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Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world, and leads to a substantial burden on healthcare services. Effective and timely management of patients with COPD has been essential to alleviate COPD exacerbation, improve the quality of life, and consequently reduce the economic burden. To achieve this, we propose an innovative tele-medicine system based on Smart Breath Analyzer (SBA) device and devoted to the tele-monitoring of exhaled air in patients suffering chronic respiratory failure and home-assisted by mechanical ventilation. In this work the main characteristics of the developed tele-medicine system are presented together with preliminary pre-clinical test results. The preliminary tests demonstrated the effective possibility to enter the SBAs in medical practice in home-ventilo-therapy protocols by suitable interpretation of the monitored parameters from a physiological point of view. Thanks to a network composed by many SBA devices that send patients data to a remote server, the doctor can tele-monitor the status of patient in order to check any state of exacerbation of the disease and consequently improve quality of life in COPD.

Chronic obstructive pulmonary (COPD) disease is a progressive illness that will intensify over time. Exacerbation are frequent and likely caused by bacterial and viral respiratory infections. The management of COPD includes home assistance by noninvasive ventilation (NIV), but no remote monitoring system is generally applied. In this work a telemedicine device based on Smart Breath Analyzer (SBA) devoted to the remote-monitoring of parameters in the exhaled air of COPD patients during NIV was developed. System architecture and preliminary pre-clinical test results were here presented.

Giuseppe Antonio Palmiotti,1 Donato Lacedonia,1 Vito Liotino,2 Pietro Schino,3 Francesco Satriano,4 Pier Luigi Di Napoli,3 Eugenio Sabato,5 Vincenzo Mastrosimone,6 Alfredo Scoditti,7 Mauro Carone,8 Elio Costantino,9 Emanuela Resta,2 Ettore Attolini,10 Maria Pia Foschino Barbaro1 1Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy; 2Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Diseases, School of Medicine, University of Bari, Bari, Italy; 3Physiopathology Respiratory Unit, F Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy; 4Pneumology Clinic, Vito Fazzi Hospital, Lecce, Italy; 5UOC of Pneumology, “N Melli” Hospital, San Pietro Vernotico, Italy; 6Division of Pulmonary Disease, Medical Center of Rehabilitation, Foundation Salvatore Maugeri, IRCCS, Marina di Ginosa, Italy; 7Department of Respiratory Diseases, San Camillo Clinic, Taranto, Italy; 8Division of Pulmonary Disease, Medical Center of Rehabilitation, Foundation Salvatore Maugeri, IRCCS, Cassano delle Murge, Italy; 9UOC of Pneumology, Hospital “Madonna delle Grazie”, Matera, Italy; 10Regional Health Agency (ARES), Bari, Italy Background: COPD is a disease associated with significant economic burden. It was reported that Global initiative for chronic Obstructive Lung Disease (GOLD) guideline-oriented pharmacotherapy improves airflow limitation and reduces health care costs. However, several studies showed a significant dissociation between international recommendations and clinicians’ practices. The consequent reduced diagnostic and therapeutic inappropriateness has proved to be associated with an increase in costs and a waste of economic resources in the health sector. The aim of the study was to evaluate COPD management in the Puglia region. The study was performed in collaboration with the pulmonology centers and the Regional Health Agency (AReS Puglia). Methods: An IT platform allowed the pulmonologists to enter data via the Internet. All COPD patients who visited a pneumological outpatient clinic for the first time or for regular follow-ups or were admitted to a pneumological department for an exacerbation were considered eligible for the study. COPD’s diagnosis was confirmed by a pulmonologist at the moment of the visit. The project lasted 18months and involved 17 centers located in the Puglia region. Results: Six hundred ninety-three patients were enrolled, evenly distributed throughout the region. The mean age was 71±9years, and 85% of them were males. Approximately 23% were current smokers, 63% former smokers and 13.5% never smokers. The mean post-bronchodilator forced expiratory volume in 1second was 59%±20% predicted. The platform allowed the classification of patients according to the GOLD guidelines (Group A: 20.6%, Group B: 32.3%, Group C: 5.9% and Group D: 39.2%), assessed the presence and severity of exacerbations (20% of the patients had an exacerbation defined as mild [13%], moderate [37%] and severe [49%]) and evaluated the appropriateness of inhalation therapy at the time of the visit. Forty-nine percent of Group A patients were following inappropriate therapy; in Group B, 45.8% were following a therapy in contrast with the guidelines. Among Group C patients, 41.46% resulted in triple combination therapy, while ~14% of Group D patients did not have a therapy or were following an inappropriate therapy. In conclusion, 30% of all patients evaluated had been following an inadequate therapy. Subsequently, an online survey was developed to inquire about the reasons for the results obtained. In particular, we investigated the reasons why 30% of our population did not follow the therapy suggested by the GOLD guidelines: 1) why was there an excessive use of inhaled corticosteroids, 2) why a significantly high percentage was inappropriately treated with triple therapy and 3) why a consistent percentage (11%) of Group D patients were not treated at all. Conclusion: The data provides an overview on the management of COPD in the region of Puglia (Italy) and represents a resource in order to improve appropriateness and reduce the waste of health resources. Keywords: COPD, appropriateness, web platform, health care spending, online survey

Introduction: the COPD exacerbations are associated with a high mortality rate, a faster decline in lung function, poor quality of life and increased health resource utilization. Aims and objectives: to evaluate COPD management in Apulia region. In this context, an “Exacerbation in COPD " study was performed in collaboration between pulmonology centers and the Regional Health Agency (AReS Puglia). Methods: an IT platform developed by the Interuniversity Consortium CINECA allowed pulmonologists the insertion of data via internet. The project lasted 18 months and involved 11 centers. Results: 764 patients were enrolled (16% female and 84% male), evenly distributed throughout the region. The platform allowed the classification of patients according to GOLD guidelines (Group A 22%, B 33.6%, C 5.9% D 38.4%), assess the presence and severity of exacerbations (19.9% had an exacerbation at the moment of the visit, respectively slight 13%, 37% mild and 49% severe) and evaluate the appropriateness of inhalation therapy at the time of the visit. We found that 49% of group A patients were following inappropriate therapy, with 14% already in ICS/LABA+LAMA; in group B, 34% of patients were following a triple combination therapy and 31% used ICS, in contrast with guidelines. Among group C patients, 41% resulted in triple combination therapy, while 22% of group D patients did not have a therapy or used a single drug. In conclusion, 47% of all patients evaluated had been following an inadequate therapy. Conclusion: the data provide an overview on the management of COPD in the Apulia region and represent a resource in order to improve appropriateness and reduce the waste of health resources.