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24/7 E-Monitoring Eases Suffering in COPD Patients
Research coordinator, Maggie Kerper, (left), meets with Edward Goldwire, 55, who reports his COPD symptoms every day via PDA to the Temple Lung Center as part of The Pennsylvania Study of COPD Exacerbations (PA-SCOPE) which is funded by the Pennsylvania Department of Health.
Like most patients afflicted with chronic obstructive pulmonary disease (COPD), Edward Goldwire lived in fear of his next breathing attack. The attacks, marked most frighteningly by shortness of breath, could strike several times a year. When he felt one coming on, he’d call an ambulance or a taxi, and head to the nearest emergency room. He never knew how long he’d have to wait for help – it could be five minutes or two hours – or whether he’d end up at a hospital unfamiliar with his disease and treatment history.
Still, when his doctor, Wissam Chatila, informed him of a new Temple Lung Center study of daily COPD symptom reporting with a personal digital assistant (electronic diary), he was skeptical.
“How are they going to really know when I’m sick?” he said.
 But a year later, Edward is amazed at the turn his disease has taken. He can walk much easier, for longer distances and longer periods of time. Plus his attacks, and therefore his need to go to the hospital, have decreased.
“The electronic diary has the potential to give patients more and easier access to health care. And it also potentially allows physicians to better coordinate their care,” said Chatila, Associate Professor of Medicine at Temple University School of Medicine and Hospital.
All Edward has to do is stay in touch electronically with his health care team. Every day, rain or shine, holidays included, Edward reports on his symptoms via his electronic diary. What is his temperature? How is his breathing? Is he able to make it through his daily routine?
The data goes directly to the Temple Lung Center where it’s analyzed by a pulmonary nurse specialist and board certified pulmonary physician with a special interest in COPD research.
Any red flags, such as shortness of breath, a change in his sputum (phlegm), breathing measurement or a fever, and the team springs into action. Sometimes a medication is prescribed. Other times an adjustment to his pulmonary medicines is made. The goal is to stabilize him at home, prevent a disabling attack and keep him out of the hospital. All changes in therapy are transmitted to the patient’s primary doctor as well as any changes in the patient’s clinical status.
Seven years ago, Goldwire, 55, was diagnosed with COPD which includes chronic bronchitis and emphysema. COPD is most often caused by smoking and leaves sufferers winded, weak and too fatigued to pursue their regular activities. Although the incidence of COPD is less among African-Americans, they often tend to suffer a more severe form of it, which brings them to the emergency room and hospital more frequently, and for longer stays.
To lessen this severity and determine its cause, Temple Lung Center is in the midst of a four-year study of COPD patients who have been supplied with electronic diaries in the form of personal digital assistants (PDAs).
The goal of this part of the study is to see if early intervention using daily symptom reporting through a PDA can reduce hospitalizations and deaths due to COPD exacerbations and improve patient quality of life, optimize lung function, and everyday activity levels. Edward has been assigned to the group with 24-hour access to pulmonary nurses and physicians via a 1-800 number.
“Panicked patients often end up in hospital emergency rooms, which can in turn, lead to hospital stays,” said Gerard Criner, MD, principal investigator of the study and director of Temple Lung Center. “The hope is that by collecting a daily diary and measuring the daily lung functions of the patients, we might be able to intervene day or night to prevent the need for admissions. All the reasons that could account for a more severe incidence of COPD among African Americans could be addressed through education and early intervention.”
As the fourth-largest killer in the United States, in 2000 alone, COPD resulted in 1.5 million emergency room visits, 726,000 hospitalizations and 119,000 deaths. And, due to higher smoking rates in women over the past several decades, the death rate from COPD has increased for women more than 150 percent since 1980.
Edward is grateful to be able to participate in this study and wishes more people could have access to such technology. His doctor has the same hopes.
“This technology, which could easily be used with other diseases, has a truly great impact on patients’ quality of life and the disease cost and burden on society,” said Chatila.
For further information on this study, please contact the PA SCOPE study coordinator at 215-707-1359.
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- By Eryn Jelesiewicz
April 10, 2006
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