A Novel Wearable Technology for Early Detection of Exacerbations in COPD

Chronic Obstructive Pulmonary Disease (COPD) is a respiratory disease which affects approximately 3 million people in the UK and 64 million in the world. This chronic condition affects mostly people over 45 and is characterised by a progressive decline of lung function. COPD is currently the fourth leading cause of death in the world, although the World Health Organisation (WHO) predicts it will become the third by 2030. The UK National Institute for Health and Clinical Excellence (NICE) estimates that the total direct cost of COPD to the NHS is over £800 million- out of which over £300 million correspond to hospitalisations. The Department of Health reports that, added to this, the cost associated to loss of productivity is in the order of £3.8 billion per year. Overall, the general worldwide consensus on COPD is that "it will become one of the major health challenges over the next few decades". Thus, it is widely acknowledged that anything that improves management and effectiveness of treatment will not just improve patients' quality of life, but also result on savings from: 1- Hospitalisations (average cost per admission estimated to be around £2,000 per patient, this being one of the most costly inpatient conditions in the NHS); 2- Potential visits to GPs; 3- Associated loss of productivity due to work absenteeism.
The main reason for hospitalisations associated with COPD are exacerbations. Severe COPD exacerbations cause one in eight of all emergency admissions in hospitals, this is the second largest cause of emergency admissions in the UK. Mild and moderate exacerbations can be managed outside the hospital but if they are not identified promptly they may progress to breathlessness and in some patients to respiratory failure. A significant proportion of these exacerbations will require in-patient treatment. A significant proportion of these exacerbations will require in-patient treatment. Added to the negative financial consequences of not managing exacerbations properly, they reduce the quality of life and increase the risk of death- the more the worse the exacerbation progresses to be; and also increased exacerbations severity irreversibly speeds disease progression.
The purpose of this research project is to create a novel wearable wireless technology- compose of a sensing unit of approximately the size of a pound coin to be worn by the patient in the neck, and a mobile phone application- that will be able to monitor COPD patients continuously, and automatically provide early detection of potential exacerbations, in order to inform patients and/or their doctors, so that these can be treated promptly to minimise their likelihood of progression to higher levels of severity.

Chronic Obstructive Pulmonary Disease (COPD) is a respiratory disease which affects approximately 3 million people in the UK and 210 million in the world. COPD is currently the fourth leading cause of death in the world, although the World Health Organisation predicts it will become the third by 2030, since unlike for other leading causes of death in which the mortality trend has decreased, for COPD this has doubled in the last 30 years. Just as an illustration of the magnitude of the problem in the UK the most recent economic analysis on COPD concluded that:

- The overall cost of COPD is estimated to be £3.8 billion a year.
- The cost to the NHS is over £800m- out of which over £300m correspond to hospitalisations.
- The annual healthcare costs in patients aged 45-64 years are £277.7 million.
- The annual costs of lost productivity due to early retirement amounts to £522.9 million.
- "Early diagnosis and management of COPD may enable patients to maintain active and productive lives for longer, thereby helping to reduce the economic burden... and improve quality of life."

Hence, finding methods for early detection and diagnosis of exacerbations (the main cause of COPD hospitalisations and irreversible disease progression) is clearly a priority on current and future COPD research.

The overall aim of this project is to create a novel acoustic-based wearable wireless technology- composed of a sensing unit of approximately the size of a pound coin to be worn by the patient in the neck, and a mobile phone application- that will be able to monitor COPD patients continuously, and automatically provide early detection of potential exacerbations, in order to inform patients and/or their doctors, so that these can be treated promptly to minimise their likelihood of progression to higher levels of severity.

The benefits of having automatic early identification of exacerbations in COPD will be : 1- Disease management optimisation, resulting in a better quality of life (related to lower severity of the symptoms); 2- Prompt treatment can slow disease progression and increase life expectancy; 3- It can lead to an optimised self-management or remote management plan for certain patients, reducing GP visits and hence healthcare costs; 4- Prompt treatment will in many cases lead to less number of patients that progress to severe exacerbations, resulting in a reduction of the number of hospitalisations and consequently on important healthcare savings; 5- Prompt treatment can reduce the severity of the symptoms, reducing work absenteeism and consequently the disease indirect costs; 6- It can potentially lead to much more personalised treatment and management, together with a more efficient use of drugs, also potentially resulting in a reduction in treatment costs. Additionally, the technology created in this project also have the potential to: 1- Provide researchers with a large database of respiratory parameters that can be used to speed up research on COPD, further clinical understanding, and facilitate testing of new treatments; 2- Be used to improve the efficiency of pulmonary rehabilitation programs ; 3- Eventually it may be used for early COPD screening- currently it is known that over 60% of patients are not diagnosed, whereas earlier diagnosis can delay the progression of the disease,