Telehealthcare for chronic obstructive pulmonary disease
Open accessAbstract
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness of telehealthcare for COPD compared with usual face-to-face care. SEARCH STRATEGY: We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed-effects modelling as heterogeneity was low (I(2) < 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference -6.57 (95% confidence interval (CI) -13.62 to 0.48); minimum clinically significant difference is a change of -4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages.
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In the third randomised controlled trial of COPD, there was evidence of a reduction in exacerbations, but the intervention was well-resourced and complex including education and visits from nurses as well as telephone support.
“There was evidence from the third randomised controlled trial of a reduction in exacerbations, however, the intervention in this trial was well-resourced and complex including education and visits from nurses as well as telephone support [64].”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [64]
There was no change in mortality in that COPD trial.
“There was also no change in mortality in this trial.”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [64]
Two reviews reported reduced hospitalisations in COPD with heterogeneous telehealthcare interventions.
“Two reviews reported reduced hospitalisations in COPD, again there was a variety of heterogeneous telehealthcare interventions pooled together, from simple repeated telephone support to complex interventions including education, telemonitoring and home some home visits [63], [64].”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [64]
McLean et al found significantly fewer emergency department visits and hospital admissions than with usual care in COPD.
“McLean et al found significantly fewer emergency department visits and hospital admissions than with usual care.”
Findings for quality of life assessed by St George's Respiratory Questionnaire were inconsistent.
“Findings for quality of life assessed by St George’s Respiratory Questionnaire were inconsistent [68].”
Despite some positive findings, the telehealth interventions were components in complex interventions and further evaluation would be required to clarify their role in COPD.
“The authors emphasized that, despite some positive findings, the telehealth interventions were components in complex interventions and further evaluation would be required to clarify their role in COPD [68].”
Both 2-star COPD meta-analyses concerned home-based telehealth using a variety of technologies, incorporating information transmission with personalized feedback.
“Both 2-star meta-analyses concerned home-based telehealth using a variety of technologies, incorporating information transmission with personalized feedback.”
The COPD reviews included 2 meta-analyses, both weighted 2 stars.
“These included 2 meta-analyses, both weighted 2 stars [67,68].”
Four reviews (3 meta-analyses and 1 narrative synthesis) analyzed the impact of telehealth on all-cause mortality, and none showed a significant difference versus usual care.
“A total of 4 reviews (3 meta-analyses and 1 narrative syntheses) analyzed the impact of telehealth on all-cause mortality, and none showed a significant difference versus usual care [65,66,68,69,71,72].”
Of the 8 COPD reviews, 7 analyzed the impact on disease control.
“Of the 8 COPD reviews, 7 analyzed the impact on disease control [27,64-69].”
None of the reviews assessing mortality in COPD showed any significant improvement with telehealth.
“In contrast, none of the reviews assessing mortality in COPD showed any significant improvement with telehealth [65,66,68,69].”
Findings for monitoring and feedback in asthma and COPD were mostly neutral or inconsistent.
“This was the most commonly described telehealth component in the included systematic reviews and was associated with improved clinical outcomes in diabetes and heart failure [33,35,36,38,42,44,54,58]; however, findings for asthma and COPD were mostly neutral or inconsistent [61-63,65,66,68,69].”
Interventions with multiple components, or more intensive interventions, may be associated with greater benefits.
“Interventions with multiple components, or more intensive interventions, may be associated with greater benefits [30,53,63,68].”
There was some evidence for reduced hospitalization with telehealth interventions in more severe asthma and COPD.
“There was some evidence for reduced hospitalization with telehealth interventions in more severe asthma and COPD [63,68]”
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“Research on the effectiveness of telemonitoring in COPD has focused primarily on the impact of interventions on hospital admissions and cost-effectiveness, although has also reported on quality of life and patient satisfaction measures [19,20].”
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- Authors
- McLean, S., Nurmatov, U., Liu, J. L., Pagliari, C., Car, J., & Sheikh, A.
- Affiliations
- University of Edinburgh (GB)
- University of Dundee (GB)
- University of Ljubljana (SI)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2011-07-06
- Volume
- 2012
- Issue
- 8
- Pages
- CD007718-CD007718
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC8939044
- OpenAlex
- W2121606815
- Cited by
- 225
- References
- 73
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 6 · 2023: 10 · 2022: 13 · 2021: 18 · 2020: 9 · 2019: 7 · 2018: 9 · 2017: 14 · 2016: 20 · 2015: 29 · 2014: 35 · 2013: 28 · 2012: 16
- FWCI
- 3.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion, other-oa)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- telemedicine, chronic obstructive pulmonary disease, COPD exacerbations, hospitalization, emergency department visits, quality of life, nurse case management, remote patient monitoring, home care, mortality, complex interventions, St George's Respiratory Questionnaire, telecare
- MeSH terms
- Emergency Service, Hospital, Hospitalization, Humans, Randomized Controlled Trials as Topic, Telemedicine, Disease Progression, Home Care Services, Hospital-Based, Pulmonary Disease, Chronic Obstructive
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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