Photo Credit: Sinenkiy

Mobile health has the potential to support patients in monitoring their physiologic status, but its adoption can be challenging.

Using a mobile health (mHealth) app may help people with COPD keep up with their treatments, according to the results of a small pilot study.

It’s a known issue that patients tend to abandon their COPD mobile health apps, but links between adherence to the apps and exacerbation-related outcomes are unknown, lead study author Erik WMA Bischoff, MD, PhD, and colleagues write in International Journal of Chronic Obstructive Pulmonary Disease.

In a secondary analysis of data from a previous randomized controlled trial, the researchers used a mHealth tool they had developed. They compared several outcomes in a group of patients who adhered to the tool with the same outcomes in patients who did not adhere. The authors compared the number of exacerbation-free weeks, differences in the type and timing of self-management actions, and self-efficacy and stages of grief between the two groups.

Patients Provided With Technology & Training

Participants averaged around 69 and had COPD with two or more symptom-based exacerbations in the previous 12 months: change of 2 or more consecutive days with aggravation of two major symptoms (dyspnea, sputum purulence, sputum amount) or increase in one major symptom and presence of one or more minor symptom (cold, wheeze, sore throat, cough). Researchers excluded patients with severe comorbidities and those who were unable to use the mHealth system after 2 weeks of daily training.

All participants received a smartphone, a pulse oximeter, a spirometer, and a forehead thermometer. They answered 12 yes-or-no questions on the smartphone’s touchscreen about changes in respiratory symptoms, physical limitations, emotions, and bronchodilator use. They were instructed to use the app every time they experienced, or had any doubts about, any change in respiratory symptoms or disease burden.

For the next 12 months, as needed, patients reported their blood oxygen level, forced expiratory volume in 1 second (FEV₁), and forehead temperature to the mHealth app. The app responded with advice, including: (1) increase bronchodilator use; (2) use your breathing techniques; (3) use your coughing techniques; (4) consider how you distribute your energy; (4) contact your healthcare professional; (5) initiate your prescription of prednisolone, antibiotics, or both; and (6) measure again tomorrow.

At 12 months, 13 (34.2%) of the 38 patients in the study continued using the mHealth app, and 25 (65.8%) stopped. Adherent patients did not differ from non-adherent patients in exacerbation-free weeks (mean 31.5 vs 33.5; P=0.63).

Slight Improvement Observed Among Adherents

Although statistically not significant, adherent patients used a bronchodilator more frequently and in more timely ways, contacted healthcare providers, and initiated prednisolone and antibiotics more often when compared with non-adherent patients. Adherent patients also showed higher baseline self-efficacy and disease acceptance scores, and lower denial, resistance, and sorrow scores (Table).

Exacerbations are common, the authors note, and up to 60% of people with COPD have two or more exacerbations per year that make them ill and that may require hospitalization. Patients often have trouble recognizing that their symptoms have worsened, and they need to adjust their treatment. Paper action plans that include strategies to use when symptoms worsen are available but not always used.

Mobile health has the potential to support patients in monitoring their physiologic status, but its adoption can be challenging, the authors write. Most mHealth applications lack personalized feedback, and technical incompetence, health illiteracy, inexperience with mHealth apps, and privacy concerns can be barriers. Making the apps safer, more attractive, and rewarding could increase adoption.

The authors acknowledge limitations to their study that include small sample size and secondary analysis design. “It can be questioned whether we had enough power to detect statistically significant differences between adherent and non-adherent patients,” they noted, adding that this pilot study is a “first step towards well-designed studies with sufficient power to confirm our findings.”

“To our knowledge, this is the first study to show that the levels of self-efficacy and disease acceptance seemed higher in patients who were adherent to the mHealth tool than those who were not,” they wrote. “Although these differences were not statistically significant and should therefore be interpreted with caution, it is remarkable that the levels of denial, resistance, and sorrow all were higher in patients who were not adherent to mHealth.”