Modernisation of chronic respiratory disease management: The integration of wearable technology

Abstract

Chronic respiratory diseases such as Chronic Obstructive Pulmonary Disease, Asthma, Interstitial Lung Disease, Cystic Fibrosis, and Pulmonary Hypertension affect over 500 million people globally and pose significant challenges for diagnosis, management, and long-term care. Traditional approaches often rely on episodic clinical assessments and patient-reported symptoms, which fail to capture the dynamic nature of respiratory health. The integration of wearable technology offers a transformative solution, enabling continuous, real-time monitoring of physiological and behavioural parameters. This review explores the evolving role of wearable devices, including activity trackers, smartwatches, spirometers, and biosensors, in modernising chronic respiratory disease management. Evidence across disease domains demonstrates that wearables can enhance physical activity, predict exacerbations, support remote rehabilitation, and facilitate personalised care. In Chronic obstructive pulmonary disease, step counters and biometric sensors have shown improvements in activity levels and early exacerbation detection. Asthma care benefits from AI-driven platforms that integrate environmental and physiological data to optimise treatment. For Interstitial lung disease and Cystic fibrosis, home spirometry and sweat biomarker monitoring empower patients and improve disease tracking. In Pulmonary hypertension, wearables provide insights into activity and sleep patterns, complementing traditional assessments. Despite promising outcomes, barriers remain. Technical limitations, data reliability, digital literacy, privacy concerns, and integration into clinical workflows hinder widespread adoption. Economic and equity considerations further challenge scalability, particularly in low-resource settings. Looking forward, the convergence of multimodal sensing, AI analytics, and digital therapeutics will enable proactive, personalised, and equitable respiratory care. Addressing validation, interoperability, and ethical governance will be critical to realising the full potential of wearable technology in CRD management.

1. Introduction

Chronic respiratory diseases (CRDs) are among the most prevalent non-communicable conditions, affecting an estimated 544.9 million people worldwide as of 2017. ¹ Their high burden is primarily driven by exposure to noxious environmental, occupational, and behavioural inhalations. ² CRDs encompass a diverse group of conditions, including Asthma, Cystic Fibrosis (CF), Pulmonary Hypertension (PH), Chronic Obstructive Pulmonary Disease (COPD) and Interstitial Lung Diseases (ILD). ³ Each condition is characterised by distinct structural and functional abnormalities within the lungs, leading to variable symptoms, disease trajectories, and prognoses. ⁴ The complexity poses significant challenges for accurate diagnosis, effective management, and long-term care, underscoring the need for multidisciplinary approaches.

Traditional management strategies including periodic clinical assessments, patient-reported symptoms, and reactive treatment, often fail to capture the dynamic nature of respiratory health, where subtle physiological changes can precipitate acute exacerbations. ⁵ These limitations have driven the development of proactive, technology-enabled, data-driven solutions that enable real-time and longitudinal monitoring of symptoms and physiological parameters. ⁶ Such innovations offer the potential to provide healthcare professionals with timely, actionable insights, bridging the gap between hospital-based care and home-based support, and ultimately reducing the burden of long-term disease management. ⁶

The COVID-19 pandemic acted as a major catalyst for the adoption of wearable technologies in healthcare. Under sustained pressure, health systems accelerated the deployment of remote monitoring tools to detect and manage respiratory symptoms. This urgency not only increased public awareness of wearable health devices but also encouraged broader adoption among healthcare providers and stakeholders. ⁷ Furthermore, the pandemic highlighted the role of wearables in addressing disparities in healthcare access, particularly for underserved populations. ⁸

Despite growing interest and uptake, uncertainties remain regarding the feasibility, acceptability, and clinical utility of wearable technologies in CRD management. This review aims to provide a comprehensive overview of the modernisation of CRD care through wearable technology integration. Specifically, it will examine the current landscape of wearable devices, disease specific applications, associated benefits and limitations, and the future potential of these tools in respiratory care.

