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Original Research: COPD |

Detection of COPD Exacerbations and Compliance With Patient-Reported Daily Symptom Diaries Using a Smartphone-Based Information SystemBlackBerry-Based Symptom Diaries for COPD Patients

Neil W. Johnston, MSc; Kim Lambert, RN, MSc; Patricia Hussack, RN; Maria Gerhardsson de Verdier, MD, PhD; Tim Higenbottam, MD, DSc; Jonathan Lewis, BSc; Paul Newbold, PhD; Martin Jenkins, MMath; Geoffrey R. Norman, PhD; Peter V. Coyle, MD; R. Andrew McIvor, MD
Author and Funding Information

From the Firestone Institute for Respiratory Health (Mr Johnston, Mss Lambert and Hussack, and Dr McIvor) and the Department of Clinical Epidemiology and Biostatistics (Dr Norman), McMaster University, Hamilton, ON, Canada; Respiratory and Inflammation Therapy Area (Dr Gerhardsson de Verdier and Mr Lewis), AstraZeneca, Molndal, Sweden; MedImmune LLC (Dr Newbold), Gaithersburg, MD; TranScrip-Partners LLP (Dr Higenbottam), Reading, England; Biometrics and Information Sciences (Mr Jenkins), AstraZeneca, Alderley Park, Macclesfield, England; and Regional Virology Laboratory (Dr Coyle), Belfast Health and Social Care Trust, Belfast, Northern Ireland.

Correspondence to: Neil W. Johnston, MSc, Firestone Institute for Respiratory Health, McMaster University, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada; e-mail: njohnsto@mcmaster.ca.


Dr McIvor was the coprincipal investigator.

Part of this article has been presented in abstract form at the European Respiratory Society 2008 Annual Meeting, Berlin, Germany (abstract 250496) and American Thoracic Society 2012 Annual Meeting, San Francisco (abstract 28081).

Funding/Support: This study was supported by a grant from AstraZeneca.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):507-514. doi:10.1378/chest.12-2308
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Background:  Paper-based diaries and self-report of symptom worsening in COPD may lead to underdetection of exacerbations. Epidemiologically, COPD exacerbations exhibit seasonal patterns peaking at year-end. We examined whether the use of a BlackBerry-based daily symptom diary would detect 95% or more of exacerbations and enable characterization of seasonal differences among them.

Methods:  Fifty participants with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage I to IV COPD began a community-based study in December 2007. Another 30 began in December 2008. Participants transmitted daily symptom diaries using a BlackBerry. Alerts were triggered when symptom changes, missed diary transmissions, or medical care for a respiratory problem occurred. Participant encounters were initiated if COPD exacerbations were suspected. Participants used their BlackBerrys to report returns to normal breathing.

Results:  Participants transmitted 99.9% of 28,514 possible daily diaries. All 191 (2.5/participant-year) COPD exacerbations meeting Anthonisen criteria were detected. During 148 of the 191 exacerbations (78%, 1.97/participant-year), patients were hospitalized and/or ordered prednisone, an antibiotic, or both. Respiratory viruses were detected in 78 of the 191 exacerbations (41%). Those coinciding with a respiratory viral infection averaged 12.0 days, and those without averaged 8.9 days (P < .04), with no difference in Anthonisen score. Respiratory symptom scores before exacerbations and after normal breathing return showed no differences. Exacerbations were more frequent during the Christmas period than the rest of the year but were not more frequent than in the rest of winter alone.

Conclusions:  Smartphone-based collection of COPD symptom diaries enables near-complete identification of exacerbations at inception. Exacerbation rates in the Christmas season do not reach levels that necessitate changes in disease management.

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