Decision Making Concepts for the Remote, Personalized Evaluation of COPD Patients’ Health Status
14 October 2013
accepted: 07 August 2014
22 January 2018 (online)
Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Biosignal Interpretation: Advanced Methods for Neural Signals and Images”.
Objectives: This paper presents the main concepts of a decision making approach for the remote management of COPD patients based on the early detection of disease exacerbation episodes.
Methods: An e-diary card is defined to evaluate a number of physiological variables and clinical parameters acquired remotely by means of wearable and environmental sensors deployed in patients’ long-stay settings. The automatic evaluation of the card results in a so-called Chronic Status Index (CSI) whose computation is tailored to patients’ specific manifestation of the disease (i.e., patient’s phenotype). The decision support method relies on a parameterized analysis of CSI variations so as to early detect worsening changes, identify exacerbation severity and track the patterns of recovery.
Results: A preliminary study, carried out in real settings with 30 COPD patients monitored at home, has shown the validity and sensitivity of the method proposed, which was effectively able to timely and correctly identify patients’ critical situation.
Conclusion: The preliminary results showed that the proposed e-diary card, which presents several novel features with respect to other solutions presented in the literature, can be practically used to remotely monitor COPD patients.
- 1 Polisena J, Tran K, Cimon K, Hutton B, McGill S, Palmer K, Scott RE. Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Telemed Telecare 2010; 16 (03) 120-127.
- 2 Vitacca M, Bianchi L, Guerra A, Fracchia C, Spanevello A, Balbi B, Scalvini S. Tele-assistance in chronic respiratory failure patients: a randomised clinical trial. Eu Resp J 2009; 33: 411-418.
- 3 Chiarugi F, Colantonio S, Emmanoulidou D, Martinelli M, Moroni D, Salvetti O. Decision support in heart failure through processing of electro- and echocardiograms. AIiM, Elsevier 2010; 50: 95-104.
- 4 Basilakis J, Lovell NH, Redmond SJ, Celler BG. Design of a decision-support architecture for management of remotely monitored patients. IEEE Trans Inf Tech Biomed 2010; 14 (05) 1216-1226.
- 5 World Health Organization. Chronic obstructive pulmonary disease. [Accessed March, 2014]. Fact sheet No. 315. Available from. http://www. goldcopd.org/guidelines-global-strategy-for-diagnosis-management.html.
- 6 Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 1608-1613.
- 7 Wedzicha J, Seemungal T. COPD exacerbations: defining their cause and prevention. The Lancet 2007; 370 9589 786-796.
- 8 Leidy NK. et al. Standardizing Measurement of Chronic Obstructive Pulmonary Disease Exacerbations. Reliability and Validity of a Patient-reported Diary. Am J Respir Crit Care Med 2011; 183 (03) 323-329.
- 9 Vijayasaratha K, Stockley RA. Reported and unreported exacerbations of COPD: analysis by diary cards. Chest 2008; 133: 34-41.
- 10 Woolhouse IS, Hill SL, Stockley RA. Symptom resolution assessed using a patient directed diary card during treatment of acute exacerbations of chronic bronchitis. Thorax 2001; 56 (12) 947-953.
- 11 Cruz J, Brooks D, Marques A. Home telemonitoring in COPD: A systematic review of methodologies and patients’ adherence. Int J Med Inform 2014; 83 (04) 249-263.
- 12 Maiolo C, Mohamed E, Fiorani C, Lorenzo AD. Home telemonitoring for patients with severe respiratory illness: the Italian experience. J Telemed Telecare 2003; 9 (02) 67-71.
- 13 Vontetsianos Th, Giovas P, Katsaras T, Rigopoulou A, Mpirmpa G, Giaboudakis P. et al. Telemedicine-assisted home support for patients with advanced chronic obstructive pulmonary disease: preliminary results after nine-month follow-up. J Telemed Telecare 2005; 11 S (01) 86-88.
- 14 Paré G, Sicotte C, St Jules D, Gauthier R. Cost-minimization analysis of a telehomecare program for patients with chronic obstructive pulmonary disease. Telemed J e-Health 2006; 12 (02) 114-121.
- 15 Trappenburg J, Niesink A, de Weert-van Oene G, van der Zeijden H, van Snippenburg R, Peters A. et al. Effects of telemonitoring in patients with chronic obstructive pulmonary disease. Telemed J e-Health 2008; 14 (02) 138-146.
- 16 Ding H, Moodley Y, Kanagasingam Y, Karunanithi M. A mobile-health system to manage chronic obstructive pulmonary disease patients at home. Conf Proc IEEE Eng Med Biol Soc 2012. 2012: 2178-2181.
- 17 van der Heijden M, Lucas PJ, Lijnse B, Heijdra YF, Schermer TR. An autonomous mobile system for the management of COPD. J Biomed Inform 2013; 46 (03) 458-469.
- 18 Song B, Wolf KH, Gietzelt M, Al Scharaa O, Tegtbur U, Haux R, Marschollek M. Decision support for teletraining of COPD patients. Methods Inf Med 2010; 49 (01) 96-102.
- 19 Rosso R, Munaro G, Salvetti O, Colantonio S, Ciancitto F. CHRONIOUS: an open, ubiquitous and adaptive chronic disease management platform for COPD, CKD and Renal Insufficiency. In Armentano RL, Monzon JE, Hudson D, Patton JL. editors Proceedings of EMBC 2010. Buenos Aires: IEEE; 2010: 6850-6853.
- 20 Burgel PR, Paillasseur JL, Caillaud D, Tillie-Leblond I, Chanez P, Escamilla R. et al. Clinical COPD phenotypes: a novel approach using principal component and cluster analyses. Eur Respir J 2010; 36 (03) 531-539.
- 21 Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA. et al. The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index, in Chronic Obstructive Pulmonary Disease. N Engl J Med 2004; 350: 1005-1012.
- 22 Isselbacher KJ. Harrison’s Principles of Internal Medicine. 9th ed. University of Michigan: McGraw-Hill; 1980
- 23 West JB. Respiratory Physiology - The Essentials. Baltimore: Williams & Wilkins; 1974
- 24 Murray JF. Textbook of respiratory Medicine. 4th ed. Philadelphia: Elsevier Saunders; 2005
- 25 Tobin MJ. Principles and practice of mechani- cal ventilation. 2nd ed. New York: McGraw-Hill; 2006
- 26 Connors Jr AF, Dawson NV, Thomas C, Harrell Jr FE, Desbiens N, Fulkerson WJ. et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). American Journal of Respiratory and Critical Care Medicine 1996; 154: 959-967.
- 27 Pitta F, Troosters T, Spruit MA, Probst VA, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2005; 171: 972-977.
- 28 Aymerich JG, Lange P, Benet M, Schnohr P, Antò JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax 2006; 61: 772-778.
- 29 Donaldson GC, Wilkinson TMA, Hurst JR, Perera WR, Wedzicha JA. Exacerbations and Time Spent Outdoors in Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine 2005; 171: 446-452.
- 30 Janssen DJ, Spruit MA, Leue C, Gijsen C, Hameleers H, Schols JM, Wouters EF. Symptoms of anxiety and depression in COPD patients entering pulmonary rehabilitation. Chron Respir Dis 2010; 7 (03) 147-157.
- 31 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (06) 361-370.
- 32 Hurst J, Donaldson G, Quint J, Goldring J, Patel A, Wedzicha J. Domiciliary pulse-oximetry at exacerbation of chronic obstructive pulmonary disease: prospective pilot study. BMC Pulm Med 2010; 10 (01) 52.