A Systematic Review and Meta-Analysis of Telemonitoring Interventions on Severe COPD Exacerbations

Abstract

This systematic review and meta-analysis aimed to provide current evidence regarding the effectiveness of telemonitoring for preventing COPD exacerbations, focusing on severe exacerbations requiring hospitalisation or emergency room (ER) visits. We systematically searched for randomised controlled trials using nine databases from August to September 2020 following the Cochrane Collaboration Guidelines. Of 2159 records identified, 22 studies involving 2906 participants met the inclusion criteria. The participants in 55% and 59% of studies had severe airflow limitations and severe exacerbation histories in the preceding year, respectively. The most commonly telemonitored data were oxygen saturation (91%) and symptoms (73%). A meta-analysis showed that telemonitoring did not reduce the number of admissions (12 studies) but decreased the number of ER visits due to severe exacerbations [7 studies combined, standardised mean difference (SMD) = −0.14; 95% confidence interval (CI): −0.28, −0.01]. Most studies reported no benefit in mortality, quality of life, or cost-effectiveness. All eight studies that surveyed participant satisfaction reported high satisfaction levels. Our review suggested that adding telemonitoring to usual care reduced unnecessary ER visits but was unlikely to prevent hospitalisations due to COPD exacerbations and that telemonitoring was well-accepted by patients with COPD and could be easily integrated into their existing care.