Home-Based Telemanagement in Advanced COPD: Who Uses it Most? Real-Life Study in Lombardy

Figures & data

Table 1. Baseline characteristics of study population.

	N.	%	Mean ± SD
Total n. patients	1074	100%
Age (Years)	1074	100%	75.44 ± 8.3
Males	824	76.7%	75.95 ± 8.22
Females	250	23.3%	73.74 ± 8.37
BMI (Kg/m^2)	1074	100%	26.07 ± 5.34
Under weight	70	6.5%	16.83 ± 1.36
Normal Weight	390	36.3%	22.13 ± 1.66
Overweight	338	31.5%	27.08 ± 1.42
Obese	276	25.7%	33.52 ± 3.35
Smoking status	1074	100%
Non-smokers	237	22.1%
Smokers/ex-smokers	837	77.9%
Co-morbidities	1074	100%
<3	57	5%
3	1017	95%
Residence	1074	100%
<5,000 inhabitants	445	41.4
≥ 5,000 inhabitants	629	58.6%
HTP prescription	1074	100.%
Valid	947	88.2%
Stable condition	493	45.9%
Post-relapse	454	42.3%
Type of Co-morbidity	1074	100%
Heart Failure	51	4.7%
Hypertension	419	39%
Diabetes	170	15.8%
Gastritis & Duodenitis	26	2.4%
CKD	32	3%
Cerebrovascular disease	18	1.7%
FEV1 (% pred)	1074	100%	43.18 ± 18.51
GOLD stage II	163	15.2%
GOLD stage III	349	32.5%
GOLD stage IV	562	52.3%
LTOT	1074	100%
Yes	646	60%
Nocturnal spO2/FiO2	1074	100%
Valid	1021	95.3%	391.3 ± 54.0
PaO2/FiO2	1074	100%	294.8 ± 62.3
Valid	1063	99%
PaCO2 (mmHg)	1074	100%	43.4 ± 7.4
Valid	1066	99.2%
pH	1074	100%	7.42 ± 3.5
Valid	1066	99.2%
Access to ER	1074	100%
Yes	60	5.6%	0.084 ± 0.075
No	1014	94.4%
GP Consultations	1074	100%
Yes	859	20%	0.015 ± 0.07
No	215	80%
Relapse	1074	100%
Yes	399	37.2%	0.019 ± 0.03
No	675	62.8%
Spirometry	1074	100%	0.043 ± 0.08
ABG	1074	100%	0.08 ± 0.08
CAT	1074	100%
Valid	593	55.2%	15.8 ± 7.5
Pharmacotherapy (%)	1074	100%
SABA	60	5.6%
LAMA	115	10.7 %
LABA+ LAMA	285	26.5 %
LABA + LAMA + ICS	614	57.2%

Legend: BMI = body mass index (under weight: BMI < 18.5; normal weight: BMI 18.5–24.9; overweight: BMI 25–29.9; obese: BMI > 30); HTP = home telemanement program; CKD = chronic kidney disease; FEV₁ = forced expiratory volume at first second; GOLD = global initiative for obstructive lung disease; LTOT = long-term oxygen therapy; SpO₂ = pulsed oxygen saturation; FiO₂ = inspiratory fraction of oxygen; PaO₂ = arterial oxygen pressure; PaCO₂ = arterial carbon dioxide; ER = emergency room; GP = general practitioner; ABG = arterial blood gases; CAT = COPD Assessment Test; SABA = short-acting beta2-agonist (bronchodilator agent); LAMA = long-acting muscarinic antagonist; LABA = long-acting beta2-agonist (bronchodilator agent); ICS = inhaled corticosteroid.

Figure 1. Number of patients enrolled (2010–2013) per hospital and district of Lombardy Region. Legends: BG = Bergamo; BS = Brescia; Co = Como; CR = Cremona; LC = Lecco; LO= Lodi; MN = Mantova; MI = Milano; MO = Monza; PV = Pavia; SO = Sondrio; VA = Varese.

Table 2. Univariate and multivariable linear regression analyses for HTP use.

	Univariate analysis			Multivariable analysis
Variables	Coeff B	Standard Error	P-value	Coeff B	Standard Error	P-value
Gender Male	0.010	0.030	0.733
Gender Female	0.000	—	—
FEV1 (% prd)	0.000	0.001	0.518
Access to ER	2.406	1.248	0.054	—	—	—
GP consultations	3.129	0.144	0.000	2.777	0.153	0.000
Relapses	4.079	0.347	0.000	1.747	0.327	0.000
HTP prescription (stable)	−0.006	0.027	0.836
HTP prescription (post-relapse)	0.000
Residence ≤ 5,000 inhabitants	−0.039	0.025	0.120
Residence > 5,000 inhabitants	0.000
CAT in	0.002	0.003	0.432
Age	−0.002	0.002	0.169
BMI	−0.003	0.002	0.164
Co-morbidities = 3	0.020	0.011	0.718
Co-morbidities < 3	0.000	—	—
ABG	0.802	0.163	0.000	0.738	0.327	0.000
Spirometry	0.964	0.154	0.000	—	—	—
paCO2	0.002	0.002	0.320
SpO2/FiO2	0.000	0.000	0.459
PaO2/FiO2	−0.000	0.000	0.751
Constant				0.960	0.016	0.000

Legend: FEV₁ = forced expiratory volume at first second; ER = emergency room; GP = general practitioner; HTP = home telemanegement program; CAT = COPD Assessment Test; BMI = body mass index; ABG = arterial blood gases; PaCO₂ = arterial carbon dioxide; SpO₂ = pulsed oxygen arterial saturation; FiO₂ = inspiratory fraction of oxygen; PaO₂ = arterial oxygen pressure. Bolded text is related to variables found statistically significant.

