Weitere Artikel dieser Ausgabe durch Wischen aufrufen
• Physiological parameters significant for COPD patients in remote settings are ECG, PaO2, PaCO2, spirometry, respiration rate, body temperature, blood pressure, and weight.
• Cardiovascular diseases are the most frequent comorbidities with COPD.
• Patch ECG monitors are a promising technology for ECG monitoring and can also provide respiration rate, which is very useful for COPD patients.
• Respiratory rate can also be obtained from pulse oximetry.
• Hypertension is a frequent comorbidity but can also be caused by medicaments, which means that it is important to measure blood pressure.
• Spirometry in acute situations is not very informative. It is used mainly in the diagnosis of COPD as well as in the assessment of its severity, progression, and prognosis. Peak expiratory flow meters are simpler and less expensive than full spirometers, but useful for COPD.
• Air pollution has been shown to be a major COPD risk factor, but smoking is first.
• A body temperature higher than 38.5 °C is one of the factors indicating severe exacerbation.
• As a consequence of respiratory failure either only PaO2 is decreased, or both PaO2 and PaCO2 are abnormal (low PaO2 and high PaCO2).
• PetCO2 is not a reliable estimate of the PaCO2 for COPD patients. PtcCO2 has recently become the preferred way of estimating PaCO2. PtcCO2 is continuous and noninvasive.
• Oxygen therapy can cause or increase hypercapnia.
• Early recognition of exacerbations and prompt treatment improves recovery, reduces the risk of hospitalization, and is associated with a better health-related quality of life. It is therefore important to detect the first signs and symptoms of exacerbations or to predict them.
• For the early detection or prediction of exacerbations, it is essential to use more advanced classification algorithms (e.g., random forest, support vector machine, logistic regression) than simple thresholding.
• For uncomplicated exacerbations, patients can be treated at home, and they prefer to be treated at home.
• Individual continuous monitoring enables prompt personalized treatments, which is recognized as a necessity for improved medical care, i.e., for personalized medicine.
Remote patient monitoring should reduce mortality rates, improve care, and reduce costs. We present an overview of the available technologies for the remote monitoring of chronic obstructive pulmonary disease (COPD) patients, together with the most important medical information regarding COPD in a language that is adapted for engineers. Our aim is to bridge the gap between the technical and medical worlds and to facilitate and motivate future research in the field. We also present a justification, motivation, and explanation of how to monitor the most important parameters for COPD patients, together with pointers for the challenges that remain. Additionally, we propose and justify the importance of electrocardiograms (ECGs) and the arterial carbon dioxide partial pressure (PaCO2) as two crucial physiological parameters that have not been used so far to any great extent in the monitoring of COPD patients. We cover four possibilities for the remote monitoring of COPD patients: continuous monitoring during normal daily activities for the prediction and early detection of exacerbations and life-threatening events, monitoring during the home treatment of mild exacerbations, monitoring oxygen therapy applications, and monitoring exercise. We also present and discuss the current approaches to decision support at remote locations and list the normal and pathological values/ranges for all the relevant physiological parameters. The paper concludes with our insights into the future developments and remaining challenges for improvements to continuous remote monitoring systems.
