title: Tele-monitoring reduces exacerbation of COPD in the context of climate change--a randomized controlled trial.
abstract: BACKGROUND
  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).
  
  
  METHODS
  Sixty-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).
  
  
  RESULTS
  From 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).
  
  
  CONCLUSIONS
  Heat 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.
  DRK00000705.
authors.affiliation: Division of Pneumological Oncology and Transplantology, Charité Universitätsmedizin Berlin, Berlin, Germany. melissa.jehn@charite.de.
authors.forename: Melissa
authors.initials: M
authors.lastname: Jehn
authors.forename: Gavin
authors.initials: G
authors.lastname: Donaldson
authors.forename: Bahar
authors.initials: B
authors.lastname: Kiran
authors.forename: Uta
authors.initials: U
authors.lastname: Liebers
authors.forename: Klaus
authors.initials: K
authors.lastname: Mueller
authors.forename: Dieter
authors.initials: D
authors.lastname: Scherer
authors.forename: Wilfried
authors.initials: W
authors.lastname: Endlicher
authors.forename: Christian
authors.initials: C
authors.lastname: Witt
mesh_terms: D000368:Aged; D057231:Climate Change; D005260:Female; D005858:Germany; D018882:Heat Stress Disorders / Q000150:complications / Q000503:physiopathology*; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000503:physiopathology*; D013686:Telemetry / Q000451:nursing