Digital technologies to deliver pulmonary rehabilitation programmes for adults with COPD: early value assessment

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

Clinitouch (Spirit Health) is an online platform that delivers a 6-week digital pulmonary rehabilitation programme and supports remote monitoring of COPD and other conditions in adults. The digital pulmonary rehabilitation programme can be accessed with a mobile phone, tablet or desktop computer. The programme includes exercise sessions 3 times a week and users are asked to complete questionnaires before and after each session. Users are also contacted weekly by local healthcare professionals to monitor their progress and increase the complexity of exercises.

Kaia Health COPD (Kaia Health) delivers a personalised pulmonary rehabilitation programme. The technology includes educational modules, customisable daily training sessions and mindfulness exercises. It also supports communication with health coaches. The technology can be accessed with a mobile phone or tablet.

myCOPD (my mhealth) is an online education, self-management, symptom reporting and pulmonary rehabilitation system. The myCOPD app includes a 6‑week pulmonary rehabilitation course. This consists of an incremental exercise programme with education sessions to help with self-management of COPD. The app also has a dashboard of self-care tools and educational resources for people with all stages of COPD. The app can be accessed with a mobile phone or tablet.

Rehab Guru (Rehab Guru) is a digital exercise programme management software. Healthcare professionals can use the technology to prescribe a personalised digital pulmonary rehabilitation programme. The technology includes exercise videos. Users can share feedback with their healthcare professional after each exercise and each session. Exercises are adjusted depending on a person's ability and goals. The technology can be accessed with a mobile phone, tablet or desktop computer.

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. The programme contains educational topics including information about medicine, breathing control and 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 with a mobile phone, tablet or desktop computer.

Wellinks (Wellinks) is an online platform that delivers a digital pulmonary rehabilitation programme and supports remote monitoring of COPD in adults. The programme includes tailored exercises, education, and motivational support. It also collects patient-generated data through an add-on pulse oximeter and spirometer. Wellinks can be accessed with a mobile phone or tablet.

COPD is a long-term and progressive respiratory condition that causes breathlessness, a persistent chesty cough, persistent wheezing and frequent chest infections. COPD includes chronic bronchitis and emphysema. COPD mainly affects older adults who smoke, and many people do not realise they have it. Breathing problems had with COPD tend to get worse over time and can limit a person's ability to do daily activities. Treatment can help keep the condition under control and includes stopping smoking, using inhalers and tablets, pulmonary rehabilitation, and surgery.

In 2020 to 2021, NHS Digital reported that approximately 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 mortality 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 on the diagnosis and management of COPD in over 16s (2019) recommends pulmonary rehabilitation to help better manage symptoms and improve exercise capacity and quality of life for people with COPD who are functionally breathless, or who have had a recent hospitalisation because of an acute exacerbation. NICE's guideline also says that pulmonary rehabilitation should be offered to all people who view themselves as functionally disabled by COPD (usually Medical Research Council [MRC] dyspnoea scale grade 3 and above).

NHS's England's policy on pulmonary rehabilitation suggests that 90% of people who complete a face-to-face pulmonary rehabilitation programme have increased exercise capacity and improved quality of life. But there is a gap in service provision for offering pulmonary rehabilitation to people who are eligible for it (see NHS England's Quality and Outcomes Framework, 2022-23).

Digital technologies to deliver pulmonary rehabilitation programmes would be offered as an option to adults with COPD who are eligible for a pulmonary rehabilitation course but cannot, or do not want to, attend face-to-face sessions. They would not replace face-to-face pulmonary rehabilitation programmes.

The comparators for this EVA were face-to-face pulmonary rehabilitation and no treatment or waitlist to have face-to-face pulmonary rehabilitation. Pulmonary rehabilitation is defined in NICE's guideline on the diagnosis and management of COPD in over 16s (2019) as a multidisciplinary programme of care for people with chronic respiratory impairment. It should be tailored for the person, in line with their physical and social needs and capacity, and follow the British Thoracic Society's 2023 clinical statement on pulmonary rehabilitation.