(2014) The top 10 causes of death. In: World Heal. Organ. http://www.who.int/mediacentre/factsheets/fs310/en/. Accessed 3 Jun 2017
Pare G, Poba-Nzaou P, Sicotte C et al (2013) Comparing the costs of home telemonitoring and usual care of chronic obstructive pulmonary disease patients: a randomized controlled trial. Eur Res Telemed 2:35–47. https://doi.org/10.1016/j.eurtel.2013.05.001 CrossRef
Sullivan SD, Ramsey SD, Lee TA (2000) The economic burden of COPD. Chest 117:5S–9S. https://doi.org/10.1378/chest.117.2_suppl.5S PubMedCrossRef
Cordova FC, Ciccolella D, Grabianowski C et al (2015) A telemedicine-based intervention reduces the frequency and severity of COPD exacerbation symptoms: a randomized, controlled trial. Telemed e-Health 22:114–122. https://doi.org/10.1089/tmj.2015.0035
Postma DS, Ten Hacken NH, Kerstjens H a, Koëter GH (1999) Home treatment of COPD exacerbations. Thorax 54:S8–S13. https://doi.org/10.1136/thx.54.2008.S8
St. George’s Respiratory Questionnaire. http://www.healthstatus.sgul.ac.uk/sgrq. Accessed 1 Jun 2016
McLean S, Nurmatov U, Liu JL, Pagliari C, Car JSA (2011) Telehealthcare for chronic obstructive pulmonary disease. Cochrane Database Syst Rev Jul 6:CD007718. https://doi.org/10.1002/14651858.CD007718.pub2
McLean S, Protti D, Sheikh A (2011) Telehealthcare for long term conditions. BMJ 342:d120. https://doi.org/10.1136/bmj.d120
Paré G, Moqadem K, Pineau G, St-Hilaire C (2010) Clinical effects of home telemonitoring in the context of diabetes, asthma, heart failure and hypertension: a systematic review. J Med Internet Res 12:e21. https://doi.org/10.2196/jmir.1357
Lundell S, Holmner Å, Rehn B et al (2015) Telehealthcare in COPD: a systematic review and meta-analysis on physical outcomes and dyspnea. Respir Med 109:11–26. https://doi.org/10.1016/j.rmed.2014.10.008 PubMedCrossRef
Pinnock H, Hanley J, McCloughan L et al (2013) Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial. BMJ 347:1–16. https://doi.org/10.1136/bmj.f6070 CrossRef
Cruz J, Brooks D, Marques A (2014) Home telemonitoring in COPD: a systematic review of methodologies and patients’ adherence. Int J Med Inform 83:249–263. https://doi.org/10.1016/j.ijmedinf.2014.01.008 PubMedCrossRef
Mosenifar Z (2015) Chronic obstructive pulmonary disease (COPD)—pathophysiology. In: Medscape. http://emedicine.medscape.com/article/297664-overview#a3. Accessed 1 Jan 2016
Han MK, Stephen C. Lazarus (2016) COPD: Clinical diagnosis and management. In: Murray Nadel’s Textb. Respir. Med., 6th ed. Elsevier Saunders, pp 767–785
Cranston JM, Crockett AJ, Moss JR, Alpers JH (2005) Domiciliary oxygen for chronic obstructive pulmonary disease. Cochrane database Syst Rev 19:CD001744. https://doi.org/10.1002/14651858.CD001744.pub2
Tiep BL, Carter R (2016) Long-term supplemental oxygen therapy. In: UpToDate. http://www.uptodate.com/contents/long-term-supplemental-oxygen-therapy. Accessed 1 Oct 2016
Vogelmeier CF, Criner GJ, Martinez FJ et al (2017) Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report GOLD executive summary. AJRCCM Artic Press 195:201701–201218. https://doi.org/10.1164/rccm.201701-0218PP
Amaddeo A, Fauroux B (2015) Oxygen and carbon dioxide monitoring during sleep. Paediatr Respir Rev 20:42-44. https://doi.org/10.1016/j.prrv.2015.11.009
Janssens JP, Borel JC, Pépin JL (2011) Nocturnal monitoring of home non-invasive ventilation: the contribution of simple tools such as pulse oximetry, capnography, built-in ventilator software and autonomic markers of sleep fragmentation. Thorax 66:438–445. https://doi.org/10.1136/thx.2010.139782 PubMedCrossRef
