Home monitoring of breathing rate in people with Chronic Obstructive Pulmonary Disease: observational study of feasibility, acceptability and change after exacerbation

Telehealth programmes to promote early identification and timely self-management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have yielded disappointing results in part because parameters monitored (symptoms, pulse oximetry, spirometry) are weak predictors of exacerbations.
Purpose: Breathing rate (BR) rises during AECOPD and may be a promising predictor. Devices suitable for home use to measure BR have recently become available, but their accuracy, acceptability, and ability to detect changes in people with COPD is not known.
Patients and methods: We compared five BR monitors, which used different monitoring technologies, with a gold standard (Oxycon-Mobile®). The monitors were validated in 21 stable COPD patients during a 57 min ‘activities of daily living protocol’ in a laboratory setting. The two best performing monitors were then tested in a 14-day trial in a home setting in 23 stable COPD patients to determine patient acceptability and reliability of signal. Acceptability was explored in qualitative interviews. The better performing monitor was then given to 19 patients recruited during an AECOPD who wore the monitor to observe BR during the recovery phase of an AECOPD.
Results: While two monitors demonstrated acceptable accuracy compared with the gold standard some participants found them intrusive particularly when ill with an exacerbation, limiting their potential utility in acute situations. A reduction in resting BR during the recovery from an AECOPD was observed in some, but not all participants and there was considerable day-to-day individual variation. Conclusion: Resting BR shows some promise in identifying exacerbations however further prospective study to assess this is required..