Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial

Walker, Paul P. and Pompilio, Pasquale P. and Zanaboni, Paolo and Bergmo, Trine S. and Prikk, Kaiu and Malinovschi, Andrei and Montserrat, Josep M. and Middlemass, Jo and Šonc, Silvana and Munaro, Giulia and Marušič, Dorjan and Sepper, Ruth and Rosso, Roberto and Siriwardena, A. Niroshan and Janson, Christer and Farre, Ramon and Calverley, Peter M. A. and Dellaca', Raffaele L. (2018) Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial. American Journal of Respiratory and Critical Care Medicine, 198 (5). pp. 620-628. ISSN 1073-449X

Full content URL: http://doi.org/10.1164/rccm.201712-2404OC

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Telemonitoring in COPD: The CHROMED Study, a Randomized Clinical Trial
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Abstract

Rationale: Early detection of COPD exacerbations using tele-monitoring of physiological variables might reduce the frequency of hospitalisation. Objectives: To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique (FOT) and cardiac parameters in older COPD patients with co-morbidities.
Methods: This multicentre, randomized clinical trial recruited 312 GOLD grade II-IV COPD patients (median age 71 years [IQR:66-76], 49.6% grade II, 50.4% grade III-IV), with a history of exacerbation in the previous year and at least one non-pulmonary co-morbidity. Patients were randomised to usual care (n=158) or tele-monitoring (n=154) and followed for 9 months. All tele-monitoring patients self-assessed lung mechanics daily and in a subgroup with congestive heart failure (n=37) cardiac parameters were also monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions.
Measurements and Main results: Primary outcomes were time to first hospitalisation (TTFH) and change in EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescriptions, hospitalisation, CAT, PHQ-9 and MLHF questionnaire scores, quality-adjusted life years and healthcare costs. Tele-monitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate and questionnaire scores. In an exploratory analysis, tele-medicine was associated with fewer repeat hospitalizations (-54%, p=0.017).
Conclusions: In older COPD patients with co-morbidities remote monitoring of lung function by FOT and cardiac parameters did not change TTFH and EQ-5D.
Clinical trial registration available at www.clinicaltrials.gov, ID NCT01960907.

Keywords:Forced oscillation technique, FOT, COPD, exacerbation, chronic pulmonary disease, home monitoring
Subjects:A Medicine and Dentistry > A300 Clinical Medicine
B Subjects allied to Medicine > B710 Community Nursing
Divisions:College of Social Science > School of Health & Social Care
ID Code:31403
Deposited On:10 Apr 2018 11:19

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