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Could mobile technology help patients with chronic obstructive pulmonary disease (COPD) who may not seek care until they experience an exacerbation? A recent study found a wearable device and mobile app were deemed useful by patients with COPD to aid in the management of their condition, based on data from 26 adults who used devices and apps for 6 months.
Self-management interventions for COPD can potentially improve quality of life and reduce hospitalizations, wrote Robert Wu, MD, associate professor in the Department of Medicine at the University of Toronto, Toronto, Ontario, Canada, and colleagues. However, data on the use of devices and apps to manage COPD by providing reminders for self-care, predicting early exacerbations, and facilitating communication with healthcare providers are limited, they said.
In a study published in COPD: Journal of Chronic Obstructive Pulmonary Disease, the researchers reported details from interviews with 26 adult patients with COPD who used a wearable device and app for 6 months to help manage their condition. The interviews were part of a larger cohort study.
“The motivation for this study was to understand the patient perspective on using wearables to help support their chronic lung condition,” Wu said in an interview. “People with COPD can be at high risk of being admitted to hospital, so it is important to see if innovative technology like wearables or remote monitoring can help them,” he said.
Individuals with COPD tend to be older and less technologically adept, and they may be less willing to adopt new technology, he added. “We wanted to understand what would make people use a self-management app,” he said.
On enrollment in the study, patients received a smartwatch and a smartphone with a preinstalled app for COPD management. The app included daily reminders to take medication, perform guided breathing sessions, check blood oxygen on the smartwatch or an oximeter, and complete a symptom questionnaire. The app also allowed participants to record when they exercised and provided feedback on heart rate and daily activity, including passive step counts. Participants earned stars for meeting daily exercise goals of active minutes and total steps.
Participants received training in the use of the app from members of the research team and completed semi-structured interviews after using the items for 6 months.
The researchers divided their findings into four main themes: Information, support and reassurance; barriers to adoption; impact on communication with healthcare providers; and opportunities for improvement.
Overall, most patients reported that the feedback they received through the app was useful. In particular, participants reported that the app and smartwatch provided reassurance and feedback about stable vitals during exercise, which encouraged some to adhere to regular exercise routines. Approximately two thirds (65%) said that the daily exercise reminders were motivational. In addition, 20% reported that they interpreted vital data, including heart rate, as a signal to slow down.
Participants rated medication reminders and the option to create an action plan for COPD management as the least useful features; 69% said that they already had medication reminders in place.
A total of four patients experienced technical difficulties with the app that kept it from impacting their disease management. Some of the suggestions from participants for improvement included adding information about food intake, weight, blood pressure, and temperature to the health information being tracked, as well as restoring the oxygen saturation measure, which had been disabled because of accuracy concerns. Barriers to use of the device and app included the bulkiness of the device as well as the reported technical malfunctions.
The findings were limited by several factors, including the small sample size and likely focus on early adopters of technology, which may not represent most patients with COPD, the researchers noted. Other limitations included the recruitment of most patients after the start of the COVID-19 pandemic, which may have affected their experience and also limited the assessment of the app on communication with healthcare providers, the researchers noted. The study also did not address financial or social barriers.
However, the results suggest that patients with COPD identified the potential value of wearable devices for disease management and that improved technology could promote patient empowerment and lifestyle changes, the researchers concluded.
Technology Can Augment Care and Connections
“As clinicians and researchers, we have ideas about what patients would want, but it is always better to get their feedback of what they really want and what they would use,” Wu told Medscape Medical News. “We thought older adults with COPD would be less likely to engage with the technology. We found that many wanted to have their data to help make connections with their condition, and some purchased smartwatches after the study to make these connections,” he said.
The takeaway message from the current study is that people with COPD may benefit from self-management apps, but they would like to use them in collaboration with their healthcare team, said Wu. “Clinicians may see more of their patients bringing in data from wearables and apps,” he noted.
Concerns persist that using technology to help support people with COPD could increase the “digital divide” and that those with lower digital literacy, financial insecurity, or with English as a second language could be left behind, and it is important to remain attentive to equity in pursuing the use of devices and apps, Wu told Medscape Medical News.
Looking ahead, research involving self-management, remote monitoring, and wearable devices has focused on other conditions such as heart failure and diabetes, and more work is needed to examine how these technologies can improve care for patients with COPD, said Wu. “We see this study as one important step — to understand what will motivate people to use self-management apps and wearables,” he said.
“Acute exacerbations of COPD are very important events that can alter quality of life, lung function, and even mortality in COPD,” said Nathaniel Marchetti, DO, medical director of the Respiratory Intensive Care Unit at Temple University Hospital, Philadelphia, in an interview.
“Many of these exacerbations are not recognized by clinicians or even patients until they present late and end up in an urgent office visit with a physician or in the emergency room [ER], so addressing exacerbations earlier has the potential to avoid ER visits or hospitalizations,” he said.
The study identified areas for further research, Marchetti said. “More information would be needed to determine if the use of an app to monitor heart rate, symptoms, and oxygen saturation could alter important outcomes in COPD such as exacerbations,” he noted.
As for limitations, “no one wants to carry two smartphones,” said Marchetti. “Future devices need to be easy to use and available on the patient’s own phone,” he said. Patients should be able to choose a smartwatch or possibly a bracelet that can be synced to a smartphone, he added. The current study also failed to address what would be done with collected data, such as link them to health professionals who would offer treatment when needed, he said.
Overall, the data from the current study suggest that patients with COPD would like some device that monitors symptoms and vital signs and offers suggestions/incentives to exercise and take medications, Marchetti told Medscape Medical News. “A larger study will be needed that compares how such a device could improve outcomes of COPD; outcomes could include admissions/ER visits, exercise performance, or compliance with medication,” he said. In addition, clinical algorithms for the identification and treatment of acute exacerbations of COPD would be needed, Marchetti noted. These algorithms would determine whether treatment decisions would be initiated by a clinical team of health professionals or whether clinicians would provide medications that the patients would then decide to take based on data collected on the app, using the investigator-provided algorithms, he said.
The study was supported in part by Samsung Research America (SRA) and was initiated by Wu with input from SRA, but the company had no role in the methods or results. The study also was supported by grants from the National Natural Science Foundation of China.
Marchetti had no relevant financial conflicts to disclose.