2. Current landscape of chronic respiratory disease management

Pharmacological therapy remains the cornerstone of CRD management, primarily aimed at symptom control and exacerbation prevention. In COPD, long-acting bronchodilators form the basis of maintenance therapy, often combined with inhaled corticosteroids in patients with frequent exacerbations or elevated eosinophil counts. ⁹ Asthma management follows a stepwise approach centred on inhaled corticosteroids, with escalation to combination therapy and biologic agents for severe phenotypes. ¹⁰ While these treatments improve quality of life and reduce exacerbation risk, they do not modify the underlying disease trajectory, and adherence remains a persistent challenge, particularly in low-resource settings. ¹⁰

Non-pharmacological strategies are equally critical in comprehensive CRD care. As early as 2001, the Global Initiative for COPD committee proposed quitting smoking as a necessary and evidence-based approach to prevent and treat COPD. ¹¹ Since then, smoking cessation continues to play a major role in non-pharmacological approaches to managing CRDs. Specifically, previous studies have demonstrated delayed progression of COPD alongside short term alleviation of respiratory symptoms and long-term improvements in lung function, quality of life, and survival rates.^12,13 However, persistent lung inflammation and a decline in lung function following smoking cessation interventions should be acknowledged, albeit in animal models. ¹⁴

Pulmonary rehabilitation (PR) is also a recognised management tool for patients with CRDs, often referred to as the cornerstone of non-pharmacological management.^15,16 PR is a highly evidence-based approach, with substantial benefits in exercise tolerance, health-related quality of life, and reductions in dyspnoea.^15,16 Standard PR programs typically involve supervised exercise training, education, and self-management support delivered in outpatient settings over an eight-twelve-week period. However, global provisions of PR remain critically inadequate, with demand far exceeding supply, particularly in low- and middle-income countries. ¹⁷ Furthermore, multiple barriers, including accessibility, uptake, and psychological factors such as anxiety and low health literacy have negative effects on uptake. Facilitators include personalised care plans, strong therapeutic alliances between patients and healthcare providers, and integration with telehealth platforms. ¹⁸ Importantly, these facilitators reflect a positive shift towards holistic, patient-centred care within PR.

Other management approaches are particularly relevant for patients with advanced disease. Long-term oxygen therapy improves survival in patients with severe resting hypoxemia and enhances exercise tolerance and quality of life. ¹⁹ Non-invasive ventilation is recommended during acute exacerbations and in selected patients with chronic hypercapnic respiratory failure. ²⁰ Advanced therapies, including lung volume reduction surgery and lung transplantation, are considered in highly selected patients with severe COPD and/or end-stage lung disease. ²¹ These resource-intensive approaches offer improvements in symptoms and in some cases, survival, but often come with significant disparities in access due to limited specialised centres. ²² Furthermore, patient selection for surgical interventions requires comprehensive assessment of functional status, psychological readiness, and comorbidities, underscoring the complexity of care in advanced CRDs.

The management of CRDs is further complicated by multimorbidity and overlapping phenotypes, such as asthma-COPD overlap, and by persistent gaps in early detection and digital integration. While precision medicine approaches and digital health tools hold promise for improving disease monitoring and individualised care, their implementation remains limited in routine clinical practice. Addressing these gaps will require coordinated efforts to integrate technology, enhance patient engagement, and ensure equitable access to evidence-based interventions.

3. Wearable technology in chronic respiratory disease management

The integration of wearable technology into CRD care represents a significant shift towards personalised, data-driven management. Wearable devices, ranging from simple step counters to advanced multi-sensor platforms, are increasingly being explored for their potential to monitor physiological parameters, detect exacerbations, and support self-management across CRDs. ²³

Current wearable technologies include activity trackers, smartwatches, patch-based sensors, and smart garments, to name a few. These devices can measure a range of physiological and behavioural metrics, including heart rate, respiratory rate, oxygen saturation (SpO₂), physical activity levels, and sleep patterns. More advanced systems incorporate accelerometers, gyroscopes, and photoplethysmography (PPG) sensors, enabling continuous monitoring of movement and cardiorespiratory function. ²⁴ Recent innovations include wearable lung patches equipped with deep learning algorithms to detect wheezing and other abnormal lung sounds, offering a promising tool for early detection of respiratory exacerbations. ²⁵

The following sections will explore disease-specific applications across five major CRDs including COPD, asthma, interstitial lung disease, cystic fibrosis, and pulmonary hypertension. A summary of which is provided in Table 1.

Table 1.

Overview of wearable technologies utilised in CRDs.

