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

Abstract

Background: Chronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent emergency room 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 pilot study, we evaluated the ability of patients with COPD 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 aged over 30 years 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 Flyp nebulizer, Smart One spirometer, the Nonin pulse oximeter, plus the Wellinks mHealth app, 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 were 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 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV₁% (forced expiratory volume in 1 second as % of predicted for the patient) of 56.2% of predicted (range 23%-113%) and FEV₁/forced vital capacity 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 2.5 times/week, and the pulse oximeter 4.2 times/week. Medication use was manually documented 9.0 times/week, nebulizer use 1.9 times/week, and symptoms recorded 1.2 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 (13/16, 81%) and easy to use (15/16, 94%). The NPS was 59.

Conclusions: This study demonstrates that our cohort of patients with COPD engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by the satisfaction survey and the NPS of 59. In this small, selected sample, patients were both willing to use the technology and capable of doing so successfully regardless of disease severity, age, or gender. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision making for better COPD management.

Keywords: COPD; digital health; mHealth; mobile apps; mobile phone; patient engagement; pulse oximetry; remote monitoring; spirometry; telemedicine.

Figure 1

Components of the Wellinks mHealth Kit, including the Flyp nebulizer, MIR Smart One spirometer, and Nonin pulse oximeter, are pictured here from left to right. Patients used their own phones to download the Wellinks mHealth App.

Figure 2

The app displays content that guides the patient while recording pulse oximetry, or inputting medications taken and symptoms experienced from a list. The medication list was prepopulated with each patient's prescribed medications.

Figure 3

The Wellinks mHealth platform recorded spirometry, pulse oximetry, and nebulizer use automatically by bluetooth. The patient manually input medications taken and symptoms experienced (if any) using the app. Data were stored securely and compiled into a summary Portable Document Format (PDF) report for the clinician monthly. API: application programming interface, HIPAA: Health Insurance Portability and Accountability Act.

Figure 4

The physician report supplied monthly summarizes prescribed scheduled medications, PRN medications and adherence, pulse oximetry and spirometry readings over time, and symptoms. PRN: pro re nata.

Figure 5

The correlation of home versus office assessments of (A) peak flow and (B) FEV₁. FEV₁: forced expiratory volume in 1 second.

Figure 6

Engagement, measured in app uses or recordings/week, fell over the course of the 8-week study, but remained above the baseline requested of 1 use/week for spirometry and oximetry recordings.