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Meta-Analysis
. 2025 May 26:27:e76323.
doi: 10.2196/76323.

Effectiveness of Digital Health Interventions for Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

Miaoqing Zhuang #  1 , Intan Idiana Hassan #  2 , Wan Muhamad Amir W Ahmad  3 , Azidah Abdul Kadir  2 , Xiaodong Liu  4 , Furong Li  5 , Yinuo Gao  1 , Yang Guan  1 , Shuting Song  1
Affiliations
Meta-Analysis

Effectiveness of Digital Health Interventions for Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

Miaoqing Zhuang et al. J Med Internet Res. .

Abstract

Background: Chronic obstructive pulmonary disease (COPD), marked by dyspnea, cough, and sputum production, significantly impairs patients' quality of life and functionality. Effective management strategies, particularly those empowering patients to manage their condition, are essential to reduce this burden and health care use. Digital health interventions-such as mobile apps for symptom tracking, wearable sensors for vital sign monitoring, and web-based pulmonary rehabilitation programs-can enhance self-efficacy and promote greater patient engagement. By improving self-management skills, these interventions also help alleviate pressure on health care systems.

Objective: This systematic review and meta-analysis assesses the clinical effectiveness of smartphone apps, wearable monitors, and web-delivered platforms in four COPD management areas: (1) quality of life (measured by the COPD Assessment Test [CAT] and St George's Respiratory Questionnaire), (2) self-efficacy (assessed by the General Self-Efficacy Scale), (3) functional capacity (evaluated via the 6-minute walk test and Modified Medical Research Council Dyspnea Scale), and (4) health care use (indicated by hospital and emergency department visits).

Methods: A systematic review was conducted using predefined search terms in PubMed, Embase, Cochrane, and Web of Science up to January 26, 2025, to identify randomized trials on digital health interventions for COPD. Two reviewers independently screened studies and extracted data. Outcomes included quality of life, self-efficacy, functional status, and health care use.

Results: This review included 17 studies with 2027 participants from 11 countries. Eleven trials involved health care professionals in digital platform use, and 12 reported adherence strategies. Digital tools for COPD primarily focused on telerehabilitation (eg, video-guided exercises) and self-management systems (eg, artificial intelligence-driven exacerbation alerts). The study participants were predominantly older adults. Meta-analysis results indicated that digital health interventions significantly improved quality of life at 3 months on the CAT (mean difference [MD] -1.65, 95% CI -3.17 to -0.14; P=.03); at 6 months on the CAT (MD -2.43, 95% CI -3.93 to -0.94; P=.001) and St George's Respiratory Questionnaire (MD 3.25, 95% CI 0.69-5.81; P=.01); at 12 months on the CAT (MD -2.53, 95% CI -3.91 to -1.16; P<.001), EQ-5D (MD 0.04, 95% CI 0.01-0.07; P=.02), and EQ-5D visual analogue scale (MD 5.88, 95% CI 0.38-11.37; P=.04); the General Self-Efficacy Scale at 3 months (MD 1.65, 95% CI 0.62-2.69; P=.002) and 6 months (MD 1.94, 95% CI 0.83-3.05; P<.001); and the Modified Medical Research Council Dyspnea Scale at more than 3 months (MD -0.23, 95% CI -0.36 to -0.11; P=.003). However, no significant differences were observed in the 6-minute walk test, emergency department admissions, hospital admissions, emergency department admissions for COPD, or hospital admissions for COPD.

Conclusions: Our findings suggest that digital health interventions may benefit COPD patients, but their clinical effectiveness remains uncertain. Further robust studies are needed, particularly those involving larger numbers of older adults with COPD.

Trial registration: PROSPERO CRD420251032053; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251032053.

Keywords: chronic respiratory disease; evidence synthesis; mHealth; mobile health; remote patient monitoring; self-management; telemedicine.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Hypothesized pathways.
Figure 2
Figure 2
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram.
Figure 3
Figure 3
Risk of bias graph of randomized controlled trials.
Figure 4
Figure 4
Risk of bias summary of randomized controlled trials. The review authors’ judgments about each risk of bias item are presented as percentages. The x-axis represents the percentage of studies that were found to have low (green), unclear (yellow), or high (red) risk of bias for each domain.
Figure 5
Figure 5
Meta-analysis results and forest plot of the digital health interventions on quality of life assessed by the Chronic Obstructive Pulmonary Disease Assessment Test at 3 months.
Figure 6
Figure 6
Meta-analysis results and forest plot of the digital health interventions on quality of life assessed by St George’s Respiratory Questionnaire at 3 months.
Figure 7
Figure 7
Meta-analysis results and forest plot of the digital health interventions on quality of life assessed by EuroQol 5 Dimensions at 3 months.
Figure 8
Figure 8
Meta-analysis results and forest plot of the digital health interventions on quality of life at 3 months.
Figure 9
Figure 9
Meta-analysis results and forest plot of the digital health interventions on quality of life assessed by the Chronic Obstructive Pulmonary Disease Assessment Test at 6 months.
Figure 10
Figure 10
Meta-analysis results and forest plot of the digital health interventions on quality of life assessed by St George’s Respiratory Questionnaire at 6 months.
Figure 11
Figure 11
Meta-analysis results and forest plot of the digital health interventions on quality of life assessed by the Chronic Obstructive Pulmonary Disease Assessment Test at 12 months.
Figure 12
Figure 12
Meta-analysis results and forest plot of the digital health interventions on quality of life assessed by EQ-5D at 12 months.
Figure 13
Figure 13
Meta-analysis results and forest plot of the digital health interventions on quality of life assessed by EQ-5D VAS at 12 months.
Figure 14
Figure 14
Meta-analysis results and forest plot of the digital health interventions on self-efficacy at 3 months.
Figure 15
Figure 15
Meta-analysis results and forest plot of the digital health interventions on self-efficacy at 6 months.
Figure 16
Figure 16
Meta-analysis results and forest plot of the digital health interventions on self-efficacy at 12 months.
Figure 17
Figure 17
Meta-analysis results and forest plot of the digital health interventions on dyspnea at 3 months.
Figure 18
Figure 18
Meta-analysis results and forest plot of the digital health interventions on dyspnea at 12 months.
Figure 19
Figure 19
Meta-analysis results and forest plot of the digital health interventions on dyspnea at 6 months.
Figure 20
Figure 20
Meta-analysis results and forest plot of the digital health interventions on 6-Minute Walk Test at 3 months.
Figure 21
Figure 21
Meta-analysis results and forest plot of the digital health interventions on 6-Minute Walk Test at 6 months.
Figure 22
Figure 22
Meta-analysis results and forest plot of the digital health interventions on emergency department admissions.
Figure 23
Figure 23
Meta-analysis results and forest plot of the digital health interventions on hospital admissions.
Figure 24
Figure 24
Meta-analysis results and forest plot of the digital health interventions on emergency department admissions for chronic obstructive pulmonary disease.
Figure 25
Figure 25
Meta-analysis results and forest plot of the digital health interventions on hospital admissions for chronic obstructive pulmonary disease.
See this image and copyright information in PMC

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