Disease	Wearable technologies	Monitoring parameters	Clinical benefits	Challenges
Asthma	Smartwatches, air quality sensors, portable spirometers, mobile apps	Heart rate, SpO2, peak flow, air pollutant exposure	Improved adherence, early exacerbation detection, personalised interventions	Inconsistent impact on hospitalisation rates; data integration issues
Interstitial Lung Disease (ILD)	Wrist-worn pulse oximeters, home spirometry, chest-worn sensors, mobile apps	SpO2, FVC, heart rate, physical activity	Early detection of progression, enhanced patient autonomy, remote symptom tracking	Digital literacy, emotional burden, limited long-term outcome data
Cystic Fibrosis (CF)	Sweat chloride patches, home spirometry, fitness trackers, mobile apps	Sweat chloride, lung function, physical activity, symptoms	Personalised physiotherapy, improved physical activity, enhanced self-management	Anxiety from over-monitoring, data overload, need for expert interpretation
COPD	Activity trackers, pulse oximeters, smart inhalers, mobile apps, wearable ECG monitors	SpO2, heart rate, respiratory rate, inhaler use, activity	Improved medication adherence, exacerbation prediction, physical activity promotion	Device fatigue, low engagement in older adults, cost and accessibility barriers
Pulmonary Hypertension (PH)	Smartwatches, chest-worn sensors, mobile apps, implantable pressure monitors	Heart rate, SpO2, physical activity, pulmonary pressure	Early detection of decompensation, remote titration of therapy, improved QoL	Limited device validation, high cost, need for specialist oversight

Abbreviations: SpO2 - Oxygen saturation; FVC – Forced Vital Capacity; ECG – Electrocardiogram; QoL – Quality of life.

3.1. Chronic obstructive pulmonary disease

Wearable devices are increasingly used in digital health interventions across COPD, providing clinically meaningful improvements in physical activity levels and health-related quality of life.^26,27 These devices can also support goal setting, self-monitoring, and symptom management, but evidence surrounding a sustained impact on routine care remains limited. ²⁸ Wearable devices play a broader role in supporting daily life activities for people with COPD, through growing social participation and developing independence. ²⁹ Furthermore, utilising these devices for remote monitoring, offers opportunities for early detection of exacerbations and improved management of COPD in home settings. ³⁰

3.1.1. Improving physical activity

It is well known that wearable technology consistently benefits the promotion of physical activity among CRDs. Over the last two decades, the focus of wearables in COPD has been on physical activity improvement using a variety of wearable devices including step counters/pedometers, accelerometers, smartphones and smartwatches.

This evidence has been collated by several systematic review and meta-analyses, including Armstrong et al. (n=12 studies), Qui et al. (n=15 studies), and Reilly et al. (n=38 studies).^31–33 Both Armstrong et al. and Qui et al. compared the use of step counters to usual care in patients with COPD, reporting improvements in physical activity (standardised mean difference (SMD) = 0.57 (95%CI 0.31-0.84) and 0.53 (0.29-0.77) respectively).^31,32 The focus on step counters alone may limit the generalisability of findings. Meanwhile, Reilly et al. focused on physical activity interventions across all CRDs, with several analyses conducted. Beginning with physical activity promotion + wearable activity monitors (n=17), a SMD (0.37 (95% CI 0.10-0.64)) demonstrated significant improvements in physical activity. Interestingly, these improvements where superior to other interventions focusing on physical activity promotion alone (n=9) or technology-based interventions (n=12). ³³

In the most recent systematic review and meta-analysis, 21 studies reported clinically meaningful improvements in physical activity, with a pooled mean difference of 850 steps/day (95% CI [494 to 1205]). 17 studies showed a pooled improvement in the 6MWT of 5.81 m (95% CI [1.02 to 10.61]), though below the threshold for clinical significance. Subgroup analysis indicated that wearables are most effective when combined with health coaching, behavioural strategies, or PR. However, long-term sustainability and impact on quality of life remain limited and require further investigation. ²⁷

Collectively, these findings emphasise the important role of wearable devices in supporting increased physical activity among people with COPD. Nevertheless, less is known about the lived experiences and preferences of those using physical activity monitoring devices. Wilde and colleagues conducted a qualitative scoping review to explore these experiences, with a view to informing future healthcare practice and identifying opportunities for long-term health behaviour change. ²⁸

Across studies in this review, many participants embraced the use of technology, particularly appreciating the ability to monitor their physical activity through digital charts and graphs. Such visual feedback helped individuals track progress, recognise achievements, and better understand how their symptoms affected daily life. ²⁸

Another key consideration was the desire for devices that integrate physical activity data with physiological parameters such as heart rate, oxygen saturation, and symptom reporting. Many people expressed a preference for comprehensive monitoring solutions over simple step counters alone, as these could better support the management of their COPD. ³⁴

This raises the question of whether basic step counters and pedometers still have a role in physical activity monitoring, or whether future research and investment should focus on more sophisticated smartphones and smartwatches. Supporting this shift is evidence that personalised goal setting and tailored feedback, features more commonly available in advanced devices, enhance motivation and behaviour change.

