monitoring of respiratory symptoms, physical activity and rescue medication in patients with COPD. Additionally, visual displays of longitudinal data may be helpful for disease management to help drive conversations between patients and caregivers and for risk-based monitoring in clinical trials.
Identifiants
pubmed: 30956796
doi: 10.1136/bmjresp-2018-000350
pii: bmjresp-2018-000350
pmc: PMC6424295
doi:
Substances chimiques
Bronchodilator Agents
0
Albuterol
QF8SVZ843E
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
e000350Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL095432
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL089856
Pays : United States
Organisme : NHLBI NIH HHS
ID : U01 HL089897
Pays : United States
Déclaration de conflit d'intérêts
Competing interests: RB, SJ and AM have no financial or personal relationships with people or organisations that could inappropriately influence this work. NL, BM and RT-S are employees of GSK and hold stock. MA is an employee of GSK.
Références
Eur Respir J. 2015 Oct;46(4):988-1000
pubmed: 26022965
J Gerontol A Biol Sci Med Sci. 2001 Oct;56 Spec No 2:23-35
pubmed: 11730235
Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55
pubmed: 17507545
Respir Med. 2016 Oct;119:55-62
pubmed: 27692148
N Engl J Med. 2004 Mar 4;350(10):1005-12
pubmed: 14999112
Am J Respir Crit Care Med. 2014 May 1;189(9):1022-30
pubmed: 24552242
Am J Respir Crit Care Med. 2009 Dec 15;180(12):1189-95
pubmed: 19797160
Lancet. 2009 Oct 3;374(9696):1171-8
pubmed: 19716598
Lancet. 2009 Aug 29;374(9691):704-11
pubmed: 19716962
J Aerosol Med Pulm Drug Deliv. 2018 Jun;31(3):191-198
pubmed: 29035120
N Engl J Med. 2010 Sep 16;363(12):1128-38
pubmed: 20843247
N Engl J Med. 2011 Sep 29;365(13):1184-92
pubmed: 21991892
Lancet Respir Med. 2013 Apr;1(2):129-36
pubmed: 24429093
Respir Med. 2005 Jun;99(6):670-82
pubmed: 15878483
PLoS One. 2017 Sep 21;12(9):e0184606
pubmed: 28934249
Thorax. 2006 Sep;61(9):772-8
pubmed: 16738033
Respir Res. 2014 Aug 06;15:89
pubmed: 25096860
Chest. 2002 May;121(5):1434-40
pubmed: 12006425
BMC Pulm Med. 2017 Dec 28;17(1):215
pubmed: 29282101
Respir Res. 2017 Jun 13;18(1):117
pubmed: 28610627
Am J Respir Crit Care Med. 2011 Feb 1;183(3):323-9
pubmed: 20813886
Am J Respir Crit Care Med. 2017 May 15;195(10):1333-1343
pubmed: 27409253
COPD. 2018 Jun;15(3):254-264
pubmed: 30183414
Br Med J. 1977 Jun 25;1(6077):1645-8
pubmed: 871704
Respir Res. 2016 Apr 05;17:38
pubmed: 27048618
COPD. 2010 Feb;7(1):32-43
pubmed: 20214461