According to a recent review, digital technology can be used for COPD self-management, learning correct inhaler technique, and receiving care from health care professionals.
A narrative review published in Therapeutic Advances in Respiratory Disease claims that digital technology can be beneficial for patients with chronic obstructive pulmonary disease (COPD) to learn proper self-management of the disease, although the authors noted that further studies will be needed to verify the effectiveness of such technology.
The aim of the review was to highlight some advancements in technology in the care of COPD, discuss potential pitfalls of these technological advancements, and provide the essential areas of research required to facilitate new technology in this area of COPD treatment.
To identify studies to include in this review, the researchers performed independent search strategies. Studies were included if they demonstrated the potential of digital health innovations for use as self-management plans, providing pulmonary rehabilitation, improving inhaler technique, and identifying exacerbations to allow early treatment. They also did a literature search to identify the potential of digital health during COVID-19. The researchers did not assess study quality using any external tools and no protocol was written or published for this review.
According to the researchers, digital health apps have the potential to provide a range of solutions to COPD care needs, including real-time video conferencing, sending and receiving emails or notifications, telehealth interventions, patient education programs, interactive self-management programs, and tools to record and communicate symptoms.
Several studies that the researchers cited indicated an improvement in COPD Assessment Test (CAT) results after patients with COPD were put on self-management plans that comprised patient education on inhaler techniques and symptom alerts compared with those who received usual care.
Digital self-management plans have been associated with improvements in patients with asthma. When given digital self-management tools, patients with asthma demonstrated an improvement in several quality-of-life scores, according to a study the researchers cited.
Telehealth interventions were also identified as a popular method of communicating with patients with COPD. According to a survey that the researchers cited, one-third of 65 COPD services from 52 National Health Service trusts reported using some form of telehealth. However, another review referenced in this article found that telehealth interventions were associated with fewer hospitalizations and emergency department visits but increased mortality in patients with COPD.
Digital health care apps, smart inhalers, and inhaler add-ons have demonstrated signs of being effective in teaching proper inhaler technique to patients with COPD. According to studies cited by the review authors, patients with asthma who used these apps had fewer critical inhaler errors, improved CAT scores, and improved 6-minute walk test scores. Adherence rates also rose to 94.3% in one study. Other studies showed the benefit of Bluetooth inhalers and smart devices, with one showing decreased use of the inhaler after 6 months of using an inhaler that tracked usage and provided disease management information.
Artificial intelligence (AI) technology has also proven useful in identifying patients with COPD who need hospital admission. According to a study the researchers cited, AI has been used to predict hospital admissions with an area under the curve of 0.74. AI was also used to predicted advanced exacerbations of COPD in a different study.
The use of digital health apps has increased in the wake of the COVID-19 pandemic. According to the authors, a recent study showed that 66% of 335 surveyed patients would consider replacing their face-to-face consultations with a telephone review. Digital health innovations could help triage those who need immediate care to avoid the risk of a patient with COPD contracting COVID-19.
Although digital health innovations offer much promise, there are still pitfalls to this technology. Accessibility, ensuring health literacy, sustained patient engagement, successful integration into health care systems, and effective regulation are a few of the barriers to ensuring digital health can be used for any patient with COPD.
Internet access is the largest barrier to digital innovations being available worldwide. Whereas the population of northern Europe has a 96% rate of internet access, only 51% of the world population has access to the internet. People without internet tend to be older and of lower socioeconomic class than average, which are 2 demographics that have a higher prevalence of COPD and have the most unmet clinical need, according to the review.
The problem of inclusivity is also apparent in the studies that the reviewers used for this review. Adherence to digital platforms is unknown in different ethnic groups and age groups, which could lead to a digital divide. This inclusivity issue can be addressed with voice interfaces for older patients. Digital accessibility is also a necessary consideration when thinking about implementing digital innovations in medicine.
Those with low health literacy could also be harmed by efforts that lack inclusion. In a study cited by the researchers, participants with low health literacy responded positively to a digital intervention program, which could mean that those with low health literacy can still benefit from the digital technology.
Although there are benefits to digital interventions, there are some drawbacks for the participants surveyed as well. A cited study showed that participants felt burdened by the increased responsibility and self-management tools in digital interventions. Other studies cited concerns around overtreatment of patients. Health care professionals have also said that they are concerned about telehealth visits as they cannot take social and physical cues from the information given to them. The researchers recommended that health care professionals get proper training in digital innovations to address their concerns.
One of the last barriers to digital innovations becoming more prevalent in health care systems is the integration of those digital innovations and providing proper training. The researchers said that digital innovations will need to be implemented with global leadership, especially for areas of low socioeconomic status. Personal commitment from leaders is crucial for successful integration.
There are some limits to this review. It deals with a rapidly evolving field that has constantly reported new feasibility studies and digital innovations. As this review was not a formal systematic review, there may be selection bias, publication bias, and other biases. The authors did not report the quality of the studies used in this review, and they also used abstracts in this review. The researchers said a proper systematic review of evidence should be done in the future.
The investigators wrote that innovative solutions are required to allow affordable, scalable access to health care to empower patients and facilitate effective self-management.
“The successful incorporation of effective and engaging digital health innovations into healthcare systems to provide digitally augmented care has the potential to remodel global disease management and meet the great unmet clinical need of COPD,” the authors concluded.
Watson A, Wilkinson TMA. Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research. Ther Adv Respir Dis. 2022;16:1-23. doi:10.1177/17534666221075493