Digital health solutions like telemedicine, e-health, and m-health can improve the diagnosis, management, monitoring, and adherence to treatment for patients with chronic conditions [1] [2]. These technologies can also enable and empower patients to take an active role in their own care.
“Patients with COPD are beginning to have access to digital monitoring and rehabilitation systems, but they must pay for them, which creates inequalities and access barriers and reduces the potential benefits of e-health tools.”
COPD Patient, Italy
“I don’t feel technically competent with digital technologies. ”
COPD patient, Czech Republic
“I use a digital oximeter, linked to Bluetooth to my tablet. I can send the results to my GP or the hospital.”
COPD patient, Ireland
“Now I make my appointments online and ask for electronic prescriptions to be sent directly to the pharmacist.”
COPD patient, Belgium
Digital health refers to healthcare practices supported by electronic processes and communication tools. It includes electronic medical records, telemedicine, evidence-based medicine, health apps and devices.
Telehealth involves a combination of various digital technologies, including teleconsultation, m-Health, and assisted living, which aim at facilitating, for example, the relocation of services from physician offices and hospitals to the patients’ homes, irrespective of whether a patient lives in a remote area or not.
Mobile health (m-health) refers to the use of generally available mobile (communication) devices such as smartphones or tablets, computer, and wearable devices, such as smart watches, on which digital health apps and sensors operate.
Medical e-records are comprehensive records of an individual patient’s health status that can be accessed by healthcare providers and by the patient.[1]
Many patients and patient organisations, including EFA [3], have advocated for a focus on patients in the implementation of digital technologies in healthcare, especially with regard to forthcoming EU legislation such as the European Health Data Space (EHDS) [4] and the Empower through Digital Health Flagship Initiative from the WHO Regional Office for Europe. Before the Covid-19 pandemic, the adoption of digital technologies for COPD by healthcare systems was sporadic, particularly when it came to patients’ self-management and telemonitoring. Healthcare professionals and institutions were slow to embrace these tools [1]. The Covid-19 pandemic has accelerated the digital transformation in healthcare. Across Europe, healthcare systems had to change how they delivered services; the adoption of technologies—primarily teleconsultations and e-prescriptions—was expedited. As a result, patients had to adapt to the fast-evolving situation, and digital tools were integrated into the clinician-patient relationship.
In 2021, EFA conducted a survey involving 506 asthma patients and 464 COPD patients to assess the use of digital technologies related to respiratory diseases and satisfaction levels. A report entitled “The asthma and COPD patients’ digital journey in Europe” presented the results [5]. After the onset of the Covid-19 pandemic, patients with COPD preferred using easy-to-access technologies, such as online booking forms for consultations and video calls, while more advanced e-health technologies, including treatment planning, disease monitoring, consultations, examinations, and diagnostics, remained largely underused. Patients were concerned about losing face-to-face interactions with healthcare providers. Another issue was connected to data protection and privacy. Additionally, up until 2021, the availability of digital services for patients with COPD from healthcare providers was inconsistent, leading to disparities. Medical centres were the primary providers of digital services (64%), followed by general practitioners (41%). Physiotherapists and hospitals offered some services online (38%), whereas the percentage of digital services offered by specialists was considerably smaller at 28%. Notably, around 20% of respondents were unsure if their healthcare providers provided services digitally. In general, patients with COPD showed greater scepticism towards digital healthcare solutions compared to those with asthma. However, individuals who utilised e-health and m-health services expressed satisfaction, valuing the convenience and control these tools provided in managing their conditions.
Throughout the pandemic years, healthcare institutions in Europe implemented significant changes to enhance access to digital services, focussing on infrastructure and regulations, such as the reimbursement of teleconsultations. In numerous countries, financial investments in digital health have not yet established a consistent structure and are being renewed periodically [6], but the changes implemented appear to be lasting.
All surveyed countries have now adopted e-prescription, and patients have become accustomed to its use. Teleconsultations and telemonitoring have proven to be cost-effective methods for providing care in chronic diseases, such as COPD [2]. Overall, every country surveyed, except for Turkey, has expanded its digital healthcare services (Table 6).