Storre JH, Magnet FS, Dreher M, Windisch W (2011) Transcutaneous monitoring as a replacement for arterial PCO(2) monitoring during nocturnal non-invasive ventilation. Respir Med 105:143–150. https://doi.org/10.1016/j.rmed.2010.10.007 PubMedCrossRef
Casati A, Squicciarini G, Malagutti G et al (2006) Transcutaneous monitoring of partial pressure of carbon dioxide in the elderly patient: a prospective, clinical comparison with end-tidal monitoring. J Clin Anesth 18:436–440. https://doi.org/10.1016/j.jclinane.2006.02.007 PubMedCrossRef
Domingo C, Canturri E, Luján M et al (2006) Transcutaneous measurement of partial pressure of carbon dioxide and oxygen saturation: validation of the SenTec monitor. Arch Bronconeumol 42:246–251. https://doi.org/10.1016/S1579-2129(06)60454-0 PubMed
Drysdale D (2014) Transcutaneous carbon dioxide monitoring: literature review. Oral Health Dent Manag 13:453–457. https://doi.org/10.1016/j.ccell.2006.02.003 PubMed
Fruchter O, Carmi U, Ingenito EP et al (2011) Transcutaneous carbon dioxide in severe COPD patients during bronchoscopic lung volume reduction. Respir Med 105:602–607. https://doi.org/10.1016/j.rmed.2010.11.005 PubMedCrossRef
Herrejón A, Inchaurraga I, Palop J et al (2006) Usefulness of transcutaneous carbon dioxide pressure monitoring to measure blood gases in adults hospitalized for respiratory disease. Arch Bronconeumol 42:225–229. https://doi.org/10.1016/S1579-2129(06)60450-3 PubMedCrossRef
Liu S, Sun J, Chen X et al (2014) The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery. PLoS One 9:e91563. https://doi.org/10.1371/journal.pone.0091563 PubMedPubMedCentralCrossRef
O’Driscoll BR, Howard LS, Davison a G (2008) BTS guideline for emergency oxygen use in adult patients. Thorax 63 Suppl 6:vi1–68. https://doi.org/10.1136/thx.2008.102947
Plant PK, Owen JL, Elliott MW (2000) One year period prevalence study of respiratory acidosis in acute exacerbations of COPD: implications for the provision of non-invasive ventilation and oxygen administration. Thorax 55:550–554. https://doi.org/10.1136/thorax.55.7.550 PubMedPubMedCentralCrossRef
Hardinge M, Annandale J, Bourne S et al (2015) British Thoracic Society guidelines for home oxygen use in adults. Thorax 70:i1–i43. https://doi.org/10.1136/thoraxjnl-2015-206865 PubMedCrossRef
Wijkstra PJ, Guyatt GH, Ambrosino N et al (2001) International approaches to the prescription of long-term oxygen therapy. Eur Respir J 18:909–913. https://doi.org/10.1183/09031936.01.00202301 PubMedCrossRef
Samolski D, Tárrega J, Antón A et al (2010) Sleep hypoventilation due to increased nocturnal oxygen flow in hypercapnic COPD patients. Respirology 15:283–288. https://doi.org/10.1111/j.1440-1843.2009.01665.x PubMedCrossRef
Windisch W, Storre JH, Köhnlein T (2015) Nocturnal non-invasive positive pressure ventilation for COPD. Expert Rev Respir Med 9:295–308. https://doi.org/10.1586/17476348.2015.1035260 PubMedCrossRef
Crimi C, Noto A, Princi P et al (2016) Domiciliary non-invasive ventilation in COPD: an international survey of indications and practices. COPD J Chronic Obstr Pulm Dis 13:483–490. https://doi.org/10.3109/15412555.2015.1108960 CrossRef
Arnal JM, Texereau J, Garnero A (2017) Practical insight to monitor home NIV in COPD patients. COPD J Chronic Obstr Pulm Dis 14:401–410. https://doi.org/10.1080/15412555.2017.1298583 CrossRef
