title: A Telemedicine-Based Intervention Reduces the Frequency and Severity of COPD Exacerbation Symptoms: A Randomized, Controlled Trial.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) may not recognize worsening symptoms that require intensification of therapy. They may also be reluctant to contact a healthcare provider for minor worsening of symptoms. A telemedicine application for daily symptom reporting may reduce these barriers and improve patient outcomes.
  
  
  METHODS
  Patients hospitalized for a COPD exacerbation within the past year or using supplemental O2were approached for participation. Patients received optimal COPD care and were given a telecommunication device for symptom reporting. Initial symptom scores were obtained while patients were in their usual state of health. Patients were randomly assigned to an intervention group or a control group (usual medical care). The control group patients were instructed to seek medical care if their condition worsened. The intervention group symptom scores were assessed by a computer algorithm and compared with initial values. Scores 1 or more points above the initial score generated an "alert," and patients were reviewed by a nurse and referred to a physician who prescribed treatment.
  
  
  RESULTS
  Eighty-six patients were screened; 79 met entry criteria and were randomized (intervention group, n=39; control group, n=40). Twelve patients submitted five or fewer symptom reports (5 intervention; 7 control) and were excluded from the analysis. Daily peak flow and dyspnea scores improved only in the intervention group. There were no differences in hospitalization and mortality rates between groups. No serious adverse events were reported.
  
  
  CONCLUSIONS
  A telemedicine-based symptom reporting program facilitated early treatment of symptoms and improved lung function and functional status.
authors.affiliation: 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.
authors.forename: Francis C
authors.initials: FC
authors.lastname: Cordova
authors.affiliation: 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Ciccolella
authors.affiliation: 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.
authors.forename: Carla
authors.initials: C
authors.lastname: Grabianowski
authors.affiliation: 2 Biostatistics Consulting Center, Temple University School of Medicine , Philadelphia, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Gaughan
authors.affiliation: 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Brennan
authors.affiliation: 3 Department of Neuroscience, Physiology, and Pharmacology, Philadelphia College of Osteopathic Medicine , Philadelphia, Pennsylvania.
authors.forename: Frederick
authors.initials: F
authors.lastname: Goldstein
authors.affiliation: 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.|4 Temple University School of Pharmacy , Philadelphia, Pennsylvania.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jacobs
authors.affiliation: 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Criner
keywords: chronic obstructive pulmonary disease exacerbations; disease management; telemedicine