title: Monitoring of Physiological Parameters to Predict Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review.
abstract: BACKGROUND
  The value of monitoring physiological parameters to predict chronic obstructive pulmonary disease (COPD) exacerbations is controversial. A few studies have suggested benefit from domiciliary monitoring of vital signs, and/or lung function but there is no existing systematic review.
  
  
  OBJECTIVE
  To conduct a systematic review of the effectiveness of monitoring physiological parameters to predict COPD exacerbation.
  
  
  METHODS
  An electronic systematic search compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. The search was updated to April 6, 2016. Five databases were examined: Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (Medline), Excerpta Medica dataBASE (Embase), Allied and Complementary Medicine Database (AMED), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and the Cochrane clinical trials database.
  
  
  RESULTS
  Sixteen articles met the pre-specified inclusion criteria. Fifteen of these articules reported positive results in predicting COPD exacerbation via monitoring of physiological parameters. Nine studies showed a reduction in peripheral oxygen saturation (SpO₂%) prior to exacerbation onset. Three studies for peak flow, and two studies for respiratory rate reported a significant variation prior to or at exacerbation onset. A particular challenge is accounting for baseline heterogeneity in parameters between patients.
  
  
  CONCLUSIONS
  There is currently insufficient information on how physiological parameters vary prior to exacerbation to support routine domiciliary monitoring for the prediction of exacerbations in COPD. However, the method remains promising.
authors.affiliation: UCL Respiratory, Royal Free Campus, University College London, London NW3 2PF, UK. Ahmed.rajeh.15@ucl.ac.uk.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Al Rajeh
authors.affiliation: UCL Respiratory, Royal Free Campus, University College London, London NW3 2PF, UK. j.hurst@ucl.ac.uk.
authors.forename: John R
authors.initials: JR
authors.lastname: Hurst
keywords: COPD; exacerbation; home monitoring; lung function; physiological signs; telehealth; vital signs