The objective of this study was to determine the effects of a homebased telemonitoring device, The Health Buddy (HB), on health consumption and health-related quality of life (HRQoL) in patients with moderate to severe chronic obstructive pulmonary disease (COPD). The HB provides daily symptom-surveillance by a case manager and education to enhance disease knowledge and self-management. A nonrandomized controlled multicenter study was established comparing the effectiveness of telemonitoring as an add-on to care as usual with a follow-up of 6 months. Four hospitals took part in the experimental group and 2 hospitals formed an equivalent control group with 59 and 56 patients, respectively. HRQoL was measured by the Clinical COPD Questionnaire. Healthcare consumption was assessed using medical records in the 6 months preceding study entry and during the study. Compared with the control group, the HB group showed a significant decrease in hospital admission rates (HB -0.11 +/- 1.16 vs. control +0.27 +/- 1.0, p = 0.02) and in the total number of exacerbations (HB -0.35 +/- 1.4 vs. control +0.32 +/- 1.2, p = 0.004). There was a tendency toward decreased hospital days and outpatient visits. No significant changes in HRQoL were observed at follow-up between both study groups. Despite inherent limitations of the study, these findings suggest that adopting telemonitoring in everyday clinical practice is feasible and can substantially improve care and decrease healthcare utilization of patients with moderate to severe COPD.

Geriatric COPD rehabilitation in a nursing home setting seems to reduce hospital admissions in frail COPD patients and to increase exercise tolerance.

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Continuous positive airway pressure (CPAP) is a first-line treatment for obstructive sleep apnea (OSA). However, the adherence to CPAP can be difficult for patients due to several reasons. In this case report we describe a patient with severe OSA who initially was treated successfully with CPAP, but after a few months adherence problems developed because of macroglossia. This was caused by amyloidosis due to multiple myeloma. During treatment with chemotherapy and stem cell transplantation, the size of the patient's tongue decreased and he could successfully use his CPAP device again.

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