Rich S (2011) Right ventricular function. Braunwald’s Hear. Dis. A Textb. Cardiovasc. Med., 9th ed. Elsevier, p 1707
Orchard CH, Kentish JC (1990) Effects of changes of pH on the contractile function of cardiac muscle. Am J Physiol - Cell Physiol 258:C967–C981. https://doi.org/10.1152/ajpcell.1990.258.6.C967 CrossRef
Pitta F, Troosters T, Probst VS et al (2006) Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. Eur Respir J Off J Eur Soc Clin Respir Physiol 27:1040–1055. https://doi.org/10.1183/09031936.06.00064105
Andrianopoulos V, Vanfleteren LEG, Jarosch I et al (2016) Transcutaneous carbon-dioxide partial pressure trends during six-minute walk test in patients with very severe COPD. Respir Physiol Neurobiol 233:52–59. https://doi.org/10.1016/j.resp.2016.08.003 PubMedCrossRef
Miravitlles M, Ferrer M, Pont a, et al. (2004) Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study. Thorax 59:387–395. https://doi.org/10.1136/thx.2003.008730
Gravil JH, Al-Rawas OA, Cotton MM et al (1998) Home treatment of exacerbations of chronic obstructive pulmonary disease by an acute respiratory assessment service. Lancet 351:1853–1855. https://doi.org/10.1016/S0140-6736(97)11048-0 PubMedCrossRef
Siafakas NM, Vermeire P, Pride NB et al (1995) Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J 8:1398–1420. https://doi.org/10.1183/09031936.95.08081398 PubMedCrossRef
(2016) Radiometer Medical ApS, Transcutaneous monitoring. http://www.radiometer.com/en/products/transcutaneous-monitoring. Accessed 1 Jan 2016
Guzik P, Malik M (2016) ECG by mobile technologies. J Electrocardiol 49:894–901. https://doi.org/10.1016/j.jelectrocard.2016.07.030 PubMedCrossRef
Tomasic I, Avbelj V, Trobec R (2015) Smart wireless sensor for physiological monitoring. In: Stud. Heal. Technol. Informatics, pHealth 2015. IOS press, 211:295–301. https://doi.org/10.3233/978-1-61499-516-6-295
Trobec R, Avbelj V, Stanič U, et al. (2017) System for mobile monitoring of vital functions and environmental context. Procedia Technology 27:157-158. https://doi.org/10.1016/j.protcy.2017.04.068
Nemati S, Malhotra A, Clifford GD (2011) Data fusion for improved respiration rate estimation. EURASIP J Adv Signal Process 926305:1–19. https://doi.org/10.1155/2010/926305.Data
Charlton PH, Bonnici T, Tarassenko L et al (2016) An assessment of algorithms to estimate respiratory rate from the electrocardiogram and photoplethysmogram. Physiol Meas 37:610–626. https://doi.org/10.1088/0967-3334/37/4/610 PubMedPubMedCentralCrossRef
Medtronic (2016) Nellcor™ Bedside Respiratory Patient Monitoring System, PM1000N. http://www.medtronic.com/covidien/products/pulse-oximetry/nellcor-bedside-respiratory-patient-monitoring-system-pm1000n. Accessed 1 Apr 2016
Kim S-H, Lilot M, Sidhu KS et al (2014) Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis. Anesthesiology 120:1080–1097. https://doi.org/10.1097/ALN.0000000000000226 PubMedCrossRef
de la Iglesia F, Díaz JL, Pita S et al (2005) Peak expiratory flow rate as predictor of inpatient death in patients with chronic obstructive pulmonary disease. South Med J 98:266–272. https://doi.org/10.1097/01.SMJ.0000152541.89483.AA PubMedCrossRef
Kelly G (2006) Body temperature variability (part 1): a review of the history of body temperature and its variability due to site selection, biological rhythms, fitness, and aging. Altern Med Rev 11:278–293 PubMed
