The Use of Wearable Technology to Acquire Signals for COPD Research

Chronic Obstructive Pulmonary Disease (COPD) is a condition characterised by progressive air-flow obstruction, decline in lung function caused by airway inflammation and damaging of air sacs. The resulting narrowing of airways makes it harder to breathe in and out. COPD is currently the fourth leading cause of death worldwide and in the UK the National Institute for Health and Clinical Excellence (NICE) estimates that the total direct cost of COPD to the NHS is over £800million - out of which £300 million correspond to hospitalisations. Therefore, it is widely acknowledged that anything that improves management and effectiveness of treatment will not only improve patients' quality of life but also result in savings from: 1) Emergency hospital admissions; 2) Potential GP visit; 3) Loss of productivity due to work in absenteeism. Severe COPD exacerbations (periods where there is acute worsening of respiratory symptoms such as cough, dyspnoea, wheezing, increased sputum production) cause one in eight hospital admissions. Mild and moderate exacerbations can be managed outside hospital but if not identified and treated promptly may progress in some patients to respiratory failure. A significant proportion of these exacerbations will require inpatient treatment and can reduce the quality of life of patients increasing their morbidity and mortality. Thus, finding modalities for early detection and diagnosis of exacerbations is clearly a priority in current and future COPD research, but currently these still do no exist. The longer term goal of our research is to have a novel acoustic based wearable wireless technology that will be able to monitor COPD patients for extended periods of time, and automatically provide early detection of potential exacerbations even prior to symptoms which can be treated promptly to minimise their likelihood of progression to higher levels of severity. We have developed a small wearable device which is easy to use and for the first time allows continuous non-intrusive recordings of respiratory sounds and more specifically has been designed to optimise transmission of the acoustic signals generated by airflow within the trachea. We will aim to acquire signals from two groups of COPD patients: 1. A group undergoing exacerbations 2. A second group of stable, potential exacerbators, COPD patients The group of patients undergoing exacerbations will be recruited from medical wards and patients who agree to participate in the trial will be fitted with the device during their inpatient stay. Clinical data will be collected including but not limited to: co-morbidities, medications, oxygen given; timing of exacerbations medications (antibiotics, steroids, nebulisers) and observations. Patients will also be given a diary to complete during their inpatient stay for when they are ambulating, documentation of sputum production as well as other activities. Patients will also be given the option of taking the device home for several days whilst recovering from their exacerbation. The stable patients will be recruited from outpatient clinics and if clinically stable trained to use a device to take home for a pre-agreed period of time, up to one month. They will be expected to wear the device at night whilst sleeping and will have support throughout if needed. They will also be asked to complete a diary which documents amongst other things, sputum production, any exacerbations, symptoms, exercise and a range of other activities. Patients in both groups will be given usability questionnaires regarding comfort, usability, ease of the device and also be invited to attend focus groups to feedback about the device. The study will aim to develop a novel acoustic based wearable technology which will in the long term monitor COPD patients for an extended time period and automatically provide early detection of potential exacerbations. This has several benefits including: 1. Disease management optimisation resulting in better quality of life and lower severity of symptoms 2. Prompt and early treatment of exacerbations leading to fewer hospital admissions and can slow disease progression 3. Can potentially result in more personalised treatment and management, with efficient use of drugs and reduction in treatment cost.