Artificial intelligence and digital technologies will revolutionize COPD care, says expert

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

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

On the other hand, digital technologies include broader tools such as telehealth and remote monitoring. Artificial intelligence is being used more often in diagnosis and risk screening, while digital technologies are being used to assess treatment uptake and adherence. Overall, Quill found that the innovations most frequently used by COPD clinicians are digital communication with patients and remote monitoring and symptom recognition.

Before discussing the benefits of artificial intelligence and digital technologies, Quill cautioned that the market may be attracting app developers for the wrong reasons, due to revenue opportunities. She emphasized that the global market for mobile health applications is currently valued at approximately $70 billion.

The FDA only regulates applications intended as accessories for medical devices. Therefore, app developers only need to call their program a “health app” to avoid FDA regulations. Developers can also bypass FDA regulatory oversight by claiming that an app is intended for educational and entertainment purposes, despite the clear intentions of using it as a means to aid medical care.

At their best, digital health innovations promise patient-centered care, self-efficacy, and self-management, while being affordable and scalable. On the other hand, these tools may encourage patients to use poorly regulated, unevidence-based interventions that divert attention from proven treatments. Additionally, digital health innovations can provide better care for patients already receiving treatment, but exclude those who receive very little treatment.

Despite these negative possibilities, artificial intelligence is being used in the diagnosis and treatment of COPD, and Quill said she considers these technologies to be a “major part of the future” of COPD treatment. An area with potential for the use of artificial intelligence is pulmonary function tests (PFTs). As PFTs are standardized worldwide, AI would incorporate the subtle diagnostic and defining features of PFTs into the diagnostic algorithm; this patient-driven AI will become smarter over time. She noted that this AI is very population specific, so doctors must enter data on all the populations they want to treat.

Regarding digital technologies, Quill discussed the potential use of digital inhalers in COPD patients. Several previous studies show that less than 50% of COPD patients use their inhalers correctly. As such, various digital devices have been made available to help improve the grip of the inhaler.

Most digital inhalers can detect activation date and time, while more advanced ones can detect peak inspiratory flow and share personalized data with healthcare professionals. Therefore, digital inhalers can help clinicians identify early symptoms of exacerbation.

Quill noted that most studies show that people who use digital inhalers use them more often, but it does not reduce patients’ exacerbation rates or improve their quality of life. For this reason, Quill explained that it would be beneficial to increase the affordability of inhalers and improve inhaler education; most of her patients cannot afford inhalers or use them incorrectly.

“I’m not sure digital inhalers are what we need right now,” Quill said. “We need better access to controller medications for people with COPD. “It (digital inhalers) doesn’t seem to me to be particularly useful in resource-constrained settings, and also in COPD there has been no real change in patient-centered outcomes.”

On the other hand, Quill explained that digital technologies offer effective methods for pulmonary rehabilitation for patients with mobility or transportation difficulties. There are different delivery methods: synchronous or asynchronous, real-time or recorded, group or individual, video demonstration or fully supervised, and human or app delivery.

Several studies suggest that telerehabilitation is safe and provides the best care for more people, including those in resource-limited settings. While there is a lack of guidance on which program or plan to use, Quill suggested that clinicians provide patients with reliable online resources to guide them in the right direction.

Quill urged clinicians to acknowledge digital inequalities and exclusions in all interventions related to AI and digital technologies. More specifically, she emphasized that they ensure training data varies within the program and reflects the patient population. Initiatives are also needed to help bring diagnostic tools to low-resource areas, especially low- and middle-income countries where the burden of COPD is high.

Finally, she stated that digital developments are moving faster than research, so doctors must fill the evidence gap, be discerning consumers and help patients be discerning consumers.

“I believe that digitally assisted care can increase the quality and quantity of COPD care,” Quill concluded. “…Building the database is really essential to make sure we are providing high-quality care to the right patient at the right time and then keep an eye on the digital divide.”