An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: A Prospective Observational Pilot Study (Preprint)

BACKGROUND Chronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent Emergency Room (ER) visits and hospitalizations. Advances in digital health have made it possible to collect data remotely from multiple devices to assist in managing chronic diseases such as COPD. OBJECTIVE In this study, we evaluated the ability of COPD patients to use the Wellinks® mHealth platform to collect information from multiple modalities important to the management of COPD. We also assessed patient satisfaction and engagement with the platform. METHODS A single-site, observational, prospective pilot study (N=19) was conducted using the Wellinks platform in adults with COPD. All patients were > 30 years old at screening, owned an iPhone, and were currently undergoing a treatment regimen that included nebulized therapy. Enrolled patients received a study kit consisting of the FlypTM nebulizer, Smart One spirometer, the Nonin® pulse oximeter, plus the Wellinks mHealth application and training for all devices. For 8 weeks, participants were to enter daily symptoms and medication use manually; spirometry, nebulizer and pulse oximeter data were automatically recorded. Data was sent to the attending physician in a monthly report. Patient satisfaction was measured via a 5-point scale and the Net Promoter Score (NPS) captured in interviews at the end of the observation period. RESULTS Average age of the patients was 79.63 (range 65–95) years old. Participants (10 female; 9 male) had an average FEV1% of 56.22% predicted (range 23-113) and FEV1/FVC of 65%. COPD severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, was mild in 2 patients, moderate in 6, and severe/ very severe in 11; 9 patients were on home oxygen. During this 8-week study, average use of the spirometer was 2.52 times/week, and the pulse oximeter 4.24 times/week. Medication use was manually documented 9.04 times/week, nebulizer use 1.93 times/week, and symptoms recorded 1.15 times/week on average. The correlation coefficients of home to office measurements for peak flow and FEV1 were high (r=0.94 and 0.96, respectively). Patients found the app valuable (82%) and easy to use (94%). The NPS was 59. CONCLUSIONS This study demonstrates that our cohort of COPD patients engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by satisfaction survey and the NPS of 59. Regardless of disease severity, age, or gender, patients were both willing to use the technology and capable of doing so successfully. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision-making for better COPD management.