Salvi SS, Barnes PJ (2009) Chronic obstructive pulmonary disease in non-smokers. Lancet 374:733–743. https://doi.org/10.1016/S0140-6736(09)61303-9 PubMedCrossRef
Rashkovska A, Tomašić I, Bregar K, Trobec R (2012) Remote monitoring of vital functions—proof-of-concept system. In: Proc. 35th Int. conv. MIPRO. pp 446–450
Fairbrother P, Pinnock H, Hanley J et al (2013) Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease: a qualitative study embedded in a randomized controlled trial. Patient Educ Couns 93:403–410. https://doi.org/10.1016/j.pec.2013.04.003 PubMedCrossRef
Majothi S, Jolly K, Heneghan NR et al (2015) Supported self-management for patients with copd who have recently been discharged from hospital: a systematic review and meta-analysis. Int J COPD 10:853–867. https://doi.org/10.2147/COPD.S74162
McKinstry B, Pinnock H, Sheikh A (2009) Telemedicine for management of patients with COPD? Lancet 374:672–673. https://doi.org/10.1016/S0140-6736(09)61542-7 PubMedCrossRef
Trobec R, Tomasic I, Rashkovska A, et al. (2018) Detection of heartbeats. In: Body Sensors Electrocardiogr. Springer, pp 49–51
Widjaja D, Taelman J, Vandeput S et al (2010) ECG-derived respiration: comparison and new measures for respiratory variability. Comput Cardiol 2010:149–152
Sankari Z, Adeli H (2011) HeartSaver: a mobile cardiac monitoring system for auto-detection of atrial fibrillation, myocardial infarction, and atrio-ventricular block. Comput Biol Med 41:211–220. https://doi.org/10.1016/j.compbiomed.2011.02.002 PubMedCrossRef
Väisänen J, Puurtinen M, Hyttinen J (2010) Viik J (2010) Short distance bipolar electrocardiographic leads in diagnosis of left ventricular hypertrophy. Comput Cardiol 37:293–296
Puurtinen M, Väisänen J, Viik J, Hyttinen J (2010) New precordial bipolar electrocardiographic leads for detecting left ventricular hypertrophy. J Electrocardiol 43:654–659. https://doi.org/10.1016/j.jelectrocard.2010.04.002 PubMedCrossRef
Puurtinen M, Nieminen T, Kähönen M et al (2010) Value of leads V4R and CM5 in the detection of coronary artery disease during exercise electrocardiographic test. Clin Physiol Funct Imaging 30:308–312. https://doi.org/10.1111/j.1475-097X.2010.00942.x PubMedCrossRef
Carvalho TD, Pastre CM, Moacir Fernandes de Godoy, et al. (2011) Fractal correlation property of heart rate variability in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 6:23-28. https://doi.org/10.2147/COPD.S15099
Arne M, Janson C, Janson S et al (2009) Physical activity and quality of life in subjects with chronic disease: Chronic obstructive pulmonary disease compared with rheumatoid arthritis and diabetes mellitus. Scand J Prim Health Care 27:141–147. https://doi.org/10.1080/02813430902808643 PubMedPubMedCentralCrossRef
Altenburg W, Wempe J, de Greef M et al (2014) Short- and long-term effects of a physical activity counselling program in COPD. Eur Respir J 44
Demeyer H, Louvaris Z, Frei A, et al. (2017) Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial. Thorax thoraxjnl-2016-209026. https://doi.org/10.1136/thoraxjnl-2016-209026
van Remoortel H, Raste Y, Louvaris Z et al (2012) Validity of six activity monitors in chronic obstructive pulmonary disease: A comparison with indirect calorimetry. PLoS One 7:1–11. https://doi.org/10.1371/journal.pone.0039198
Hansel TT, Barnes PJ (2009) New drugs for exacerbations of chronic obstructive pulmonary disease. Lancet 374:744–755. https://doi.org/10.1016/S0140-6736(09)61342-8 PubMedCrossRef