Additionally, many individuals disliked having to manually enter step counts into an app or website after checking a pedometer at the end of each day. Compared with automatic data integration offered by smartphones and smartwatches, this extra burden contributed to stress, frustration and anxiety. ²⁸

In summary, evidence consistently demonstrates that wearable technologies can meaningfully support physical activity enhancement in people with COPD and other CRDs, particularly when integrated with behavioural strategies, personalised feedback, and supportive interventions such as health coaching or PR. While step counters have historically dominated the field, patient experiences highlight a growing preference for more sophisticated devices that offer integrated symptom and physiological monitoring, seamless data capture, and personalised goal-setting features. These insights underscore a shift towards more holistic and technologically advanced solutions that align with the lived experiences and expectations of users. Future research should therefore prioritise evaluating multifaceted, connected wearable symptoms and explore how they can best promote long-term adherence, behaviour change, and sustained improvements in health outcomes.

3.1.2. Assessment of walking gait

Gait has a significant impact on well-being, survival, and independence in older adults and people with long-term health conditions. ³⁵ Walking gait is often described as an individual’s pace, rhythm and variability, and is typically measured through walking cadence, speed and stride length/duration. ³⁶ For individuals with COPD, the role of gait in their daily lives remains largely unknown due to a lack of scientific evidence and walking gait not routinely being assessed in clinical practice. ³⁷

Mobilise-D was a 5-year multi-centre project aiming to develop validated and widely accepted digital mobility outcomes to monitor daily life gait in people with various mobility problems, including COPD. ³⁸ Two wearable sensor devices, the McRoberts MoveMonitor+ and Axivity AX6, were used to record free-living activity data throughout the Mobilise-D work packages. Since its inception in 2019, Mobilise-D has published several articles focusing on walking and gait characteristics for people with COPD.^37,39–41

In their latest publication, Delgado-Ortiz and colleagues used the Mobilise-D method (a single wearable device and processing pipeline to extract gait parameters), to comprehensively characterise daily life gait in people with COPD. ³⁷ They found that real-world gait digital mobility outcomes were quantifiable and worsened with increasing disease severity. Furthermore, people with COPD exhibit altered real-world walking speed and cadence compared to healthy older adults, particularly during longer walks. ³⁷ Future research should investigate how these digital mobility outcomes can be improved through treatment to enhance mobility and minimise adverse events.

3.1.3. Prediction of exacerbations

Wearable technology and remote monitoring have emerged as important management tools in the early detection of exacerbations, which are a major contributor to healthcare burden and patient mortality, making timely identification and intervention critical.

Recent studies have demonstrated the feasibility and clinical potential of wearable biometric devices, such as wristbands, smartwatches and rings, that continuously monitor heart rate, respiratory rate, SpO₂, activity levels and sleep patterns in real-world settings. These devices allow for multisystem tracking of physiological changes, revealing distinct patterns that can signal the onset or resolution of exacerbations. For example, elevated heart rate and respiratory rate, coupled with reduced activity and sleep disturbance, have been identified as early biomarkers of exacerbation onset.

Iorio and colleagues implemented the use of a biometric wristband (EmbracePlus, Empatic Inc), and biometric ring (Oura Gen III, Oura Health Oy), to monitor heart rate, respiratory rate, SpO₂, skin temperature, and sleep quality in people with severe COPD (n=9) during an acute exacerbation. ⁴² They reported high wear-time compliance (94% for wristbands), and strong data usability for heart rate and temperature. Although respiratory rate was less reliable, a moderate to strong correlation between wearable-derived and nurse-obtained vital signs was reported, particularly for heart rate (r = 0.91, p = 0.0086). ⁴²

Following the investigation of device feasibility, the same research team conducted a prospective observational cohort study in a larger sample of COPD patients (n=21). They found a significant association between questionnaire derived symptom scores and physiological biomarkers collected from two wearable devices, providing insightful knowledge towards exacerbation pathophysiology and the knowledge gaps for future real-world implementation of these devices. ⁴³

