AI, Digital Technologies Set to Revolutionize COPD Care, Expert Says

Caroline Quill, MD, associate professor of medicine at the University of Rochester Medical Center, discussed how artificial intelligence (AI) and digital technologies could revolutionize chronic obstructive pulmonary disease (COPD) diagnosis and treatment at the CHEST 2024 annual meeting in Boston, Massachusetts.

She began her presentation during the session, “New Horizons in COPD,” by discussing the difference between AI and digital technologies. Quill defined AI as computers performing high-order tasks that previously required human input; the 2 most common AI types seen in clinical practice are machine and deep learning, where computers and programs learn from existing data to improve prediction and inform practice.

Conversely, digital technologies include broader tools like telehealth and remote monitoring. AI is more frequently used during diagnosis and screening risk, while digital technologies are used to assess therapy use and adherence. Overall, Quill said the innovations most used by clinicians treating those with COPD are digital communication with patients and remote monitoring and symptom recognition.

Caroline Quill, MD, highlighted the potential of artificial intelligence (AI) and digital technologies to enhance chronic obstructive pulmonary disease (COPD) treatment at the CHEST 2024 annual meeting in Boston, Massachusetts. | Image Credit: Shuo - stock.adobe.com

Before discussing the benefits of AI and digital technologies, Quill warned that the market may attract app developers for the wrong reasons due to moneymaking opportunities. She highlighted that the global mobile health app market is currently valued at about $70 billion.

The FDA only regulates apps intended as an accessory to medical devices. Therefore, all app developers must do is call their program a “health app” to avoid FDA regulation. Developers can also bypass FDA regulatory oversight by saying that the app is intended for education and entertainment purposes despite clear intentions for its use as a medical care adjunct.

At their best, digital health innovations promise patient-centered care, self-efficacy, and self-management while being affordable and scalable. Conversely, these tools may encourage patients to adopt poorly regulated, non-evidence-based interventions that distract from proven treatment methods. Additionally, digital health innovations may deliver more care to patients already receiving treatment but exclude those who receive very little treatment.

Despite these negative possibilities, AI is being used within COPD diagnosis and treatment, and Quill said she considers these technologies a "major part of the future" for COPD treatment. An area with potential for AI use is pulmonary function tests (PFTs). Since PFTs are standardized globally, AI would incorporate subtle diagnostic and defining characteristics of PFTs into a diagnostic algorithm; this patient-driven AI will get smarter over time. She noted that this AI is very population-specific, so clinicians must input data on all populations they wish to treat.

As for digital technologies, Quill discussed the potential use of digital inhalers among patients with COPD. Several past studies suggest that less than 50% of patients with COPD use their inhalers correctly. Consequently, various digital devices have been made available to help improve inhaler adherence.

Most digital inhalers can detect the date and time of actuation, while more advanced ones can detect peak inspiratory flow and share personalized data with health care providers. Therefore, digital inhalers can help clinicians identify early exacerbation signs or symptoms.

Quill noted that most studies show that people using digital inhalers take their inhalers more, but they did not decrease patients' exacerbation frequency or improve their quality of life. Because of this, Quill explained that it would be more beneficial to make inhalers more affordable and improve inhaler education; most of her patients cannot afford their inhalers or use them incorrectly.

“I’m not sure that digital inhalers are what we need right now,” Quill said. “What we need is better access to controller medication for people with COPD. This [digital inhalers] doesn’t strike me as super useful in resource-limited settings, and, again, in COPD, no real change in patient-centered outcomes occurred.”

On the other hand, Quill explained that digital technologies offer effective methods to deliver pulmonary rehab to patients with mobility or transportation difficulties. There are various delivery methods: synchronous vs asynchronous, real-time vs recorded, group vs individual, video demonstrated vs fully supervised, and human vs app delivered.

Several studies suggest that telerehab is safe and brings the best care to more people, including those in resource-limited settings. Although guidance on which program or plan to use is lacking, Quill suggested that clinicians share reliable online resources with patients to guide them in the right direction.

Quill urged clinicians to acknowledge the digital inequities and exclusions across all AI and digital technology interventions. More specifically, she emphasized that they ensure program training data is diverse and reflects their patient population. Also, initiatives are needed to help bring diagnostic tools to areas of low resources, especially low- and middle-income countries, where the COPD burden is high.

Lastly, she stated that digital development is occurring faster than research, so clinicians must bridge the evidence gap, be discerning consumers, and help patients be discerning consumers.

“I think digitally augmented care has the potential to increase quality and quantity of care for COPD,” Quill concluded. “...Building an evidence base is really essential to make sure that we’re deploying high-quality care to the right patient at the right time, and then keeping an eye on the digital divide.”