Abstract
BackgroundA home based tele-monitoring system was developed to assess the effects of heat stress (days > 25°C) on clinical and functional status in patients with chronic obstructive pulmonary disease (COPD).MethodsSixty-two COPD patients (GOLD II–IV) were randomized into a tele-monitoring Group (TG, N = 32) or Control Group (CG, N = 30). Tele-monitoring included 1) daily clinical status (COPD Assessment Test-CAT), 2) daily lung function and 3) weekly 6-minute walk test (6MWT). Duration of monitoring lasted a total of nine months (9 M).ResultsFrom June 1st–August 31st 2012, 32 days with heat stress (29.0 ± 2.5°C) were recorded and matched with 32 thermal comfort days (21.0 ± 2.9°C). During heat stress, the TG showed a significant reduction in lung function and exercise capacity (FEV1% predicted: 51.1 ± 7.2 vs. 57.7 ± 5.0%; P <0.001 and 6MWT performance: 452 ± 85 vs. 600 ± 76 steps; P <0.001) and increase in CAT scores (19.2 ± 7.9 vs. 16.2 ± 7.2; P <0.001).Over summer, significantly fewer TG patients suffered exacerbation of COPD compared to CG patients (3 vs. 14; P = 0.006). Over entire 9 M follow-up, the TG group had fewer exacerbations compared to CG (7 vs. 22; P = 0.012), shorter cumulative hospital stay (34 vs. 97 days) and 43% fewer specialist consultations (24. vs. 42; P = 0.04).ConclusionHeat stress affects clinical and functional status in COPD. Tele-monitoring reduces exacerbation frequency and health care utilization during heat stress and other periods of the year. Trial registrationDRKS-ID: DRK00000705.
Highlights
A home based tele-monitoring system was developed to assess the effects of heat stress on clinical and functional status in patients with chronic obstructive pulmonary disease (COPD)
To be eligible for the study, patients had to be diagnosed with COPD Stage IIIV on the basis of a clinical history such as smoking status, physical examination and meet the post-bronchodilator spirometric criteria according to the Global initiative for obstructive lung disease (GOLD) guidelines (FEV1 < 80% predicted & Forced expiratory volume in one second (FEV1)/FVC ratio
Patient characteristics Sixty-two patients with COPD were included in this current study analysis (TG, N = 32; control group (CG) N = 30) with moderate to very severe disease (GOLD II, N = 25; GOLD III, N = 25, GOLD IV, N = 12)
Summary
A home based tele-monitoring system was developed to assess the effects of heat stress (days > 25°C) on clinical and functional status in patients with chronic obstructive pulmonary disease (COPD). Tele-monitoring included 1) daily clinical status (COPD Assessment Test-CAT), 2) daily lung function and 3) weekly 6-minute walk test (6MWT). The lung is of particular interest in this context, because it can be seen as the portal organ of the environment For this reason, chronic obstructive pulmonary disease (COPD) is an ideal disease model to help us comprehend the dynamics between human health and climate change [1]. There is abundant epidemiological data showing increased morbidity and mortality rates during heat waves in patients with respiratory diseases, including COPD [7,8,9,10]. Evidence has shown that elderly patients with COPD are at greater risk for exacerbation of COPD if the following social and/or working factors apply: 1) living alone, 2) confined to the house, 3) have poor social contact, 4) poverty, 5) no access to transportation, 6) no green space and 7) no working fan or air conditioning use [11]
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