Meanwhile, Wilde and colleagues reported concerns surrounding real-time health metrics, with participants identifying monitoring of oxygen saturation and heart rate as an exacerbator for worsening anxiety, particularly during exacerbations or periods of breathlessness. While some participants were reassured by this data, others were confused and overwhelmed by abnormal readings. ⁴⁴

These findings accentuate the growing role of wearable technology in the monitoring of COPD symptoms. With continuous tracking of physiological variables, wearable technology can help detect early changes that precede exacerbations, allowing for timely interventions to improve patient outcomes. Future wearable technology for health metrics should provide contextualised information to guide safe interpretation of data and avoid unnecessary worry. This may include resources that provide clear explanations of what different metrics mean and when further advice or support should be requested. ⁴⁴

Integration with digital health platforms and/or AI-driven analytics prospers the opportunity to harness advances in hardware, software, and ‘big data’ to modernise COPD management even further, through personalised diagnostic monitoring and more timely, appropriate treatment approaches.

3.1.4. Current key technologies and apps for self-management

Digital technologies to support self-management of COPD provide various aspects of self-management including education about the condition, individualised planning within the app, symptom tracking, remote monitoring, exercise, and communication features with healthcare professionals. However, due to the array of optionality and heterogenies nature of content across these technologies, it is important to access robust evidence to support their overall effectiveness across CRD’s.

The National Institute for Health and Care Excellence (NICE) undertook an early value assessment of digital technologies for COPD, which was most recently updated in February 2026. Thirteen technologies have been included within this evaluation (Active+me REMOTE, Clinitouch, COPDhub, COPDPredict, Current Health, DOC@HOME, Doccla, Lenus, myCOPD, patientMpower, Space for COPD, and Wellinks), with four currently recommended for use within the NHS (Clinitouch, COPDhub, Luscii, and myCOPD), while more evidence is generated. ⁴⁵

MyCOPD is the most popular digital tool for people with COPD. It offers education on correct inhaler use a personalised self-management plan prescription assessment and detailed symptom tracking. This includes daily reporting and monthly CAT scores. ⁴⁶ Self-management plans embedded within the app can be updated by healthcare professionals and integrated into the patient review process, supporting shared care.

3.2. Asthma

Asthma is a major non-communicable respiratory disease, characterised by variable airflow obstruction and inflammation. This leads to common symptoms such as cough, wheeze, chest tightness and shortness of breath.^47,48 Although effective treatments are available, preventable hospital admissions and asthma related mortality remain high. ⁴⁹ These poor outcomes are often linked with non-adherence to medication, limited engagement with primary care, inadequate asthma reviews, and a lack of accessible diagnostic tests.

Recent advancements in wearable technology have supported remote asthma diagnosis, virtual consultations, continuous monitoring, adherence tracking, and the integration of artificial intelligence. These innovations enable more personalised, timely, and effective interventions, while also empowering patients to take a more active role in self-management and decision-making, ultimately contributing to improved health outcomes. ⁵⁰

3.2.1. Physiological monitoring

Recent advancements in wearable technology have significantly enhanced asthma management by enabling continuous physiological and environmental monitoring. These innovations support remote diagnosis, virtual consultations, adherence tracking, and personalised interventions, empowering patients to take a more active role in their care.

One notable development is the AirPredict eHealth platform, introduced by Atzeni et al., which integrates multiple wearable devices, including the Fitbit Charge 6, Atmotube PRO air quality sensor, and MIR SmartOne spirometer, into a unified mobile application. This system facilitates real-time tracking of physiological metrics (e.g. heart rate, oxygen saturation), environmental exposures (e.g. air pollutants), and symptom burden, while enabling clinician feedback. In a feasibility study involving eight asthma patients and eight clinicians, the platform was rated highly for usability and perceived benefit. Participants reported improved disease awareness and control, with unanimous endorsement from both patients and clinicians. ⁵¹

Complementary evidence from a systematic review by Mosnaim et al. examined 19 clinical trials evaluating remote monitoring interventions in asthma. The review found that such interventions were associated with improved adherence to maintenance inhalers, reduced reliance on reliever medications, and enhanced asthma control. However, the impact on exacerbation rates and healthcare utilisation was inconsistent, likely due to limitations in study design, sample size, and duration. The authors concluded that while remote monitoring improves intermediary outcomes, further research is needed to assess long-term clinical benefits. ⁵²

Together, these findings underscore the growing role of wearable technology in asthma care. By enabling personalised, real-time monitoring and facilitating patient-clinician interaction, these tools offer promising avenues for improving disease control and patient engagement. Future research should focus on validating clinical outcomes, optimising integration with care pathways, and addressing barriers to sustained use.