Tele-rehabilitation is available to patients with COPD in Ireland, Italy, the Netherlands, and Sweden, though the level of availability varies across these countries. A study in Denmark found that patients with COPD who participated in a weekly telemonitoring programme experienced a greater sense of security and enhanced overall health and wellbeing. Additionally, patients participating in the telemonitoring programme received a more personalised treatment plan [7]. The results aligned with findings from other studies involving patients with chronic diseases, such as cardiovascular diseases and diabetes [2]. Additionally, following e-health programmes and enhancing self-management seems to depend on a blended care model that includes healthcare professionals to assist patients throughout their journey. Patients with COPD more often used e-Health platforms in an integrated care setting compared to those who used them on their own [8].
Table 6. Digital healthcare services available to patients in the countries surveyed
| Country | Telemedicine/e-prescriptions | Tele-rehabilitation | Digital peer support |
|---|---|---|---|
 |  |  |  |
| Austria |  | ||
| France | | ||
| Iceland | | ||
| Ireland | | | |
| Italy | | | |
| Netherlands | | | |
| Portugal | | ||
| Spain | |  | |
| Sweden | | ||
| Turkey |
*Not available nationwide.
A series of instructional videos on various inhalation devices designed to help patients with lung and respiratory diseases, such as COPD, avoid common inhalation mistakes.
© Österreichische Lungenunion, 2024
Patient peer support is a form of mutual aid and encouragement among individuals sharing similar challenges or conditions. It fosters empathy, understanding, and shared experiences to improve wellbeing. Online peer support is available in Ireland and the Netherlands. Despite their increased availability, some hospitals only use more advanced digital tools for monitoring and rehabilitation in restricted programmes, which limits their widespread use among patients. Furthermore, many of these tools require payment, creating disparities and barriers to their use.
The Italian patients’ organisation Respiriamo Insieme offers basic and intermediate-level in-person and online courses dedicated to advanced-age patients with a respiratory disease who are willing to learn about digital tools. The goal is to help participants gain confidence with digital tools and services, particularly digital health, as well as to provide digital peer support.
Wearables and other electronic devices can measure vital signs such as temperature, breathing rate, blood oxygen, or have other functions like locating the wearer.
The use of apps and wearables may also reinforce the effectiveness of smoking cessation programmes [9]. Patients of all ages can well-receive user-friendly digital health tools that address their needs, provided that they receive the training required to use them. Other digital devices are specifically designed for medical use. These devices, which include digital spirometry and peak flow devices, can improve daily health monitoring. Researchers demonstrated the feasibility and safety of adopting connected mobile spirometers.
While most patients have yet to embrace digital tools for COPD self-monitoring, those who have express a strong level of satisfaction, with ratings reaching 8.2 out of 10 [10]. FA’s research reveals that patients view digital peak flow devices, digital oxygen devices, and digital inhalers positively and consider them particularly valuable tools, despite their limited use [5]. This positive feedback highlights the untapped potential of digital spirometry in enhancing patient outcomes and quality of life, as well as the potential to reduce the economic burden associated with chronic respiratory conditions [11].
Medical e-records are comprehensive records of an individual patient’s health status that are accessible to both healthcare providers and patients. As part of its digital strategy 2030, the EU and its Member States are committed to supporting secure, interoperable, and accessible e-records for patients living in Europe [4]. E-records are also important for research, data collection, and monitoring, particularly for chronic diseases like COPD. As advocated by the Respiriamo Insieme association in Italy, the implementation of e-records and patient registries in all countries will be a significant step forward both to identify cases of COPD and to reduce barriers to access to treatment for COPD patients. In addition, when creating these tools, data protection and patients’ privacy must be prioritised. Therefore, regulatory safeguards for the use of digital technologies in the health sector must be enforced.
The use of artificial intelligence (AI) in the medical field is growing. It is being explored particularly to improve the diagnosis of COPD by using data from pulmonary function tests and computed tomography scanning or for symptom assessment [12] As part of its activities to improve the quality of care for patients with respiratory diseases, EFA is a partner of the TOLIFE project – Combining Artificial Intelligence and smart sensing TOward better management and improved quality of LIFE in chronic obstructive pulmonary disease, an EU-funded project that aims at validating the use of AI to process daily patient data that can be collected using sensors. The goal is to optimise personalised treatment, continuous assessment of patients’ health and ultimately improve quality of life in COPD patients.
