More research needed on telehealth use in COPD

Key takeaways:

• Teleconsultation and remote follow-up; telerehabilitation; and tele-education and self-management make up three forms of telehealth.
• Each form has unique needs in future research.

PHILADELPHIA — Telehealth can be divided into three forms, all of which require more data to capture the full picture of its use in COPD care, according to a presentation at the 2024 GOLD COPD International Conference.

Jean Bourbeau

“Telehealth for COPD, as for other chronic diseases, is here to stay,” Jean Bourbeau, MD, FRCPC, FCAHS, professor at McGill University and respirologist at McGill University Health Centre, said at the conference.

During his presentation, Bourbeau outlined three forms of telehealth: teleconsultation and remote follow-up; telerehabilitation; and tele-education and self-management.

Teleconsultation, remote follow-up

For patients with COPD who reside far away from a health care professional, teleconsultation and remote follow-up provide a method for connection without the hassle of traveling.

Despite the simple appearance of this concept, Bourbeau highlighted multiple challenges that could potentially arise on the patient’s side: “lack of access, unreliable internet connectivity, discomfort with technology or limited financial resources.”

When looking for studies assessing remote consultation, Bourbeau said there are little data available on this topic but outlined some current recommendations for its use in practice.

“First of all, you need the state-of-the-art system that ensures the security of data exchange,” Bourbeau said. “[Additionally,] legislation and prerequisites may differ between countries and jurisdiction, and in some jurisdictions, in fact, teleconsultation activity will require that the doctor know the patient, [meaning the doctor] has seen the patient face-to-face in the last 12 months.”

Looking ahead, more research is needed on the use of teleconsultation and remote follow-up. Bourbeau specifically noted that studies should evaluate teleconsultation against in-office care to determine the pros and cons of its use when it replaces in-person care or when it is used in combination with in-person care.

Further, the impact of teleconsultation and remote follow-up should be reported over the short-term and long-term, Bourbeau said. Researchers also need to conduct studies that confirm that moving to telehealth lowers health care disparities rather than heightens them, according to Bourbeau.

Telerehabilitation

Another form of telehealth is telerehabilitation.

“Telerehab programs may make use of specialized exercise equipment or minimal equipment [and] can be delivered to a variety of locations, including the patient’s home,” Bourbeau said.

Based on the section titled "Delivery of pulmonary rehabilitation, education & self-management: in-person versus virtual” in the 2025 GOLD report, Bourbeau summarized that one model is not favored over another using current available data.

“Telerehab certainly has the potential to increase availability, access and flexibility of program location, time, and it might be cost-saving, but such programs may not be suitable or acceptable for all patients,” Bourbeau said.

To gain a better and clearer understanding of telerehabilitation, several factors should be considered in future research. According to Bourbeau, these factors include finding the optimum model, outlining technological requirements and assessing use of telerehabilitation in patients who experienced a respiratory exacerbation, patients from linguistically-diverse backgrounds and patients from low-resource settings.

“Remote assessment of exercise capacity and patient-reported outcomes should support wider rehabilitation access by making all program components effectively delivered via telehealth,” Bourbeau said.

Tele-education, self-management

In addition to teleconsultation and telerehabilitation, tele-education and self-management on the patient side are involved in telehealth.

During his presentation, Bourbeau said that patients with COPD have reported a lack of education related to the disease and treatments as shown in a 2014 survey conducted by the COPD Foundation.

“You’re aiming for the patient to have the skill and have the self confidence that they can then implement disease management on the day-to-day basis,” Bourbeau said.

With regard to studies on telehealth interventions to support disease self-management, Bourbeau outlined six components that have been suggested as measures to capture in this research:

• “patient education and information provision;
• remote monitoring with feedback and action plans;
• telehealth-facilitated clinical review;
• adherence support;
• psychological support; and
• lifestyle interventions.”

Taking a closer look at each component, Bourbeau said none had been “found to be consistently effective or consistently ineffective,” according to a systematic review and meta-analysis published in Journal of Medical Internet Research.

Similar to the other forms of telehealth, tele-education and self-management require more research. According to Bourbeau, this includes data on what telehealth adds to self-management intervention, effective structures/strategies for implementation and generalizing interventions for different disease severity levels.

“The recommendation in future study is to use that PRISMS taxonomy of self-management, and that is needed to gain more insight into the optimal combination of in-person care and eHealth self-management,” Bourbeau said.

References:

• COPD Foundation releases groundbreaking COPE survey results: Low patient awareness about COPD exacerbations poses barrier to effective management. https://www.businesswire.com/news/home/20140617005140/en/COPD-Foundation-Releases-Groundbreaking-COPE-Survey-Results-Low-Patient-Awareness-About-COPD%C2%A0Exacerbations-Poses-Barrier-to-Effective-Management. Published June 17, 2024. Accessed Nov. 18, 2024.
• Hanlon P, et al. J Med Internet Res. 2017;doi:10.2196/jmir.6688.