Related Articles

The Effect of Smartphone Interventions on Patients With Chronic Obstructive Pulmonary Disease Exacerbations: A Systematic Review and Meta-Analysis.

JMIR Mhealth Uhealth. 2016;4(3):e105

Authors: Alwashmi M, Hawboldt J, Davis E, Marra C, Gamble JM, Abu Ashour W

Abstract
BACKGROUND: The prevalence and mortality rates of chronic obstructive pulmonary disease (COPD) are increasing worldwide. Therefore, COPD remains a major public health problem. There is a growing interest in the use of smartphone technology for health promotion and disease management interventions. However, the effectiveness of smartphones in reducing the number of patients having a COPD exacerbation is poorly understood.
OBJECTIVE: To summarize and quantify the association between smartphone interventions and COPD exacerbations through a comprehensive systematic review and meta-analysis.
METHODS: A comprehensive search strategy was conducted across relevant databases (PubMed, Embase, Cochrane, CINHA, PsycINFO, and the Cochrane Library Medline) from inception to October 2015. We included studies that assessed the use of smartphone interventions in the reduction of COPD exacerbations compared with usual care. Full-text studies were excluded if the investigators did not use a smartphone device or did not report on COPD exacerbations. Observational studies, abstracts, and reviews were also excluded. Two reviewers extracted the data and conducted a risk of bias assessment using the US Preventive Services Task Force quality rating criteria. A random effects model was used to meta-analyze the results from included studies. Pooled odds ratios were used to measure the effectiveness of smartphone interventions on COPD exacerbations. Heterogeneity was measured using the I(2)statistic.
RESULTS: Of the 245 unique citations screened, 6 studies were included in the qualitative synthesis. Studies were relatively small with less than 100 participants in each study (range 30 to 99) and follow-up ranged from 4-9 months. The mean age was 70.5 years (SD 5.6) and 74% (281/380) were male. The studies varied in terms of country, type of smartphone intervention, frequency of data collection from the participants, and the feedback strategy. Three studies were included in the meta-analysis. The overall assessment of potential bias of the studies that were included in the meta-analysis was "Good" for one study and "Fair" for 2 studies. The pooled random effects odds ratio of patients having an exacerbation was 0.20 in patients using a smartphone intervention (95% CI 0.07-0.62), a reduction of 80% for smartphone interventions compared with usual care. However, there was moderate heterogeneity across the included studies (I(2)=59%).
CONCLUSION: Although current literature on the role of smartphones in reducing COPD exacerbations is limited, findings from our review suggest that smartphones are useful in reducing the number of patients having a COPD exacerbation. Nevertheless, using smartphones require synergistic strategies to achieve the desired outcome. These results should be interpreted with caution due to the heterogeneity among the studies. Researchers should focus on conducting rigorous studies with adequately powered sample sizes to determine the validity and clinical utility of smartphone interventions in the management of COPD.

PMID: 27589898 [PubMed]

Exhaled breath contains thousands of volatile organic compounds (VOCs) that reflect the metabolic process occurring in the host both locally in the airways and systemically. They also arise from the environment and the airway microbiome. Comprehensive analysis of breath VOCs (breathomics) provides opportunities for non-invasive biomarker discovery and novel mechanistic insights.

Applications in obstructive lung diseases, such as asthma and COPD, include not only diagnostics (especially in children and other challenging diagnostic areas) but also the identification of clinical treatable traits such as airway eosinophilia and risk of infection/exacerbation that are not specific to diagnostic labels. Whilst many aspects of breath sampling and analysis are challenging, proof of concept studies with mass-spectrometry and electronic noses technologies have provided independent studies with moderate to good diagnostic- and phenotypic accuracies.

The present review evaluates the data obtained by breathomics in:

• predicting the inception of asthma or COPD,
• inflammatory phenotyping,
• predicting exacerbations
• and treatment stratification.

The current findings merit the current efforts step of large multi-centre studies, using standardized sampling, shared anaytical methods and databases, including external validation cohorts. This will position this non-invasive technology in the clinical assessment and monitoring of chronic airways diseases.

Physical recovery following critical illness is slow, often incomplete and is resistant to rehabilitation interventions. We aimed to explore the contribution of persisting inflammation to recovery, and investigated the potential role of human cytomegalovirus (HCMV) infection in its pathogenesis.Methods

In an a priori nested inflammatory biomarker study in a post-intensive care unit (ICU) rehabilitation trial (RECOVER; ISRCTN09412438), surviving adult ICU patients ventilated >48 h were enrolled at ICU discharge and blood sampled at ICU discharge (n=184) and 3 month follow-up (N=123). C-reactive protein (CRP), human neutrophil elastase (HNE), interleukin (IL)-1β, IL-6, IL-8, transforming growth factor β1 (TGFβ1) and secretory leucocyte protease inhibitor (SLPI) were measured. HCMV IgG status was determined (previous exposure), and DNA PCR measured among seropositive patients (lytic infection). Physical outcome measures including the Rivermead Mobility Index (RMI) were measured at 3 months.

Results

Many patients had persisting inflammation at 3 months (CRP >3 mg/L in 59%; >10 mg/L in 28%), with proinflammatory phenotype (elevated HNE, IL-6, IL-8, SLPI; low TGFβ1). Poorer mobility (RMI) was associated with higher CRP (β=0.13; p<0.01) and HNE (β=0.32; p=0.03), even after adjustment for severity of acute illness and pre-existing co-morbidity (CRP β=0.14; p<0.01; HNE β=0.30; p=0.04). Patients seropositive for HCMV at ICU discharge (63%) had a more proinflammatory phenotype at 3 months than seronegative patients, despite undetectable HMCV by PCR testing.

Conclusions

Inflammation is prevalent after critical illness and is associated with poor physical recovery during the first 3 months post-ICU discharge. Previous HCMV exposure is associated with a proinflammatory phenotype despite the absence of detectable systemic viraemia.

Physical recovery following a critical illness is important for patients, family and clinicians.1–3 However, there is limited beneficial effect demonstrated from the intervention studies that have investigated physical rehabilitation across the continuum of critical illness recovery, starting in the intensive care unit (ICU) and continuing to the community setting with home-based rehabilitation and follow-up clinics4–8 What is the reason for this lack of treatment effect? As with all trials that show a lack of effect, we must consider a number of factors, including the intervention delivered, the target population and the outcome measure used.

In the recent RECOVER trial,8 there was an improvement in the functional status of patients following critical illness, as evidenced by the Rivermead Mobility Index (RMI); however, the delivery of a post-ICU bundled therapies intervention did not...