Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, USA.
Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, University of Colorado Anschutz Medical, Aurora, Colorado, USA.
BMJ Open Respir Res. 2019 Feb 18;6(1):e000350. doi: 10.1136/bmjresp-2018-000350. eCollection 2019.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterised by airflow obstruction and other morbidities such as respiratory symptoms, reduced physical activity and frequent bronchodilator use. Recent advances in personal digital monitoring devices can permit continuous collection of these data in COPD patients, but the relationships among them are not well understood.
184 individuals from a single centre of the COPDGene cohort agreed to participate in this 3-week observational study. Each participant used a smartphone to complete a daily symptom diary (EXAcerbations of Chronic pulmonary disease Tool, EXACT), wore a wrist-worn accelerometer to record continuously physical activity and completed the Clinical Visit PROactive Physical Activity in COPD questionnaire. 58 users of metered dose inhalers for rescue (albuterol) were provided with an inhaler sensor, which time stamped each inhaler actuation.
Rescue inhaler use was strongly correlated with E-RS:COPD score, while step counts were correlated with neither rescue use nor E-RS:COPD score. Frequent, unpatterned inhaler use pattern was associated with worse respiratory symptoms and less physical activity compared with frequent inhaler use with a regular daily pattern. There was a strong week-by-week correlation among measurements, suggesting that 1 week of monitoring is sufficient to characterise stable patients with COPD.
The study highlights the interaction and relevance of personal real-time monitoring of respiratory symptoms, physical activity and rescue medication in patients with COPD. Additionally, visual displays of longitudinal data may be helpful for disease management to help drive conversations between patients and caregivers and for risk-based monitoring in clinical trials.
慢性阻塞性肺疾病（COPD）是一种异质性疾病，其特征为气流阻塞和其他病态，如呼吸症状、体力活动减少和频繁使用支气管扩张剂。个人数字监测设备的最新进展可以允许 COPD 患者连续收集这些数据，但它们之间的关系尚不清楚。
COPDGene 队列的一个中心的 184 名个体同意参加这项为期 3 周的观察性研究。每个参与者都使用智能手机完成每日症状日记（慢性阻塞性肺病加重工具，EXACT），佩戴腕戴式加速度计连续记录体力活动，并完成临床访视 PROactive 慢性阻塞性肺病体力活动问卷。58 名使用计量吸入器（沙丁胺醇）进行急救的患者配备了吸入器传感器，该传感器为每次吸入器动作计时。
急救吸入器的使用与 E-RS:COPD 评分密切相关，而步数与急救使用或 E-RS:COPD 评分均无相关性。与有规律日常模式的频繁吸入器使用相比，频繁、无规律的吸入器使用模式与更严重的呼吸症状和更少的体力活动相关。各项测量之间存在很强的每周相关性，表明 1 周的监测足以描述 COPD 稳定患者的情况。
该研究强调了 COPD 患者呼吸症状、体力活动和急救药物的个人实时监测的相互作用和相关性。此外，纵向数据的直观显示可能有助于疾病管理，以帮助推动患者和护理人员之间的对话，并用于临床试验中的基于风险的监测。
