How Telehealth Could Help Keep Your COPD More Stable

What if technology could make a difference in the progression and stability of your respiratory health? Good news! It just might, according to a recent study by researchers at the University of Alabama, Burlington.¹

The technology I'm referring to is called "video telehealth." The study looked at what might happen when this technology was used right after a hospitalization for a COPD exacerbation. And they found that it greatly lessened the chances that patients would need to go back in the hospital within the next 30 days.

The risk of COPD exacerbations

First of all, let's clarify this long word: exacerbation. What does it mean, in case you haven't had the pleasure? An exacerbation is simply a fancy medical term for a severe worsening of your usual COPD symptoms. It is also referred to as a "flare up" or "flare."² Such flare-ups are often caused by respiratory infections. But in some cases, they may be caused by exposure to some kind of trigger or environmental irritant. Other times, the cause is unknown.

Exacerbations should be taken seriously, as they can lead to death, when untreated. Most often, though, they lead to hospitalization. And that can be costly, both from a financial standpoint and a health standpoint. In fact, hospitalizations account for up to 2/3 of all health care costs for COPD patients. Even more concerning is that 1 out of every 5 patients who were hospitalized for a flare ended up going back into the hospital within 30 days.³

But what is telehealth?

I remember 25 years ago when I was working in home health care, telemedicine (as it was called back then) was just emerging as an innovative approach to monitoring patients from afar. At that time, modems were still operating at unbelievably slow speeds. And there was no such thing yet as the world wide web. The applications I was seeing were primarily heart health-related. We partnered with a company that could do remote EKGs via telephone.

Telehealth, however, provides a broader scope of remote health care and digital technologies. This is because it encompasses more than just clinical care. It can also include certain non-clinical services. Specifically, the Health Resources Service Administration defines telehealth as:⁴

"the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration."

The New England Journal of Medicine defines it as:⁵

"the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies."

Examples of telehealth technologies include:

• Live video conferencing
• Mobile health apps
• Electronic transmission of health data
• Remote patient monitoring (RPM)

How our world has changed in the last couple of decades! According to the NEJM, 95 percent of Americans today own cell phones and 77 percent own smartphones.⁵ Why does this matter? It matters because it allows patients to participate actively in their own care, by doing things such as:

• Tracking health measurements
• Setting medication and appointment reminders
• Sharing information with their health care teammates

There are many avenues patients can use to engage in telehealth. We're going to look specifically at video teleconferencing.

Telehealth and COPD

Most phones, computers, and tablets today have high-resolution video cameras as standard equipment. So, video teleconferencing between patients and health care staff becomes rather easy. This can greatly improve access to health care services and promote a better quality of care.

The study I mentioned earlier used the fact that previous studies have shown that pulmonary rehabilitation following a hospital stay for COPD has managed to reduce readmissions by 56% in many cases.³ Pulmonary rehabilitation includes multidisciplinary services whose goal is to improve the quality of life and disease stability.

Using that approach, but remotely, the researchers designed a program that delivered pulmonary rehab via video telehealth. Here are more details of the study:

• All patients had been hospitalized for a COPD exacerbation
• All levels of COPD severity were included
• Rehab consisted of 36 exercise sessions provided over 12 weeks, and adapted to each patient's health status
• Exercises included breathing, stretching and aerobic exercises
• Goal was to achieve heart rates between 60% and 80% of the maximum baseline (measured by a 6-minute walk test)

Results of the study

The results were significant. In fact, there was a marked decrease in the number of patients readmitted to the hospital, among those who participated in the telehealth sessions:³

• Only 6.2% of patients who had the telehealth sessions were rehospitalized within the 30 days
• 18.1% of those who didn't participate were rehospitalized

So three times as many patients who did not participate in telehealth had negative outcomes as those who did!

In Summary

According to Surya P. Bhatt, M.D., associate professor in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Alabama, Burlington: “Participating in an exercise program soon after hospitalization for an acute exacerbation of COPD is associated with a substantially lower readmission rate within 30 days of discharge."⁶

This study shows some promising results. However, researchers emphasize that evidence needs to be confirmed in a larger, randomized clinical trial.

Unfortunately, pulmonary rehab programs are not always widely available, depending on where you live. Or, you may have no easy way to access them, due to your mobility or lack of transportation. Should more programs become available via video telehealth, there is potential for many more COPD patients to be helped. And that, hopefully, will lead to better health outcomes.

If you're hospitalized for a COPD flare-up or respiratory infection, be sure to ask your doctor about the availability and value of pulmonary rehab for you.