Another example of the potential applications of AI is provided by the DRAGON project – The RapiD and SecuRe AI enhAnced DiaGnosis, Precision Medicine, and Patient EmpOwerment Centred Decision Support System for Coronavirus PaNdemics. Funded under the Innovative Medicine Initiative of the UE, it aims at using AI and machine learning to deliver a decision support system for precise Covid-19 diagnosis using CT scanning, and to better predict the outcomes of patients.
There is a need to further implement e-health, particularly in the case of chronic diseases, in two main directions: (1) to inform and empower patients; and (2) to help prevent disease exacerbation. Each patient should be free to decide whether to use digital health solutions, and, in any case, they should never replace in-person care.
Telehealth can empower patients to take an active part in their treatment and care by improving self-management skills and encouraging a more effective co-production of health [1]. In terms of access to digital health services, satisfaction among older people has grown over time, and older people are increasingly using these tools [6]. These findings confirm the results of EFA’s survey [5], thereby highlighting that encouraging the widespread adoption of digital solutions for patients’ monitoring and self- monitoring can improve patient care. The integration of telehealth technologies may help patients to actively participate in their treatment and care, fostering a proactive approach to symptom management and early intervention to prevent disease aggravation. Digital health strategies may play a pivotal role in preventing disease exacerbation by linking symptom management and therapy. These tools not only enhance prevention efforts but also contribute to better adherence to treatments, by providing real-time information back to the provider for intervention and/or targeted follow-up [1].
Digital health initiatives should be designed to align with patients’ preferences and should complement in-person care. Importantly, patients, particularly of advanced age, are more comfortable using technology they are already familiar with; therefore, developers should prioritise existing technological devices such as laptops, smartphones, and smartwatches [1]. The crucial factors of patient income and digital literacy continue to impact telemedicine access, and there is still a need to improve digital health access for the elderly and patients residing in rural areas. All patients should have access to digital health solutions and receive comprehensive training programmes. Furthermore, concerns about digital health solutions replacing in-person interactions with healthcare professionals should be acknowledged and addressed by actively involve patients in shaping initiatives and regulations at both national and international levels.
To effectively support people living with COPD it is essential to enable and develop digital health and care strategies that prioritise patients’ needs and on usability.
1. Socha-Dietrich K. Empowering the health workforce to make the most of the digital revolution. OECD Health Working Papers. 2021.↩
2. Creber A, Leo DG, Buckley BJR, Chowdhury M, Harrison SL, Isanejad M, et al. Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis. BMC Cardiovasc Disord. 2023;23:469.↩
3. EFA. EFA 2019 Active Patients Access Care. Brussels, Belgium: European Federation of Allergy and Airways Diseases Patients’ Associations; 2019.↩
4. European Commission. Implementation of the Digital Decade objectives and the Digital Rights and Principles. 2023.↩
5. EFA. The asthma and COPD patients’ digital Journey in Europe. European Federation of Allergy and Airways Diseases Patients’ Associations. Brussels, Belgium; 2022.↩
6. OECD. The future of telemedicine after COVID-19. 2023.↩
7. Nissen L, Lindhardt T. A qualitative study of COPD-patients’ experience of a telemedicine intervention. Int J Med Inform. 2017;107:11–7.↩
8. van Zelst CM, Kasteleyn MJ, van Noort EMJ, Rutten – van Molken MPMH, Braunstahl G-J, Chavannes NH, et al. The impact of the involvement of a healthcare professional on the usage of an eHealth platform: a retrospective observational COPD study. Respiratory Research. 2021;22:88.↩
9. Liao Y, Wu Q, Kelly BC, Zhang F, Tang Y-Y, Wang Q, et al. Effectiveness of a text-messaging-based smoking cessation intervention (“Happy Quit”) for smoking cessation in China: A randomized controlled trial. PLOS Medicine. 2018;15:e1002713.↩
10. Kupczyk M, Hofman A, Kołtowski Ł, Kuna P, Łukaszyk M, Buczyłko K, et al. Home self-monitoring in patients with asthma using a mobile spirometry system. J Asthma. 2021;58:505–11.↩
11. Newham JJ, Presseau J, Heslop-Marshall K, Russell S, Ogunbayo OJ, Netts P, et al. Features of self-management interventions for people with COPD associated with improved health-related quality of life and reduced emergency department visits: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2017;12:1705–20.↩
12. Ding H, Fatehi F, Maiorana A, Bashi N, Hu W, Edwards I. Digital health for COPD care: the current state of play. Journal of Thoracic Disease. 2019;11 Suppl 17. ↩
