This week at ATS 2019, Propeller Health presented three new findings on COPD, all of which used digital health tools to monitor patients’ medication use in a real-world setting and reveal new insights about their disease.
This is the latest research to demonstrate how digital health tools continue to revolutionize the way we treat respiratory disease. When providers and patients can monitor the patient’s daily medication use, they’re more likely to adhere to their maintenance medication regimen and thereby experience fewer symptoms and require emergency treatment less often.
Here are three insights from the research Propeller Health presented this week at ATS 2019:
1. Digital medicines could be a proxy for the CAT for measuring COPD impact.
The COPD Assessment Test (CAT) is an eight-question patient questionnaire that assesses the the symptom burden of COPD. The CAT is a widely accepted standard in COPD care, but it has limitations — namely, that patients have to actively fill it out for it to be useful, and it’s mostly conducted in a clinical setting. Our study sought to examine whether digital medicines recording the use of rescue medications could reveal similar insights to the CAT by collecting data passively via a sensor attached to the patient’s inhaler.
The study enrolled more than 2,000 patients on the Propeller program, which provides insights on the patient’s disease by connecting their inhaled COPD medications to their smartphone via a sensor. The patients were asked to take the CAT on the Propeller app at the time of enrollment. The sensor then recorded the time and date of each medication use.
The study found a significant and direct association between higher rescue use and higher CAT scores, reflecting greater disease burden. This suggests that passively collected collected data from digital health tools could serve as a surrogate for the CAT. The study also found that patients who were more adherent to their medication regimen were more likely to have lower CAT scores.
2. COPD patients have higher levels of adherence with advancing age and disease severity.
It’s well-understood that adherence to daily maintenance medication helps improve outcomes for patients with COPD, but real-world data on adherence has been difficult to attain before the advent of digital health tools. This study looked to answer the question: Does adherence to a maintenance medication help a patient decrease their use of a rescue inhaler?
The study collected data from 839 patients over the age of 40 with COPD, who were all using an inhaled maintenance medication with a Propeller sensor attached. The study showed that patients with higher levels of adherence to their daily medication actually also had a higher level of SABA use. The study also showed that adherence was higher in patients over the age of 60 compared to those between age 40 and 59.
The correlation between advanced age and SABA use, and medication adherence and SABA use, suggests to us that SABA use is driven by disease severity. That is, patients experiencing a more severe level of COPD may experience more daily symptoms requiring SABA use and better maintenance medication adherence.
3. COPD patients experience higher rescue use in the morning.
While past research has examined the daily and seasonal patterns of asthma symptoms in patients, less research has been done on the same topic for COPD. This study used a digital health tool to objectively track the time and date of rescue inhaler use in COPD patients, then analyzed how rescue inhaler use changed based on time of day or season.
The study looked at 3,287,928 hours of data from 2,012 patients and found:
- Patients’ use of their rescue medication was lowest between midnight and 4 AM
- Patients’ use of their rescue medication was highest between 8 AM and 11 AM
- Seasonal variation of rescue use was minimal, with daily rescue use per month ranging from 2.2 puffs/day in December (lowest) to 2.8 puffs/day in February (highest)