The evaluation of a remote support program on quality of life and evolution of disease in COPD patients with frequent exacerbations.
Chronic obstructive pulmonary disease (COPD) patients often present considerable individual medical burden in their symptoms, limitations, and well-being that complicate medical treatment. To improve their overall health status, while reducing the number of exacerbations, a multidisciplinary approach including different elements of care is needed. The aim of this study was to evaluate the effects of a remote support program on COPD patients at high risk of experiencing worsening of their disease and other health-related outcomes.



An observational, multicenter, prospective study aimed at evaluating the impact of a 7-month remote support program on COPD patients in exacerbations control and changes in health status measured with the COPD assessment test (CAT). Factors associated with a clinically relevant decrease in CAT were assessed using a logistic regression analysis.



A total of 114 subjects started the program. The majority of the study population were males (81.6 %), retired (70.2 %), without academic qualifications or with a low level of education (68.4 %), and ex-smokers (79.8 %). The mean ± SD age was 69.6 ± 9.1 years and the BMI was 27.8 ± 5.5 Kg/m2. Overall, 41.9 % (95 % CI 31.9-52.0) patients, significantly improved health status (CAT decrease ≥ 2 points). Univariate analysis showed that significant improvement in CAT was associated with baseline CAT scores [high CAT score 19.2 (±7.5) vs. low CAT score 12.4 (±6.4); OR = 1.15, 95 % CI: 1.07-1.24; p < 0.001] and with being non-compliant [62.5 % (15/24) of non-compliant vs 34.7 % (24/69) of compliant patients significantly improved CAT scores; OR = 3.13, 95 % CI: 1.19-8.19; p = 0.021). After controlling for the effect of all variables in a multivariable logistic regression model, the only factor that remained significant was baseline CAT score. The proportion of smokers in the total population remained constant during the study. There was a significant reduction in the number of exacerbations after entering this remote support program with median -1 (IQR: -2, 0), (p < 0.001). The Morisky-Green questionnaire showed an increase of treatment compliance, namely at baseline, 25.8 % (24/93) of patients were noncompliant while in the end 66.7 % (16/24) of them became compliant) (p = 0.053).



A remote support program for high-risk COPD patients results in an improvement of the patients' health status, particularly in those with initially poor health status, and it helps to reduce COPD exacerbations.
Hospital de Alta Resolución de Loja, Agencia Sanitaria H. de Poniente, Avda Tierno Galván s/n., CP 18300, Loja, Granada, Spain. balcazarnavarrete@gmail.com.
Bernardino
0000-0003-2356-9366
B
Alcazar
Hospital Universitario Gregorio Marañón, Madrid, Spain.
Pilar
P
de Lucas
Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain.
Joan B
JB
Soriano
Departamento médico Takeda Farmacéutica España S.A., Madrid, Spain.
Alonso
A
Fernández-Nistal
Hospital Son Llàtzer, Mallorca, Spain.
Antonia
A
Fuster
Hospital Universitario Gregorio Marañón, Madrid, Spain.
Jose Miguel Rodríguez
JM
González-Moro
Hospital Universitario Puerta del Mar, Cádiz, Spain.
Aurelio
A
Arnedillo
Hospital de la Plana, Castellón, Spain.
Patricia García
PG
Sidro
Hospital Universitario Virgen de la Salud, Toledo, Spain.
María José Espinosa
MJ
de Los Monteros
D000368:Aged; D018450:Disease Progression; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D011788:Quality of Life; D012648:Self Care; D012720:Severity of Illness Index; D013030:Spain; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*
Chronic obstructive pulmonary disease; Education; Exacerbations; Management; Quality of life