Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research

Abstract

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality despite current treatment strategies which focus on smoking cessation, pulmonary rehabilitation, and symptomatic relief. A focus of COPD care is to encourage self-management, particularly during COVID-19, where much face-to-face care has been reduced or ceased. Digital health solutions may offer affordable and scalable solutions to support COPD patient education and self-management, such solutions could improve clinical outcomes and expand service reach for limited additional cost. However, optimal ways to deliver digital medicine are still in development, and there are a number of important considerations for clinicians, commissioners, and patients to ensure successful implementation of digitally augmented care. In this narrative review, we discuss advantages, pitfalls, and future prospects of digital healthcare, which offer a variety of tools including self-management plans, education videos, inhaler training videos, feedback to patients and healthcare professionals (HCPs), exacerbation monitoring, and pulmonary rehabilitation. We discuss the key issues with sustaining patient and HCP engagement and limiting attrition of use, interoperability with devices, integration into healthcare systems, and ensuring inclusivity and accessibility. We explore the essential areas of research beyond determining safety and efficacy to understand the acceptability of digital healthcare solutions to patients, clinicians, and healthcare systems, and hence ways to improve this and sustain engagement. Finally, we explore the regulatory challenges to ensure quality and engagement and effective integration into current healthcare systems and care pathways, while maintaining patients’ autonomy and privacy. Understanding and addressing these issues and successful incorporation of an acceptable, simple, scalable, affordable, and future-proof digital solution into healthcare systems could help remodel global chronic disease management and fractured healthcare systems to provide best patient care and optimisation of healthcare resources to meet the global burden and unmet clinical need of COPD.

Agarwood Oil Nanoemulsion Attenuates Cigarette Smoke-Induced Inflammation and Oxidative Stress Markers in BCi-NS1.1 Airway Epithelial Cells

“…Cigarette smoking is the main cause of COPD [ 75 ], and it is known to cause inflammation and oxidative stress which, together, play fundamental roles in the pathogenesis of chronic inflammatory diseases such as COPD [ 76 , 77 ]. Current treatment strategies for COPD involve pulmonary rehabilitation, smoke cessation, and pharmacological relief of symptoms through inhalational therapy [ 78 ]. Despite this, COPD still represents a leading cause of morbidity and mortality worldwide [ 79 ].…”

Experiences With a Postpartum mHealth Intervention During the COVID-19 Pandemic: Key Informant Interviews Among Patients, Health Care Providers, and Stakeholders

“…Face-to-face assessment of mothers and providing access to a phone receptionist who can facilitate personal assistance when needed were examples raised by mothers and stakeholders to help mothers who might lack the competencies to navigate the digital health care system. An integrative approach to the implementation of digital interventions should be built into the service to ensure accessibility and inclusivity [ 39 ].…”

Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis

“…Instead, it was related to whether patients did or did not have a computer at home or whether their computer skills were (perceived to be) too low. Several studies in the systematic review authored by Koivunen and Saranto [60] and other studies of various chronic diseases, including COPD [65][66][67], have highlighted that lack of access and skills are obstacles to using eHealth tools among patients. For example, we recently found that among patients with COPD enrolled in primary care, about 40% of eligible patients with COPD declined participation in an eHealth intervention due to no/limited experience with computers [17].…”

“…Participants also had high knowledge of how to use the internet, with 91% having used the internet during the last 3 months and 85% almost every day. Taken together, indicating that although low access and computer skills are obstacles to using eHealth tools across various patient groups [65][66][67], it is vital that health care professionals do not draw firm conclusions based on their perception of the computer skills of their patients. Instead, a more relevant alternative for health care professionals would be to assess the level of health literacy among their patients to aid them in deciding whether the incorporation of an eHealth tool would be feasible.…”