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Jean Bourbeau,1 Pere Casan,2 Silvia Tognella,3 Peter Haidl,4 Joëlle B Texereau,5,6 Romain Kessler7 On behalf of the COMET investigators 1Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada; 2Hospital Universitario Central de Asturias, Facultad de Medicina, Oviedo, Spain; 3Lung Department, Ospedale Orlandi, Bussolengo VR, Italy; 4Krankenhaus Kloster Grafschaft, Schmallenberg, Germany; 5Air Liquide Healthcare, Medical Research and Development, Jouy-en-Josas, 6Assistance Publique-Hôpitaux de Paris, Service de Physiologie Clinique, Hôpital Cochin, Paris, 7Department of Pulmonary Medicine, Translational Medicine Federation of Strasbourg, University Hospital of Strasbourg, Strasbourg, France Introduction: Most hospitalizations and costs related to COPD are due to exacerbations and insufficient disease management. The COPD patient Management European Trial (COMET) is investigating a home-based multicomponent COPD self-management program designed to reduce exacerbations and hospital admissions.Design: Multicenter parallel randomized controlled, open-label superiority trial.Setting: Thirty-three hospitals in four European countries.Participants: A total of 345 patients with Global initiative for chronic Obstructive Lung Disease III/IV COPD.Intervention: The program includes extensive patient coaching by health care professionals to improve self-management (eg, develop skills to better manage their disease), an e-health platform for reporting frequent health status updates, rapid intervention when necessary, and oxygen therapy monitoring. Comparator is the usual management as per the center’s routine practice.Main outcome measures: Yearly number of hospital days for acute care, exacerbation number, quality of life, deaths, and costs. Keywords: COPD, disease management, exacerbations, hospitalization, home care, clinical trial

Objectives: Telemonitoring (TM) of home non-invasive ventilation (NIV) has been shown to facilitate home/outpatient therapy set-up. However, the impact of long-term TM on therapy dropouts, compliance and leak control has not yet been clearly determined. This study evaluated whether the NIV dropout rate was reduced by TM combined with remote patient support compared with a non-telemonitoring (NTM) pathway., Design: Retrospective cohort study., Setting: Data were obtained from all agencies of a single home care provider in France., Participants: Adults with chronic respiratory failure (n=659) who started nocturnal NIV between January 2017 and December 2019 and had ≥8 days of NIV therapy (51% male; mean age 68.5±13.8 years; 35.5% on long-term oxygen therapy) were included. The TM group included 275 patients who spent ≥80% of the follow-up using TM, and the NTM group included 384 patients who had 0 to ≤10 days of telemonitoring during follow-up., Primary and Secondary Outcome Measures: The primary outcome was the rate of NIV dropouts at 1 year (ie, treatment discontinuation, excluding deaths). Secondary outcomes included therapy compliance and leaks., Results: 82 patients died during follow-up. Significantly fewer patients in the TM vs NTM group had dropped out of NIV therapy at 1 year (13% vs 34%; p<0.001). After adjustment for age, sex, NIV usage at 1-month follow-up and the main underlying respiratory disease, TM was significantly associated with a lower risk of dropout (HR 0.33, 95% CI 0.23 to 0.49; p<0.001). At 1, 4, 8 and 12 months, a greater proportion of patients in the TM vs NTM group had NIV usage of >4 hours/day and control of leaks., Conclusions: In patients starting home NIV, TM with home care provider first-line support was associated with a lower therapy dropout rate at 1 year, and better compliance and leak control, compared with standard follow-up., Competing Interests: Competing interests: RLM declares receipt of personal fees from Orkyn-Pharmadom, CGG declares receipt of personal fees from Orkyn-Pharmadom. FK is an employee of Pharmadom-Orkyn. JT is an employee of Air Liquide Healthcare. ACM and MR are employees of Alira Health. FG declares receipt of personal fees from Air Liquide Sante, Asten Sante, Inspire, Bioprojet, ResMed and Sefam, payment for presentations from Asten Sante, Bioprojet, Cidelec, Jazz Pharmaceuticals, Philips Respironics, and ResMed, and non-financial support from Asten Sante. WT declares payment for presentations from Bioprojet and Astra Zeneca and non-financial support from Asten Sante. The authors perceive that these disclosures pose no academic conflict for this study., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To investigate sleep apnoea prevalence, factors influencing severity, and associations between sleep apnoea severity and micro-/macrovascular complications in a large population of patients with type 1 diabetes., Materials and Methods: This French multicentre prospective cohort study was conducted between July 2016 and June 2020. Adults with type 1 diabetes using an insulin pump were eligible. Home care provider nurses collected demographic and clinical data and set up oximetry to determine the oxygen desaturation index (ODI). No, mild-moderate and severe sleep apnoea were defined as ODI <15 events/h, 15 to <30 events/h and ≥30 events/h, respectively. Univariate and multivariate analyses were performed to identify factors associated with sleep apnoea, and associations between sleep apnoea severity and micro-/macrovascular complications were determined using logistic regression., Results: Of 769 participants, 12.4% and 3.4% had mild-to-moderate or severe sleep apnoea, respectively. Factors significantly associated with sleep apnoea on multivariate analysis were age, sex, body mass index (BMI) and hypertension. After adjustment for age, sex and BMI, presence of severe sleep apnoea was significantly associated with macrovascular complications (odds ratio vs. no sleep apnoea: 3.96 [95% confidence interval 1.43-11.11]; P < 0.01), while mild-to-moderate sleep apnoea was significantly associated with presence of diabetic retinopathy (odds ratio 2.09 [95% confidence interval 1.10-3.74]; P < 0.01)., Conclusion: Sleep apnoea is a significant comorbidity in patients with type 1 diabetes, especially with respect to diabetic complications. This highlights the need for sleep apnoea screening and management in these individuals., (© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflow obstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths.For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference -5.3, 95% CI -13.7 to -3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9% versus 14.2%; p<0.001), with no difference in exacerbation frequency. Patient profiles and hospitalisation practices varied substantially across countries.The COMET disease management intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients., Competing Interests: Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com, (Copyright ©ERS 2018.)