Guidance assessment consultation document for: HTE10030 Digital technologies to support self-management of COPD: early value assessment

Active+me REMOTE (Aseptika) is a cloud-based platform that supports self-management and remote monitoring of adults with COPD at home. The Active+me REMOTE app includes an education programme delivered in small lessons and interactive exercise videos that increase in difficulty as a person's fitness and strength improve. The technology also collects patient-generated data through an add-on pulse oximeter, spirometer, and smart inhaler. The technology can be accessed through a mobile phone, tablet, or desktop.

Clinitouch (Spirit Health) is a web-based or app-based self-management platform that enables remote clinical monitoring of people with COPD. People can log into the platform to answer clinically approved questions and measure various vital signs, such as blood pressure and oxygen saturation. The platform supports monitoring of COPD by providing health status and health trend data. Also, the platform offers secure messaging, video conferencing and educational content, including exercise programmes.

COPDhub (The Institute of Clinical Science and Technology) is a digital personalised care plan for people with COPD delivered by an app. It includes a monthly COPD checker to track symptoms and has real-time guidance to identify those at risk. The technology provides educational content including videos on inhaler techniques and breathing exercises, downloadable care summaries, and reminder features to support self-management of COPD. It also features the COPD Assessment Test (CAT) and the Modified British Medical Research Council (mMRC) score functionality for assessment. It can be used to record healthcare data such as GP appointments.

COPDPredict (NEPeSMO) is a digital self-monitoring app with artificial intelligence-enabled exacerbation prediction capability for people with COPD. The technology focuses on prevention by combining remote monitoring and patient-personalised exacerbation prediction. Prediction algorithms are constructed from time-series data on symptoms, lung function, and biomarkers in blood or saliva supplied by people using a bespoke app that connects wirelessly to monitoring devices. There is also an online Clinician Early Warning System that provides alerts on impending exacerbations, allowing timely intervention.

Current Health (BEST BUY Health) is an individually tailored self-management app. It helps people manage their care with automated messaging and reminders. Current Health technology supports people with COPD by enabling remote monitoring and facilitating early hospital discharge. People showing signs of clinical deterioration who present to emergency departments or in community care are monitored at home, which may prevent unnecessary hospital admissions. This technology has clinical team capacity through a central monitoring hub, staffed by trained staff proactively monitoring vital signs and responding to health alarms.

DOC@HOME (Docobo) is a digital platform for remote monitoring and case management, that can be used by people with COPD at home and in care homes. It enables remote patient monitoring by collecting vital signs such as blood oxygen levels through home pulse oximetry kits, blood pressure, weight and temperature. Users can also log their symptoms. The platform offers self-help information and alerts healthcare professionals to critical changes such as reduced blood oxygen levels, allowing medical intervention if needed.

Doccla (Doccla) is a remote self-management and monitoring service for people with COPD who have been discharged from hospital wards, aiming to reduce the need for in-person visits. This includes mobile and web apps to track health metrics through wearable and spot-check devices, communication with healthcare providers, and access to information about their condition and a self-management plan. The app also provides automated alerts if health metrics fall outside predefined thresholds and can provide reminders to take medicines and attend appointments. Clinicians can use an online portal to review clinical data and communicate with users. This portal is within a virtual ward platform that allows the simultaneous monitoring of many users whilst integrating with electronic health records for ease of data exchange.

Lenus COPD Support Service (Lenus Health) is a remote management app for people with COPD. The technology offers standardised self-management advice and personalised care plans, with the option for clinicians to activate a rescue plan when necessary. Users can input patient-reported outcome measures and maintain a symptom diary. They can also communicate non-urgent queries with their clinical care team through a messaging feature. A website provides additional self-management resources. A clinician dashboard integrates data from electronic health records, PROMs, and wearable devices for remote monitoring. The technology combines data from patient-reported outcomes, medical and wearable devices and clinical records, and can highlight anyone at risk enabling early intervention. People can also manage their appointments through the platform.

