Abstract

Background: Preventing hospital readmission after severe acute exacerbations of COPD (AECOPD) is a priority. Detecting clinical deterioration in the home is challenging and current methods have proven ineffective. Neural respiratory drive (NRD) measured with parasternal electromyography is a non-invasive, effort-independent biomarker that detects inpatient deterioration during AECOPD (1,2).

Hypotheses: 1. Home NRD measurement is feasible 2. NRD tracks clinical trajectory following AECOPD.

Method: Hospitalised AECOPD patients received home visits for 30 days (NCT03443505). NRD indices (1,2) were compared to subjective and objective metrics.

Results: Between Feb-Dec 2018, 301 patients screened, 56 eligible, 18 recruited, 3 withdrawn (no AECOPD), 5 withdrew. Median (IQR) age 68 (63-76), AECOPD frequency 4/year (2-5), FEV1 0.52 L (0.36-0.61), 188 home visits to 10 patients. Feasibility: adherence to home visits and NRD measurements was high (85% (71-98), 100% respectively). All 373 NRD traces were analysable. Clinical: 3 patients were readmitted within 30 days of discharge. NRD and standard metrics (SpO2, EXACT-PRO, CAT, inspiratory capacity (IC)) improved between admission and day 28 post-discharge (p<0.05). Change in NRD was associated with change in IC between admission and day 7 (r2=0.98 p=0.004) and FEV1 between admission and day 28 (r2=0.95 p=0.017).

Conclusion: This is the first study to conduct NRD measurements in the home.  Home NRD is feasible to perform and improves during AECOPD recovery. Its clinical utility as a physiological biomarker to enhance outcomes following AECOPD must be evaluated.

1. Murphy PB et al. Thorax 2011;66:602-8.

2. Suh ES et al. Thorax 2015;70:1123-30.