Abstract

Evidence of clinical benefit and cost-effectiveness from daily symptom and simple telemonitoring in COPD is unproven. The CHROMED study explored the effect of telemonitoring in older people with COPD and significant co-morbidity who performed daily forced oscillation measurements via RESMON PRO DIARY to identify early physiological change associated with an exacerbation.

Six centres in 5 countries randomised 312 people to 9 months telemonitoring (154) or daily symptom questionnaires (158). Each day the monitored group recorded symptoms, pulse, BP, oxygen saturation and airway resistance and reactance. An alert was generated if results exceeded pre-determined parameters and the participant was contacted by their local clinical centre to consider additional treatment.

Baseline characteristics were evenly matched: mean age 71 years, FEV1 1.3L (50% predicted) and SGRQ score 49. 61% of subjects had 2+ exacerbations and 42% had been hospitalised in the previous year.

Time to first hospitalisation did not differ albeit the monitoring group had fewer hospitalisations (79 vs 103; p=ns) and days in hospital (329 vs. 650; p=ns). However, subjects hospitalized with an AE COPD in the previous year (n=128) had a lower hospitalisation rate (p<0.04). Quality of life (EQ-5D) and health status (CAT) did not differ between groups. Mean cost in the monitored group was marginally lower (€4,615 vs €4,831; p=ns).

Telemonitoring including daily forced oscillation impacted neither time to first hospitalisation nor health status. Reduction in hospitalisation rate in subjects with previous hospitalisation suggests these individuals may benefit from telemonitoring and earlier treatment.