Luscii (Luscii) is a self-management app for people with COPD. It allows users to self-monitor by recording their symptoms, completing assessments from standardised questionnaires and measuring vital signs, such as oxygen saturation levels. The app is accessible through any internet connected device and integrates with portable monitoring devices to upload data. It also provides educational resources including updates, information on effective inhalation methods, strategies for coping with COPD and motivational messages to promote self-management of COPD. The app allows users to contact their healthcare team and supports video consultations.

myCOPD (my mhealth) is a self-management platform for people with COPD. The app provides education on correct inhaler use, a personalised self-management plan, prescription assessment and detailed symptom tracking with daily reporting and monthly COPD Assessment Test (CAT) scores. The self-management plan can be updated by clinicians and integrated into the patient review process, supporting shared care. Additional features include structured education, an activity diary, breathing techniques, communication with healthcare providers, web-based access, and therapeutic interventions such as inhaler instruction, chest clearance guidance, cognitive behavioural therapy, mindfulness exercises, and stopping smoking advice. It also offers a structured exercise, education and psychosocial support programme. These features allow clinicians to monitor and support people with COPD remotely.

The patientMpower (patientMpower) platform is designed for people with respiratory conditions, focusing on remote monitoring and self-management. It includes a patient-facing app with integrated medical devices for data collection as well as questionnaires. This app records physiological parameters such as spirometry, pulse oximetry, and blood pressure, as well as patient-reported outcomes. Users can also monitor exercise, air quality, and medicine adherence. The platform empowers healthcare professionals to create virtual care pathways. It allows remote monitoring of clinical data and gives medicine reminders, supporting people with stable COPD and enabling quick intervention for deteriorating cases through a clinician web portal.

SPACE for COPD (University Hospitals of Leicester NHS Trust) is a digital self-management programme designed to help people with COPD manage their condition more effectively. SPACE for COPD is a structured programme of exercise, education and psychosocial support. The programme contains educational topics including information about medicine, breathing control, exercise and nutritional advice. Users are encouraged to set goals, progress through a prescribed exercise programme and achieve weekly targets. The technology can be accessed through a mobile phone, tablet, or desktop. Clinicians can monitor user logins, progress and wellbeing on the programme, and answer any questions that the user sends to them.

Wellinks (Wellinks) is an online platform designed to empower people with COPD. It offers health coaching for self-management support by respiratory professionals, and a patient-centred app with connected devices such as pulse oximeters and spirometers for remote monitoring and education.

In 2020 to 2021, NHS Digital reported that about 1.17 million people (1.9% of the population) in England have been diagnosed with COPD. It is estimated that a further 2 million remain undiagnosed. Incidence of diagnosed COPD has risen from 1.7% to 1.9% of the population over the last 10 years. Chronic lower respiratory diseases were reported as the third most common cause of death in England and Wales in 2023 (Office for National Statistics, 2023). COPD is much more common in areas of high deprivation. People living in these areas have a lower life expectancy than the general population, and COPD is responsible for 8% of this difference in men and 12% in women. Managing COPD in the UK costs the NHS over £800 million a year.

NICE's guideline for the diagnosis and management of COPD in over 16s states that COPD care should be delivered by a multidisciplinary team that includes respiratory nurse specialists. Self-management plans should include education and an individualised exacerbation action plan for people at risk of exacerbations. These plans should improve the confidence and knowledge of people with COPD. Treatments and plans including inhaler technique and onward referral for exercise interventions should be revisited at every review. People with COPD should be on the primary care COPD register and should attend a follow-up review in primary care at least once a year and more often if needed. The current model of delivery of these interventions is usually face-to-face interactions between people with COPD and specialist respiratory staff.

People who have had in-hospital care after an exacerbation are given care bundles. Care bundles aim to help people cope better once home from hospital and potentially prevent further readmission by improving outcomes. There were 75.5% of people with COPD exacerbations discharged from hospitals in England, Scotland and Wales between October 2019 and February 2020 who were given a discharge bundle, according to the National Asthma and COPD Audit Programme (NACAP) COPD clinical audit (PDF). Despite this, mortality within 30 days of index admission was 6.3%, and mortality within 90 days was 12%. There is a need to support people to self-manage COPD more effectively, which may reduce the risk of the initial exconacerbation and potentially reduce the likelihood of people being readmitted after their initial exacerbation.

The comparator for this health technology evaluation is standard care. Standard care includes self-management of COPD without digital technologies. This may include face-to-face appointments and monitoring.