Research Study Abstract

Real-world Use of Rescue Inhaler Sensors, Electronic Symptom Questionnaires and Physical Activity Monitors in COPD

  • Published on February 18, 2019

Background: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease characterised by airflow obstruction and other morbidities such as respiratory symptoms, reduced physical activity and frequent bronchodilator use. Recent advances in personal digital monitoring devices can permit continuous collection of these data in COPD patients, but the relationships among them are not well understood.

Methods: 184 individuals from a single centre of the COPDGene cohort agreed to participate in this 3-week observational study. Each participant used a smartphone to complete a daily symptom diary (EXAcerbations of Chronic pulmonary disease Tool, EXACT), wore a wrist-worn accelerometer to record continuously physical activity and completed the Clinical Visit PROactive Physical Activity in COPD questionnaire. 58 users of metered dose inhalers for rescue (albuterol) were provided with an inhaler sensor, which time stamped each inhaler actuation.

Results: Rescue inhaler use was strongly correlated with E-RS:COPD score, while step counts were correlated with neither rescue use nor E-RS:COPD score. Frequent, unpatterned inhaler use pattern was associated with worse respiratory symptoms and less physical activity compared with frequent inhaler use with a regular daily pattern. There was a strong week-by-week correlation among measurements, suggesting that 1 week of monitoring is sufficient to characterise stable patients with COPD.

Discussion: The study highlights the interaction and relevance of personal real-time monitoring of respiratory symptoms, physical activity and rescue medication in patients with COPD. Additionally, visual displays of longitudinal data may be helpful for disease management to help drive conversations between patients and caregivers and for risk-based monitoring in clinical trials.

Full text:


  • Russell Bowler 1,2,3
  • Matthew Allinder 4
  • Sean Jacobson 1
  • Andrew Miller 2
  • Bruce Miller 4
  • Ruth Tal-Singer 4
  • Nicholas Locantore 4


  • 1

    Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado, USA

  • 2

    Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, University of Colorado Anschutz Medical, Aurora, Colorado, USA

  • 3

    Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA

  • 4

    Research & Development, GSK, Collegeville, Pennsylvania, USA


BMJ Open Respiratory Research


, , , , ,