title: Using a mobile health application to support self-management in chronic obstructive pulmonary disease: a six-month cohort study.
abstract: BACKGROUND
  Self-management strategies have the potential to support patients with chronic obstructive pulmonary disease (COPD). Telehealth interventions may have a role in delivering this support along with the opportunity to monitor symptoms and physiological variables. This paper reports findings from a six-month, clinical, cohort study of COPD patients' use of a mobile telehealth based (mHealth) application and how individually determined alerts in oxygen saturation levels, pulse rate and symptoms scores related to patient self-initiated treatment for exacerbations.
  
  
  METHODS
  The development of the mHealth intervention involved a patient focus group and multidisciplinary team of researchers, engineers and clinicians. Individual data thresholds to set alerts were determined, and the relationship to exacerbations, defined by the initiation of stand-by medications, was measured. The sample comprised 18 patients (age range of 50-85 years) with varied levels of computer skills.
  
  
  RESULTS
  Patients identified no difficulties in using the mHealth application and used all functions available. 40% of exacerbations had an alert signal during the three days prior to a patient starting medication. Patients were able to use the mHealth application to support self- management, including monitoring of clinical data. Within three months, 95% of symptom reporting sessions were completed in less than 100 s.
  
  
  CONCLUSIONS
  Home based, unassisted, daily use of the mHealth platform is feasible and acceptable to people with COPD for reporting daily symptoms and medicine use, and to measure physiological variables such as pulse rate and oxygen saturation. These findings provide evidence for integrating telehealth interventions with clinical care pathways to support self-management in COPD.
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Maxine
authors.initials: M
authors.lastname: Hardinge
authors.affiliation: Oxford Health Foundation Trust, Oxford, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Rutter
authors.affiliation: Department of Engineering Science, University of Oxford, Oxford, UK. carmelo.velardo@eng.ox.ac.uk.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Velardo
authors.affiliation: Department of Engineering Science, University of Oxford, Oxford, UK.
authors.forename: Syed Ahmar
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Veronika
authors.initials: V
authors.lastname: Williams
authors.affiliation: Department of Engineering Science, University of Oxford, Oxford, UK.
authors.forename: Lionel
authors.initials: L
authors.lastname: Tarassenko
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Farmer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D063731:Mobile Applications / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012648:Self Care / Q000592:standards*; D017216:Telemedicine / Q000592:standards*