Assessing the Usefulness of the Prevexair Smartphone Application in the Follow-Up High-Risk Patients with COPD

Figures & data

Table 1 The Inclusion Criteria and Exclusion Criteria

The inclusion criteria

- patients aged ≥40 years - smokers or ex-smokers (of at least 10 pack-years) - COPD diagnosed on the basis of spirometric tests (FEV1/FVC post-bronchodilation<0.7 in the stable phase of the disease - having a history of at least two exacerbations treated with oral corticosteroids and/or antibiotics or having been hospitalized at least once for exacerbation in the past 12 months - owning a smartphone and having the cognitive and motor ability to operate a smartphone

The exclusion criteria

- having other significant respiratory diseases - reporting an exacerbation during the run-in period

Figure 1 Screenshots from the Prevexair app on a smartphone.

Table 2 Baseline Characteristics of Analyzed Population

	All Patients (n= 69)
Gender (male), (%)	82.6
Age (years), m (SD)	66.84 (7.96)
Active smokers, (%)	10.1
Smoking pack-years, m (SD)	44.1 (23.60)
BMI kg/m^2, m (SD)	26.26 (4.30)
Number of comorbidities, m (SD) ≥3, (%)	2.62 (1.41) 50.7
Dyspnea (mMRC) ≥2, (%)	73.9
CAT questionnaire, m (SD)	14.18 (5.71)
Post-BD FEV1%, m (SD)	43.52(15.77)
Post-BD FEV1 mL, m (SD)	1211.30 (510.22)
Post-BD FVC %, m (SD)	71.6 (15.2)
Post-BD FVC mL, m (SD)	2890 (880)
Number of severe-moderate exacerbations in the last year, median (IQR)	3(2–3)
Number of moderate exacerbations in the last year ≥2, (%)	56.8
Number of severe exacerbations in the last year ≥1, (%)	59.4
GOLD level of risk
C (%)	26.1
D (%)	73.9
Drug treatment for COPD, (%)
LAMA monotherapy	5.8
LAMA-LABA combination	34.8
LABA+ ICS combination	5.8
Triple therapy	53.6
Long-term oxygen therapy, (%)	34.8

Abbreviations: BMI, body mass index; mMRC, modified Medical Research Council; post-BD FEV1%, post-bronchodilator FEV1% predicted; Triple therapy, LABA, (long-acting beta-2 agonists) + LAMA (long-acting antimuscarinic agents) + ICS (inhaled corticosteroids); CAT, COPD Assessment Test; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Figure 2 Exacerbation frequency and characteristics as recorded via the Prevexair app or according to visit records.

Figure 3 Distribution of exacerbations according to the healthcare utilization for their treatment detected in the app (A) or recorded in visit (B).

Table 3 Relationship Between Exacerbation Frequency Determined Using App Records and Patient Recall

	Exacerbation Rate Recorded in the App	Exacerbation Rate Recall by the Patient During Visit	P-value	Correlation Coefficient
†Mild exacerbation median (IQR) m (SD)	0 (0–1) 0.62 (1.01)	0 (0–0) 0.32 (0.65)	<0.001	0.270*
§Moderate exacerbation median (IQR)	1 (0–2) 1.11 (0.91)	0 (0–1) 0.60 (0.75)	<0.001	0.449**
#Severe exacerbation median (IQR)	0 (0–0) 0.15 (0.40)	0 (0–0) 0.12 (0.36)	0.257	0.558**

Notes: Data are expressed as median and interquartile range (IQR† Mild exacerbation refers to exacerbations treated with only an increase in bronchodilators; § moderate exacerbation refers to exacerbations requiring outpatient management with antibiotics and/or systemic corticosteroids; # severe exacerbation refers to exacerbations requiring hospitalization; p-value: comparison of the number of exacerbations recorded by the app versus recalled by the patient at six months of follow-up using the non-parametric Wilcoxon test; *p<0.05; **p<0.001.

Table 4 Characteristics of Stable and Unstable Exacerbator Patients by App Records or Recalled by Patient During Visit

	Stable Exacerbator	Unstable Exacerbator	p-value
Exacerbations in app
n (%)	19 (27.5)	50 (72.5)	0.092
Age (years), mean (SD)	64.22 (7.56)	67.83 (7.95)	0.725
Sex (male), %	78.9	84.0	0.143
BMI (kg/m^2), mean (SD)	27.50	25.79	1.000
Active smokers, (%)	10.5	10.0	0.377
Number of comorbidities ≥3, (%)	42.1	54.0	0.062
Dyspnea scale (mMRC) baseline≥2, (%)	57.9	80	0.031
Dyspnea scale (mMRC) at 6 months ≥2, (%)	35.2	64.0	0.344
CAT score baseline, m (SD)	13.76 (9.05)	15.85 (7.00)	0.027 0.302
CAT score at 6 months, m (SD) Drug treatment for COPD, (%)	11.73 (4.96)	15.12 (5.75)
LAMA monotherapy	0.0	8.0
LAMA-LABA combination	31.6	36.0
LABA+ ICS combination	10.5	4.0
Triple therapy	57.9	52.0
Exacerbations recalled during visit
n (%)	36 (52.2)	33 (47.8)	0.090
Age (years), mean (SD)	64.52 (7.19)	69.36 (8.09)	0.868
Sex (male), %	83.3	81.8	0.143
BMI (kg/m^2), mean (SD)	27.50 (5.21)	25.79 (3.86)	0.108
Active smokers, (%)	16.7	3.0	0.116
Number of comorbidities ≥3, (%)	41.7	60.6	0.011
Dyspnea scale (mMRC) baseline≥2, (%)	61.5	87.9	0.046
	45.5	69.7	0.010
Dyspnea scale (mMRC) at 6 months ≥2, (%)	14.60 (9.18)	16.03 (6.18)	0.462
CAT score baseline, m (SD)	12.52 (5.44)	16.00 (5.52)	0.011
CAT score in 6 months, m (SD)
Drug treatment for COPD, (%)	5.6	6.1	0.826
LAMA monotherapy	33.3	36.4
LAMA-LABA combination	8.3	3.0
LABA+ ICS combination	52.8	54.5
Triple therapy

Abbreviations: BMI, body mass index; mMRC, modified Medical Research Council; CAT, COPD Assessment Test; Triple therapy, LABA (long-acting beta-2 agonists) + LAMA (long-acting antimuscarinic agents) + ICS (inhaled corticosteroids).