Abstract
Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new.
Highlights
As stated above, post-bronchodilator spirometry is necessary to confirm the diagnosis of chronic obstructive pulmonary disease (COPD) and determine the degree of airway obstruction
Chronic obstructive pulmonary disease (COPD) was conceptualized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2021 [1] as a common, preventable, and treatable disease characterized by persistent symptoms and airflow limitation
Systemic effects of COPD, in addition to aggravating exertional dyspnea, lead to detrimental outcomes in other ways. It has been known since 1996 that a low timed walk distance, arguably a measure of the overall “protoplasm” of a patient, was a stronger predictor of mortality than FEV1 in COPD patients completing pulmonary rehabilitation [9]. This was exemplified by the development of a multi-component staging system, BODE (body mass index, airway obstruction (FEV1), dyspnea (Medical Research Council rating), and exercise capacity) which was a stronger predictor of survival in COPD than any component alone [10]
Summary
Chronic obstructive pulmonary disease (COPD) was conceptualized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in 2021 [1] as a common, preventable, and treatable disease characterized by persistent symptoms and airflow limitation. Post-bronchodilator spirometry is necessary to confirm the diagnosis of COPD (in the appropriate clinical setting) and determine the degree of airway obstruction. This information, necessary, is not sufficient to capture the full impact of this disease on the individual. Systemic effects of COPD, in addition to aggravating exertional dyspnea, lead to detrimental outcomes in other ways It has been known since 1996 that a low timed walk distance, arguably a measure of the overall “protoplasm” of a patient, was a stronger predictor of mortality than FEV1 in COPD patients completing pulmonary rehabilitation [9]. This will be the main focus of the remainder of this review
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