Health Europa’s Rosemary Lobley spoke to NEPeSMO about its COPDPredict solution that uses digital predictive technology to anticipate exacerbations in chronic obstructive pulmonary disease
Digital healthcare pioneer NEPeSMO was founded in 2017 with the goal of improving the lives of patients with chronic obstructive pulmonary disease (COPD) through Artificial Intelligence (AI)-enabled digital predictive solutions capable of detecting and anticipating COPD exacerbations. HEQ speaks to NEPeSMO co-founder and COO Monica Spiteri and Executive Chairman and CEO Trevor Phillips about the benefits and potential applications of their technology.
What are the key challenges currently facing the management and treatment of COPD?
MS: Chronic obstructive pulmonary disease (COPD) is a global healthcare challenge: according to WHO figures, some 67 million people have moderate to severe COPD worldwide; we believe there are many more living with COPD but who have not yet been diagnosed.
There is currently no cure for COPD and so this condition is associated with significant morbidity and mortality. Exacerbations or acute lung attacks occur in the majority of patients within three years of diagnosis and contribute significantly to their progressive clinical decline. On top of this, some 29% of patients experience two or more acute episodes a year: they are known as ‘frequent exacerbators’. These exacerbations can be life-threatening; they are the second most common cause of emergency hospitalisations and responsible for around two thirds of all COPD-related healthcare costs. National audits have shown that one in every three COPD patients who are admitted into hospital and then discharged are later readmitted: it’s a never-ending cycle. It follows that detecting these exacerbations remains the biggest challenge in COPD.
A proactive approach to managing exacerbations is urgently needed to prevent clinical deterioration and need for hospital admission. A smart tool which predicts these acute episodes in a timely manner and provides both patients and clinicians with a window of opportunity to intervene and limit their severity by escalating treatment at home, would take us a long way towards improving clinical outcomes in COPD.
Another challenge is the disparity in the quality of COPD care which patients are able to access to manage their condition; this varies across and within same-country regions, as well as between countries. The situation has worsened during the COVID-19 pandemic. Routine reviews with healthcare teams to assess progress and treatment plans have largely been reduced or postponed as non-urgent face-to-face consultations are paused. Use of digital technology and remote monitoring can be used effectively to provide continual and closer monitoring of patients and clinical decision support as required. The real challenge is ensuring that everyone can have access to this technology and be appropriately coached and motivated to use it.
How can digital solutions help with the management of COPD? How can ‘predict and prevent’ interventions help patients and clinicians?
MS: The greatest advantage of digital solutions is that they enable continuous monitoring from the patient’s home, with data being transmitted securely to their healthcare team who can review their patient’s condition in real time and intervene as appropriate. This is hugely important in COPD as invariably a decline in clinical condition through, for example, an impending exacerbation often goes unnoticed and unreported. Whilst there are many and varied forms of digital products already on the market, to have an impact on COPD management the digital technology needs to be clearly purposeful. There are a lot of remote monitoring solutions available ranging from devices which just record symptoms to inhaler chips that track user compliance to various wearables capturing vital signs. Our digital solution, COPDPredict™, is different. Unlike other products, COPDPredict has been specifically designed and developed from inception to combine remote monitoring with personalised exacerbation prediction. COPDPredict is purposefully focused on helping healthcare providers and clinicians deliver a model of care based around prevention, whilst supporting patients to remain in control of their COPD.
How can AI technology help patients with COPD?
MS: AI allows us to improve the performance of digital solutions to manage disease, particularly long term conditions such as COPD. For example when using solutions such as COPDPredict, which uses a bio-clinical profiling approach to anticipate exacerbations, one starts creating individual-specific datasets over a period of time which can then be interrogated to identify personalised trends such as the likely causes of an exacerbation in that individual or responses to certain treatments. Such patterns allow personalisation and precision in exacerbation prediction; they also enable the potential development of novel treatments targeted towards specific patient cohorts or phenotypes. Using AI in this way can be crucially important to address the complex heterogeneity that exists amongst COPD patients.
Can you tell me a bit about COPDPredict and RemoteCOVID™? What are the public health benefits of these remote self-monitoring solutions?
MS: COPDPredict is our clinically validated, CE-marked digital monitoring solution with embedded exacerbation prediction algorithms. The product launched commercially on the app stores in August. A patient-facing app, available on iOS and Android, allows individuals to input, collect, log and track trend bioclinical data on symptoms, lung function and oxygen levels, biomarkers, and treatment in their home. The app connects to Bluetooth-enabled hardware, such as lung function monitors. Collected data is shared with and viewed in real time by the clinical team via a secure cloud-based platform. The smart analytics process transmits data to generate patient-specific bioclinical profiles; the prediction algorithms identify changes in COPD health status and stratify severity to provide clinicians with patient-specific alerts of imminent exacerbations via email and SMS. Patients receive notifications via their app. This allows timely appropriate intervention at home, preventing clinical deterioration and avoiding unnecessary hospitalisation.
When the COVID-19 pandemic broke out, we used some concepts from COPDPredict to develop RemoteCOVID as an open web-based digital solution which is free to all UK residents. As a health digital company we wanted to develop something quickly that would help citizens by providing an app for self-assessment of COVID-19 symptoms and signs. RemoteCOVID helps the patient self-assess how they feel, measure their breathing rate and record their temperature; the user can share their assessment and progress report with their GP. We were amongst the very first developers to provide such a self-monitoring tool that allowed individuals to determine whether they needed a COVID-19 test and to self-isolate.
TP: Digital applications have the capability to make a significant impact in healthcare right now; and the COVID-19 pandemic has really highlighted the importance of wider provision of digital support. The shift from in-person GP visits towards remote appointments can be explored further with solutions such as COPDPredict, which can aid in the treatment of a very severe, debilitating disease at home; thereby saving the finite resources of the health services and protecting the patient – because clinic appointments and specialist visits, particularly within hospitals, inevitably incur a degree of risk of infection.
How do you see NEPeSMO progressing in the future? Are there plans for expansion?
TP: Digital health has a big role to play going forward; and COPDPredict plays a part in that. It’s focused on a debilitating disease for which there is no cure, which is an important factor: COPD can only be managed to give the patient the best possible quality of life, so we must deploy whatever mechanisms we can to support patients with diseases such as this, while minimising the burden on both the health service and their own lives. COPDPredict has been developed to enable a large portion of the activities that are needed to help manage the patient to be undertaken at home: wellbeing scores are recorded on the app; lung function tests can be performed using an at-home instrument which automatically shares the data it gathers with COPDPredict to help with the assessment of the patient’s condition.
At present we do still have the occasional requirement for blood sampling every eight to 10 weeks, to evaluate levels of a single biomarker to enable an additional component of the exacerbation prediction algorithm. This blood sample is performed by a healthcare professional using fingerprick point-of-care testing in a community clinic or in the patient’s home. Our planned next stage of development, which we have already validated from a clinical perspective, is to try to switch from blood samples to saliva samples and develop an at-home analyser so that the patient can take and test their own saliva sample at home and in their own time.
We’re also looking at beginning work on a version of COPDPredict designed for asthma patients: this is another serious, debilitating disease, where we believe we can create a predictive algorithm to detect and anticipate worsening of conditions. Again, this would enable physicians to direct the patient at home to take preventative care measures before their asthma condition becomes worse. We are working very closely on the respiratory health arena as a whole: we hope COPDPredict will become part of the fabric of care for COPD patients, not only in the UK, but in other countries as well. We’re really looking to expand this endeavour into a global approach to managing COPD and integrating digital health into the wider field of respiratory disease.