Background Exacerbations of COPD are one of the commonest causes of admission to hospital in the UK. Re-admission is also a significant problem and is currently the fifth most common cause of hospitalisation. Self-management interventions have shown benefits in improving health related quality of life and reducing hospital admissions. We explored the potential for an online self-management system to improve outcomes for COPD patients recently admitted to hospital with an exacerbation.
Methods We conducted a feasibility randomised controlled trial of a digital health platform ‘myCOPD’. 41 Patients were recruited following an admission to hospital with an acute exacerbation of COPD. Patients gave written informed consent and were randomised to either receive usual care (n=21) (including written self-management plan) or the myCOPD app (n=20) for 3 months. Patients attended 2 visits and received monthly telephone contacts to capture AEs. Exacerbations, readmission, CAT and PAM scores were captured. Inhaler technique was assessed for critical errors, pre and post intervention by a blinded team. Analysis was performed by an independent blinded statistician to an a priori SAP.
Results The overall cohort had a mean (SD) age of 66.6 (7) years, and had moderate to very severe disease FEV1 44 (17.6)% predicted. Exacerbations were less frequent in the digital arm compared to usual care over 3 m; 18 vs 34, p=0.047 for mean difference. Hospital readmissions were lower in the digital intervention arm than in usual care 4 vs 13. Patients’ inhaler technique (total critical error count) improved in the digital intervention arm (101 improving to 20 errors) compared to usual care (100 and 72) p=0.008.As did CAT scores, with a differential improvement of −4.8 (CI −8.8 to −0.7) p=0.021 in favour of digitally enhanced care. No differences were seen between treatment arms for HAD, MRC, SGRQ or PAM scores.
Conclusion In this early clinical study of the digital self- management platform myCOPD, its use has been shown to significantly improve exacerbation rates, lower re-admission numbers, improve symptom control and reduce the number of critical errors in inhaler technique compared to usual written self-management. This provides a strong basis for the design of a large multicentred trial.
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