Digital Respiratory Healthcare

Digital technologies are increasingly used to support asthma management and improve medication adherence. Evidence shows that digital adherence interventions can have important benefits on medication adherence and outcomes. While there remain some uncertainties about how best to implement digital interventions into everyday practice and whether digital interventions are cost-effective and acceptable to end users, digital interventions are likely to bring significant benefits for patients, health professionals and society. Interventions include digital inhalers and spacers, self-management apps, web interventions, telehealth and text message services. Interventions vary in functionality, maturity of the technology, and the amount of evidence supporting their use. Careful selection of the digital intervention that is best suited for the patient's asthma needs, lifestyle, abilities and preferences is important to ensure successful implementation. Ongoing evaluation of the rapidly evolving technology and long-term benefits they bring is needed to support sustained adoption and engagement. Further research into the added value of digital adherence interventions in practice is needed.

Cite as: Chan AHY, van Boven JFM. Digital adherence interventions for asthma. In: Pinnock H, Poberezhets V, Drummond D, eds. Digital Respiratory Healthcare (ERS Monograph). Sheffield, European Respiratory Society, 2023; pp. 185–198 [https://doi.org/10.1183/2312508X.10001823].

COPD is a common progressive respiratory condition, representing 3.9% of global disease burden. Symptoms include difficult breathing, frequent exacerbations, reduced functional status and impaired quality of life. Telehealth care, including synchronous and asynchronous modalities, and digitally supported self-management, provides an opportunity for more efficient, flexible and personalised care approaches. Current evidence for the benefits of telehealth care in COPD is unclear due to small participant numbers and heterogeneous interventions. Some evidence suggests that telehealth can reduce re-admission rates but impact on exacerbations and quality of life remains unclear. There is also little evidence that digitally supported self-management improves outcomes in COPD. The use of telehealth in managing comorbid anxiety and depression is still an emerging area of research, and any benefits in advanced care planning and palliative care are yet to be clearly demonstrated. There is little evidence to suggest that telehealth interventions cause harm, although studies have not routinely collected adverse event information. Despite the limitations of the current evidence base, telehealth may provide an exciting opportunity to meet the complex health needs of people with COPD, and future exploration of the potential benefits and patient perspectives is warranted.

Cite as: Disler R, Ly L, Carter D, et al. Telehealth in COPD. In: Pinnock H, Poberezhets V, Drummond D, eds. Digital Respiratory Healthcare (ERS Monograph). Sheffield, European Respiratory Society, 2023; pp. 216–228 [https://doi.org/10.1183/2312508X.10002023].

Extensive literature is available regarding the use of telemedicine for continuous positive airway pressure treatment and monitoring in adults. Telemedicine is less well developed in children and for other sleep disorders. Remote consultations are considered part of the telemedicine model. These consultations can be used for screening or diagnosis, and allow the incorporation of questionnaires, but they can also be used for the communication of test results and treatment options, for tele-education and for follow-up. There is also evidence that cognitive behavioural therapy for insomnia can be successfully offered via remote consultations. A remote approach can enable earlier access to sleep professionals, but also saves travel time and costs, with less missed work/school time. Overall, the use of remote consultation helps increase the value of healthcare delivery and has high satisfaction rates.

Cite as: Fauroux B, Bonsignore MR, Verbraecken J. Remote consultations in sleep disorders. In: Pinnock H, Poberezhets V, Drummond D, eds. Digital Respiratory Healthcare (ERS Monograph). Sheffield, European Respiratory Society, 2023; pp. 236–249 [https://doi.org/10.1183/2312508X.10002323].

Pulmonary rehabilitation (PR) is an evidence-based and cost-effective treatment to improve exercise capacity, quality of life and symptom management in patients with chronic respiratory disease. However, it is significantly underutilised worldwide. Telerehabilitation has been recommended as a potential solution to address barriers to traditional PR and can be delivered via telephone, videoconferencing and web/app programmes, and may incorporate remote monitoring of physiological parameters. Although the use of telehealth drastically increased during the coronavirus disease 2019 pandemic and evidence suggests that telerehabilitation may achieve similar benefits to centre-based PR, the certainty of the evidence is limited. Additionally, there are a number of patient, health professional and system-level barriers that may hinder implementation in clinical services. To facilitate adoption of telerehabilitation in clinical services, high-quality clinical trials evaluating the effectiveness, safety and cost-effectiveness compared with centre-based PR programmes are needed, as well as the development of evidence-based clinical guidelines for implementation and quality assurance.

Cite as: Hume E, Megaritis D, Vogiatzis I. Telerehabilitation in chronic respiratory disease. In: Pinnock H, Poberezhets V, Drummond D, eds. Digital Respiratory Healthcare (ERS Monograph). Sheffield, European Respiratory Society, 2023; pp. 261–275 [https://doi.org/10.1183/2312508X.10002123].