Trial of E-Health Platform Supported Care vs Usual Care After Exacerbation of COPD

This is a validated symptom scoring system used in COPD studies9 The CAT questionnaire contains eight questions and provides a reliable measure of the impact of COPD on health status. Patients read the two statements for each item, which describe the best and worst scenario, (e.g I never cough - I cough all the time), and decide where on the scale of 0-5 they fit. The maximum score is out of 40. The higher the CAT score the greater the impact of symptoms on their health status. Experts involved in the development of CAT suggest that any change of 2 or more in the patient's final score may indicate a clinically significant change. CAT will be recorded at the start prior to any intervention at visit one and 3 months post intervention at visit 4

As different inhaled medication devices require different techniques, each participant's inhaler technique will be assessed according to manufactures guidelines for each device and critical errors recorded. Their technique will be video recorded at visit one and visit two. Any changes to devices during the study will be recorded prior to starting any new treatment. Each participant's technique will be evaluated and the number of critical errors recorded for each device and a composite . Each device will have its own critical error list we have created based on manufactures guidelines. Participants technique will be videoed and assessed using a critical error list for each device by a Health care Professional. This assessment will take place at visit one prior to intervention and 3 months post intervention at visit 4. The difference in the number of errors for each device pre and post intervention will then be recorded.

The SGRQ questionnaire has 50 items with 76 weighted responses. It has good discriminative and evaluative properties and is responsive to therapeutic trials. It was developed and validated in both asthma and COPD and designed to measure the health impairment of patients with respiratory disease. We will be assessed at visit one prior to intervention and 3 months post intervention

The mMRC dyspnoea scale comprises five statements that describe almost the entire range of respiratory disability from none (Grade 0) to almost complete incapacity (Grade 4). It can be self-administered by asking subjects to choose a phrase that best describes their degree of breathlessness associated with activity. This will be assessed prior to and three months post intervention

This clinical scale was developed in 1983 and is in common use in clinical and trial settings. It consists of 7 questions scored form 0-3 to create a score out of 21. It is easily administered and has been well validated for the assessment of patients with COPD. This will be assessed prior to and three months after intervention

PAM is a tool used for measuring the level of patient engagement in their healthcare. It was designed to assess an individual's knowledge, skill and confidence for self-management. PAM is a 13-item scale that asks people about their beliefs, knowledge and confidence for engaging in a wide range of health behaviors and then assigns an activation score based on their responses to the 13-item scale. This will be assessed prior to and three months post intervention.

The Work Productivity and Activity Impairment (WPAI) questionnaire is a well validated instrument to measure impairments in work and activities. The 6 questions relate to work absenteeism (hours missed work) Work presenteeism (impairment whilst working) and work productivity lost due to a health condition. This will be assessed prior to and three months post intervention

The VSAQ is validated Self administered questionnaire developed to estimate exercise capacity for the development of exercise prescription. The VSAQ consists of physical activities listed in progressive order according to their energy demand estimated by metabolic equivalents (METs). One MET is equal to resting oxygen consumption 3.5 ml/kg/min. Therefore, numbers of METs express the energy cost of physical activities as a multiple of the resting metabolic rate. This will be assessed prior to and three months post intervention

COPD exacerbation data will be collecting from their primary prescriber on their exacerbation history. The numbers of COPD exacerbations requiring oral antibiotics and/or oral steroids by the participants one year prior to starting the study will be recorded at visit one. If the participant has any exacerbations requiring oral antibiotics and/or steroids required during the period of the study this will be recorded at visit four.

Admission and readmission data will be collected at visit 1 and visit 4 and verified by the GP patient records or other source data.