Fortier PJ, Puntin B, Aljaroudi O (2011) Improved patient outcomes through collaborative monitoring and management of subtle behavioral and physiological health changes. Proc Annu Hawaii Int Conf Syst Sci 1–10. doi: 10.1109/HICSS.2011.236
van der Heijden M, Lucas PJF, Lijnse B et al (2013) An autonomous mobile system for the management of COPD. J Biomed Inform 46:458–469. https://doi.org/10.1016/j.jbi.2013.03.003 PubMedCrossRef
Mohktar MS, Redmond SJ, Antoniades NC et al (2015) Predicting the risk of exacerbation in patients with chronic obstructive pulmonary disease using home telehealth measurement data. Artif Intell Med 63:51–59. https://doi.org/10.1016/j.artmed.2014.12.003 PubMedCrossRef
Kessler R, Faller M, Fourgaut G et al (1999) Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 159:158–164. https://doi.org/10.1164/ajrccm.159.1.9803117 PubMedCrossRef
Clini E, Vitacca M, Foglio K et al (1996) Long-term home care programmes may reduce hospital admissions in COPD with chronic hypercapnia. Eur Respir J 9:1605–1610. https://doi.org/10.1183/09031936.96.09081605 PubMedCrossRef
Seemungal TA, Donaldson GC, Paul EA et al (1998) Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157:1418–1422. https://doi.org/10.1164/ajrccm.157.5.9709032 PubMedCrossRef
Osman IM, Godden DJ, Friend J a, et al. (1997) Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease. Thorax 52:67–71. https://doi.org/10.1136/thx.52.1.67
Bourbeau J, Julien M, Maltais F et al (2003) Reduction of hospital utilization in patients with chronic obstructive pulmonary disease (a disease-specific self-management intervention). Arch Intern Med 163:585–591. https://doi.org/10.1001/archinte.163.5.585 PubMedCrossRef
Crapo RO, Jensen RL, Hegewald M, Tashkin DP (1999) Arterial blood gas reference values for sea level and an altitude of 1, 400 meters. Am J Respir Crit Care Med 160:1525–1531. https://doi.org/10.1164/ajrccm.160.5.9806006 PubMedCrossRef
Barrett KE, Barman SM, Boitano S, Brooks HL (2012) Hypothalamic regulation of hormonal functions. In: Ganong’s rev. med. Physiol., 24th ed. McGraw-hill, pp 307–321
Di Mino TL, Ivanov AF. Burke JR. Kowey P (2005) Electrocardiography. In: Rosendorff C (ed) Essent. Cardiol. Princ. Pract., 2nd ed. Humana Press, pp 135–136
Konecny T, Park JY, Somers KR et al (2016) Relation of chronic obstructive pulmonary disease to atrial and ventricular arrhythmias. Am J Cardiol 114:272–277. https://doi.org/10.1016/j.amjcard.2014.04.030 CrossRef
Sievi NA, Clarenbach CF, Camen G et al (2014) High prevalence of altered cardiac repolarization in patients with COPD. BMC Pulm Med 14:55. https://doi.org/10.1186/1471-2466-14-55
(2000) Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J 21:1502–1513. https://doi.org/10.1053/euhj.2000.2305
Barrett KE, Barman SM, Boitano S, Brooks HL (2012) Arterial & arteriolar circulation. In: Ganong’s Rev. Med. Physiol., 24th ed. pp 577–579
National Institute for Health and Clinical Excellence (2011) Hypertension: clinical management of primary hypertension in adults (NICE clinical guideline 127).
Barrett KE, Barman SM, Boitano S, Brooks HL (2012) Respiratory physiology. In: Ganong’s rev. med. Physiol., 24th ed. McGraw-Hill, p 619
- Continuous remote monitoring of COPD patients—justification and explanation of the requirements and a survey of the available technologies
- Springer Berlin Heidelberg
Neuer Inhalt/© ITandMEDIA