Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence

Farias, Raquel; Sedeno, Maria; Beaucage, Danielle; Drouin, Isabelle; Ouellet, Isabelle; Joubert, Alexandre; Abimaroun, Rita; Patel, Meena; Rjeili, Mira Abou; Bourbeau, Jean

doi:10.1136/bmjresp-2018-000379

Cited by 27 publications

(32 citation statements)

References 33 publications

(42 reference statements)

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“…COPD written action plan adherence can be further enhanced with the use of telehealth technologies in a specialized clinic with experience in COPD self-management. 42 Patients followed up by the tele-system recovered faster from exacerbations and had a further decrease in COPD-related emergency department visits and hospitalizations. These promising results will need to be tested in a randomized clinical trial properly designed and with sufficient power.…”

Section: Solutions That Empower Both Patients and Caregivers In Theirmentioning

confidence: 92%

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

Bourbeau

Echevarria

2020

Chron Respir Dis

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Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant morbidity and mortality, and treatments require a multidisciplinary approach to address patient needs. This review considers different models of care across the continuum of exacerbations (1) chronic care and self-management interventions with the action plan, (2) domiciliary care for severe exacerbation and the impact on readmission prevention and (3) the discharge care bundle for management beyond the acute exacerbation episode. Self-management strategies include written action plans and coaching with patient and family support. Self-management interventions facilitate the delivery of good care, can reduce exacerbations associated with admission, be cost-effective and improve quality of life. Hospitalization as a complication of exacerbation is not always unavoidable. Domiciliary care has been proposed as a solution to replace part, and perhaps even all, of the patient’s in-hospital stay, and to reduce hospital bed days, readmission rates and costs; low-risk patients can be identified using risk stratification tools. A COPD discharge bundle is another potentially important approach that can be considered to improve the management of COPD exacerbations complicated by hospital admission; it comprised treatments that have demonstrated efficacy, such as smoking cessation, personalized pharmacotherapy and non-pharmacotherapy such as pulmonary rehabilitation. COPD bundles may also improve the transition of care from the hospital to the community following exacerbation and may reduce readmission rates. Future models of care should be personalized – providing patient education aiming at behaviour changes, identifying and treating co-morbidities, and including outcomes that measure quality of care rather than focusing only on readmission quantity within 30 days.

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Section: Solutions That Empower Both Patients and Caregivers In Theirmentioning

confidence: 92%

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

Bourbeau

Echevarria

2020

Chron Respir Dis

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“…Patients with COPD, even those with mild disease, can experience exacerbations [ 48 – 51 ], which account for a large proportion of total COPD burden on the healthcare system [ 52 , 53 ]. Recommendations for reducing COPD exacerbations and treatment of stable COPD have been provided by GOLD [ 2 ], the European Respiratory Society/American Thoracic Society [ 54 ], and the Spanish Society of Pulmonology and Thoracic Surgery [ 55 , 56 ].…”

Section: Initial Studies With Tiotropium Inhalation Powdermentioning

confidence: 99%

Tiotropium in chronic obstructive pulmonary disease – a review of clinical development

Anzueto

Miravitlles

2020

Respir Res

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Background: Bronchodilators are the mainstay of pharmacological treatment in chronic obstructive pulmonary disease (COPD), and long-acting muscarinic antagonist (LAMA) monotherapy is recommended as initial treatment for Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups B, C, and D. Main body: Tiotropium bromide was the first LAMA available for COPD in clinical practice and, because of its long duration of action, is administered once daily. Tiotropium was initially available as an inhalation powder delivered via a dry-powder inhaler (DPI). Later, tiotropium also became available as an inhalation spray delivered via a soft mist inhaler (SMI). The SMI was designed to overcome or minimize some of the issues associated with other inhaler types (eg, the need for strong inspiratory airflow with DPIs). Results of short-and long-term randomized, controlled clinical trials of tiotropium in patients with COPD indicated tiotropium was safe and significantly improved lung function, health-related quality of life, and exercise endurance, and reduced dyspnea, lung hyperinflation, exacerbations, and use of rescue medication compared with placebo or active comparators. These positive efficacy findings triggered the evaluation of tiotropium in fixed-dose combination with olodaterol (a long-acting β 2-agonist). In this review, we provide an overview of studies of tiotropium for the treatment of COPD, with a focus on pivotal studies. Conclusion: Tiotropium is safe and efficacious as a long-term, once-daily LAMA for the maintenance treatment of COPD and for reducing COPD exacerbations. The SMI generates a low-velocity, long-duration aerosol spray with a high fine-particle fraction, which results in marked lung drug deposition. In addition, high inspiratory flow rates are not required.

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“…14 Adherence to self-management interventions in patients with chronic diseases like COPD and CHF might be influenced by factors, such as age, social support, disease perception and knowledge, the role of the healthcare provider and case manager, (digital) health literacy, and to what level an intervention fits a patient's needs and competences. [17][18][19][20][21][22][23][24][25] Electronic health (eHealth) could play an important role in improving adherence, as it makes it easier to provide tailored information, give reminders, and adapt to patients' needs. 21,[26][27][28][29] Self-management interventions are increasingly provided to patients with COPD or CHF by using eHealth technology at home to support patients in health communication (eg teleconsultation), selfmonitoring (eg symptom diary, wearables), and their medical treatment (eg self-treatment with prednisolone).…”

Section: Introductionmentioning

confidence: 99%

Adherence to an eHealth Self-Management Intervention for Patients with Both COPD and Heart Failure: Results of a Pilot Study

Sloots¹,

Bakker²,

Palen³

et al. 2021

COPD

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Background: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) often coexist and share periods of symptom deterioration. Electronic health (eHealth) might play an important role in adherence to interventions for the self-management of COPD and CHF symptoms by facilitating and supporting home-based care. Methods: In this pilot study, an eHealth self-management intervention was developed based on paper versions of multi-morbid exacerbation action plans and evaluated in patients with both COPD and CHF. Self-reporting of increased symptoms in diaries was linked to an automated decision support system that generated self-management actions, which was communicated via an eHealth application on a tablet. After participating in selfmanagement training sessions, patients used the intervention for a maximum of four months. Adherence to daily symptom diary completion and follow-up of actions were analyzed. An add-on sensorized (Respiro ® ) inhaler was used to analyze inhaled medication adherence and inhalation technique. Results: In total, 1148 (91%) of the daily diaries were completed on the same day by 11 participating patients (mean age 66.8 ± 2.9 years; moderate (55%) to severe (45%) COPD; 46% midrange left ventricular function (LVF) and 27% reduced LVF). Seven patients received a total of 24 advised actions because of increased symptoms of which 11 (46%) were followed-up. Of the 13 (54%) unperformed advised actions, six were "call the case manager". Adherence to inhaled medication was 98.4%, but 51.9% of inhalations were performed incorrectly, with "inhaling too shortly" (<1.25 s) being the most frequent error (79.6%). Discussion: Whereas adherence to completing daily diaries was high, advised actions were inadequately followed-up, particularly the action "call the case manager". Inhaled medication adherence was high, but inhalations were poorly performed. Future research is needed to identify adherence barriers, further tailor the intervention to the individual patient and analyse the intervention effects on health outcomes.

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Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence

Cited by 27 publications

References 33 publications

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

Models of care across the continuum of exacerbations for patients with chronic obstructive pulmonary disease

Tiotropium in chronic obstructive pulmonary disease – a review of clinical development

Adherence to an eHealth Self-Management Intervention for Patients with Both COPD and Heart Failure: Results of a Pilot Study

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