At Home Spirometry and Video Module Education for COPD Patients

Chronic obstructive pulmonary disease (COPD) results in nearly 750,000 hospitalizations
annually and is the third leading cause of 30-day hospital readmissions in the United
States.Improving the quality of care for hospitalized COPD patients has recently become a
national priority through the Centers for Medicare and Medicaid Services' Hospital
Readmissions Reduction Program. A key element of improving care quality is translating
existing evidence into improved practice. Extensive evidence exists to support the efficacy
of inhaled medications to control and reduce COPD symptoms and to improve patient outcomes.
However, the real-world effectiveness of these medications is often limited due both to poor
inhaler technique and to insufficient adherence to treatment plans. Most interventions for
hospitalized patients with COPD focus on medication reconciliation, treatment optimization,
and inhaler technique education prior to being discharged home. However, after discharge
home, patients quickly lose inhaler technique skills, have difficulty adhering to complex
regimens, and lack tools to aid adherence, such as lung function response to their treatment
regimen. Interventions to reinforce skills and support adherence are needed across care
transitions to reduce the risk of deleterious health outcomes.

Simple and feasible at-home interventions to provide skills training and adherence support
are needed. This novel idea is to pair at-home inhaler skill training with at-home spirometry
measurements to comprehensively support both medication skill and adherence. The investigator
proposes testing a novel at-home self-management support program called "BREATHES" (Bringing
Respiratory Education for improved Adherence and Technique Home through E-interventions for
Self-management) Program. BREATHES will include two main components: first, self-directed
inhaler skill training sessions through the virtual Teach-To-Goal (V-TTG) intervention the
investigator developed and tested during a K23 grant and, second, a handheld lung function
device to provide physiologic feedback and capture medication adherence called SpiroPD. TTG
is a patient-centered strategy that uses cycles of assessment and demonstration tailored to
patients' self-management needs; the investigator's research shows in-person TTG is effective
for teaching inhaler technique and reduces acute care utilization. Virtual-TTG delivers the
key features of TTG using virtual patient-directed lessons through novel adaptive technology
that provides tailored self-assessment and training. The investigator's studies demonstrate
participants' willingness to use V-TTG at-home for post-discharge booster education and show
that V-TTG is effective and may be non-inferior to in-person TTG in significantly reducing
inhaler misuse among hospitalized patients. However, it remains unknown whether at-home V-TTG
sessions will maintain self-management skills over the longer term and how direct physiologic
lung monitoring support can impact medication adherence. The proposed studies will determine
whether combining at-home skill training with objective measurements of lung function and
adherence monitoring through the BREATHES Program improves self-management skills and
medication adherence in the first 30 days after hospitalization for COPD.

Inclusion Criteria:

1. Age 18 years and older

2. Physician-diagnosed COPD (prior to or during hospitalization)

3. Owns a wifi-enabled device (desktop, laptop, tablet, smart phone, etc.)

4. Discharged with a rescue and/or controller MDI, metered dose inhaler.

Exclusion Criteria:

1. Currently in an intensive care unit

2. Physician declines to provide consent

3. Patient unable to provide consent (e.g., history of cognitive impairment, unable to
understand English) or declines to provide consent