Table 3. Variables associated with relapse at multivariable analysis.

	Univariate analysis				Multivariable analysis
			95% C.I.for EXP(B)				95% C.I.for EXP(B)
Variables	P	OR	Lower	Upper	P	OR	Lower	Upper
Gender (male versus female)	0.779	1.043	0.777	1.399
Age	0.607	0.996	0.981	1.011
Co-morbidities (3 versus < 3)	0.085	1.699	0.929	3.104	—	—	—	—
Smoking status (smokers/ex-smokers vs. non-smokers)	0.022	1.433	1.052	1.952	0.020	1.542	1.069	2.217
Residence (<5,000 inhabitants vs. ≥ 5,000 inhabitants)	0.392	1.116	0.868	1.434
BMI	0.494	0.992	0.969	1.016
PaO2/FiO2	0.982	1.000	0.998	1.002
SpO2/FiO2	0.778	1.000	0.997	1.002
PaCO2	0.606	1.004	0.988	1.021
FEV1 % prd	0.333	1.003	0.997	1.010
Access to ER (yes vs no)	0.119	1.517	0.899	2.559
O2 therapy (yes vs no)	0.246	0.860	0.667	1.109
Specialist consultation request (yes vs. no)	0.000	3.656	2.806	4.763	0.000	2.895	2.144	3.910
GP consultation request (yes vs. no)	0.000	7.779	5.523	10.957	0.000	6.575	4.521	9.561
Constant					0.000	0.298	—	—
Test						χ^2	df	P
Goodness-of-fit test
Hosmer & Lemeshow						5.490	4	0.241
(H-L)

Legend: P-value calculated using the Wald test. Cox and Snell R² = .188. Nagelkerke R² = .256. -2loglikehood = 1085.560

BMI = body mass index; PaO₂ = arterial oxygen pressure; FiO₂ = inspiratory fraction of oxygen; SpO₂ = pulsed oxygen saturation; PaCO₂ = arterial carbon dioxide; FEV₁ = forced expiratory volume at first second; ER = emergency room; O₂ = oxygen; GP = general practitioner. Bolded text is related to variables found statistically significant.

Table 4. Univariate and multivariable linear regression analyses for CAT score at the end of the pathway.

	Univariate analysis			Multivariable analysis
Variables	Coeff B	Standard Error	P-value	Coeff B	Standard Error	P-value
Gender Male	−1.197	0.761	0.116
Gender Female	0.000
FEV1 (% prd)	−0.037	0.016	0.023	—	—	—
Access to ER	−11.052	29.365	0.707
GP consultations	0.518	3.700	0.889
Relapse	−1.713	9.039	0.850
COPD-related hospitalization	0.832	0.900	0.356
Non-COPD-related hospitalization	0.834	0.362	0.022	—	—	—
HTP/w	0.920	0.791	0.245
HTP prescription (stable conditions)	−3.605	0.634	0.000	−2.606	0.570	0.000
HTP prescription (post-relapse)	0.000			0.000
O2 therapy yes	−2.179	0.628	0.001	−1.866	0.570	0.001
O2 therapy no	0.000			0.000
Residence ≤ 5,000 inhabitants	−1.580	0.648	0.015	—	—	—
Residence > 5,000 inhabitants	0.000			—	—	—
Smoking status (non-smoker)	−0.412	0.776	0.596
Smoking status (smoker/ex-smoker)	0.000
CAT in	0.618	0.039	0.000	0.558	0.039	0.000
Age	0.027	0.039	0.495
BMI	−0.067	0.061	0.275
Co-morbidities = 3	4.115	1.275	0.001	3.561	1.049	0.001
Co-morbidities < 3	0.000			0.000
ABG	2.613	3.871	0.500
Spirometry	1.215	3.723	0.744
PaCO2	0.206	0.044	0.000	—	—	—
SpO2/FiO2	−0.021	0.006	0.001	—	—	—
PaO2/FiO2	−0.029	0.006	0.000	—	—	—
Constant				5.250	1.274	0.000

Legend: FEV₁ = forced expiratory volume at first second; ER = emergency room; GP = general practitioner; HTP/w = home telemanement program use normalized on a “per week” basis (i.e., total number of scheduled calls, unscheduled calls and pulmonologist consultations required /number of patient's follow-up weeks); O₂ = oxygen; CAT = COPD Assessment Test; BMI = body mass index; ABG = arterial blood gases; PaCO₂ = arterial carbon dioxide; SpO₂ = pulsed oxygen saturation; FiO₂ = inspiratory fraction of oxygen; PaO₂ = arterial oxygen pressure. Bolded text is related to variables found statistically significant.