REal-time Data Monitoring for Shared Adaptive, Multi-domain and Personalised Prediction and Decision Making for Long-term Pulmonary Care Ecosystems (RE-SAMPLE)

Inclusion criteria

• Clinical diagnosis of COPD according to the GOLD criteria [5] (FEV1 < 80% of the predicted value and FEV1/FVC < 0.70);
• Patients can be included both at stable state and during exacerbation/hospitalization;
• At least one comorbidity:

diabetes mellitus (glucocorticoid-induced, or stable type 1 or 2), chronic heart failure (clinical diagnosis according to the ESC guidelines), ischaemic heart disease (history of myocardial infarction, angina pectoris), active symptoms of anxiety and/or depression (≥11 Hospital Anxiety and Depression Scale , and/or anxiety or depression symptoms being treated at the time of inclusion);

• Under treatment at one of the pilot sites (MST, TUK, GEM);
• >40 years of age;
• Smoker or ex-smoker;
• Able to understand, read and write the language spoken in the country of the pilot site.
• Accessibility to internet;
• Written informed consent from the subject prior to participation.

Furthermore, 25% of the patients should also have ≥ 2 exacerbations, defined as respiratory problems that required a course of oral corticosteroids / antibiotics in the two years preceding study entry; and/or ≥ 1 hospitalisation for respiratory problems in the two years preceding study entry; and/or modified MRC (mMRC) score of 3 or 4 (COPD patients with these scores have a higher chance of exacerbating).

Exclusion criteria

• Serious other diseases with a low survival rate;
• Presence of any other active lung disease (e.g., sarcoidosis);
• Severe psychiatric illness, diagnosed by anamnesis;
• Maintenance therapy with antibiotics
• Patients with cognitive impairment (Mini Mental State Examination (MMSE) < 24)