Remote Electronic Monitoring in Chronic Pulmonary Diseases

Remote Electronic Monitoring in Chronic Pulmonary Diseases

S. Bella (Bambino Gesù Paediatric Hospital, Research and Care Institute, Italy) and F. Murgia (Bambino Gesù Paediatric Hospital, Research and Care Institute, Italy)
Copyright: © 2013 |Pages: 18
DOI: 10.4018/978-1-4666-2979-0.ch012
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Abstract

In this chapter the main aspects of telemonitoring are described and discussed in the field of chronic respiratory diseases. The authors describe the various challenges they faced, in the order in which they did. First, they face the problem of effectiveness of the method, then, the problems related to the economic viability, and finally, the problems related to the operating method. The authors conclude that remote monitoring is a promising method in terms of effectiveness of follow-up that must be performed under well controlled conditions. They still require further validation studies to improve the effectiveness and reduce the effects of new issues that arise.
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1. Clinical Aspects

Background

Innovative technologies and informatics applied to medicine offer both health operators and patients a wide range of services that have changed the traditional concept of health care. In the last few years, the availability of handy equipment, easy to transport and use, and suitable to collect and transmit various clinical data, have resulted in a fast development of Homecare. The earliest application of Telemonitoring has involved the follow-up of acute patients affected by arrhythmia or heart failure, diabetes, acute respiratory insufficiency as bronchial asthma, the control of breast-feeding mothers during lactation and the assessment of post surgery patients (Scalvini, 2004).

Only recently Telehomecare (THC) became an opportunity for the follow-up of chronic diseases such as cardiopulmonary, bronchial asthma and heart failure (Meystre, 2005), although the impact of Telemonitoring on patients’ conditions still remains uncertain (Paré, 2007).

The natural course of Cystic Fibrosis (CF) is characterized by a progressive lung destruction, caused by obstruction of the airways due to dehydrated thickened secretions, resultant endobronchial infection and an exaggerated inflammatory response leading to development of bronchiectasis and progressive obstructive airways disease (Flume, 2006).

Prevention and control of lung infections is one of the main objectives of therapy in CF patients with the aim to slow down the progressive decline of the pulmonary function (Que, 2006).

Many researchers demonstrated that, in case of infectious relapse, pulmonary function modifications often precede the clinical symptoms and that monitoring variations in pulmonary function can be useful in children and in adults (Davis, 2001) (Mohon, 1993).

Early recognition of infectious relapse allows to promptly administer an antibiotic therapy, to prevent serious complications, and to use less aggressive therapies (Rajan, 2002).

Since 2001 distance monitoring of lung parameters has been used in the follow-up of patients with CF in the Cystic Fibrosis Centre of the Bambino Gesù Children’s Hospital - IRCCS - in Rome.

In 2009 we have published data from the first years of this activity (Bella, 2009).

Purpose of this study was to assess the effect of THC in the follow-up of CF patients, by systematically monitoring respiratory parameters (O2 saturation during the night and spirometry), to early detect pulmonary infectious relapses, and to measure the impact on respiratory function over time.

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