3.2.2. Predictive analytics and AI integration

The integration of artificial intelligence (AI) with wearable technology is rapidly advancing asthma care by enabling predictive analytics and personalised interventions. These systems combine physiological and environmental data to forecast exacerbations, support treatment optimisation, and enhance patient autonomy.

One notable innovation is the ‘AI Asthma Guard’ developed by Almuhanna et al., a wearable device designed to predict asthma attacks using machine learning algorithms. The system integrates heart rate and oxygen saturation data with environmental metrics such as air pollutant exposure to classify risk levels and deliver timely alerts. While the device’s technical feasibility is well-established, clinical validation in asthma populations remains limited and warrants further investigation. ⁵³

Complementary work by Sang et al. introduced an accelerometer-based wearable patch capable of detecting respiratory wheeze using deep learning. This device demonstrated high fidelity in sound analysis, outperforming digital stethoscopes, and proved particularly effective in populations where traditional diagnostic tools are less reliable, such as individuals with obesity. ²⁵

AI is also increasingly used to personalise asthma treatment plans. By analysing longitudinal data, these systems can predict exacerbation risk, stratify patients, and recommend tailored interventions. Real-time feedback mechanisms further support medication adherence and dynamic treatment adjustments, contributing to improved disease control and reduced healthcare utilisation. ⁵⁴

Collectively, these innovations highlight the transformative potential of AI-enhanced wearables in asthma management. Future research should focus on clinical validation, algorithm transparency, and integration into routine care to ensure safe and equitable deployment.

3.3. Interstitial lung disease

ILD encompasses a diverse group of pulmonary disorders characterised by inflammation and/or fibrosis of the lung parenchyma, which impairs gas exchange and contributes to exertional dyspnoea and reduced quality of life. The unpredictable progression and subtle early symptoms of ILD present significant challenges for timely diagnosis and effective disease monitoring. ⁵⁵

While in-home spirometry has gained traction, broader applications of telehealth in ILD remain underexplored. ⁵⁶ Emerging evidence suggests that remote monitoring of forced vital capacity (FVC) and SpO₂ may help predict disease progression and support personalised care planning.^57,58 Additionally, tracking symptom burden, medication use, and patient-reported outcomes in real time has shown promise in enhancing long-term disease management. ⁵⁹

Moor et al. evaluated a comprehensive home monitoring programme incorporating wireless spirometry, weekly symptom reporting, and e-consultations. Among ten participants, 80% found daily spirometry easy to perform, and 90% reported it was not burdensome. All participants expressed willingness to continue using the system, and no adverse effects on anxiety or quality of life were observed. ⁵⁹ Similarly, Edwards et al. reported high satisfaction and sustained engagement among ILD patients using a mobile app and home spirometry over a six-week period. ⁶⁰

Digital self-monitoring has also empowered patients to take a more active role in their care. Individuals with ILD have used wearable and mobile technologies to initiate contact with healthcare providers in response to symptom changes, facilitating timely treatment adjustments and enhancing patient autonomy.^59,61

In summary, wearable and digital technologies offer promising avenues for improving ILD management by enabling remote monitoring, personalised care, and enhanced patient engagement. Future research should focus on validating long-term clinical outcomes, addressing emotional burden, and ensuring equitable access to these innovations.

3.4. Cystic fibrosis

CF is a lifelong, multisystem condition caused by mutations in the CFTR gene, leading to thickened mucus secretions, chronic respiratory infections, and progressive lung damage. Management traditionally involves intensive physiotherapy, frequent hospital visits, and close monitoring of respiratory function and infection status. ⁶²

Recent advancements in wearable technology have begun to simplify CF management by enabling personalised physiotherapy, remote monitoring, and enhanced patient autonomy. These innovations support early detection of exacerbations and promote sustained engagement with self-management strategies.

3.4.1. Sweat biomarker monitoring

Sweat chloride concentration is a key diagnostic and monitoring biomarker in CF. Traditionally measured in clinical settings, recent developments have enabled non-invasive, home-based monitoring using wearable microfluidic sweat patches. In a feasibility study, Nelson et al. demonstrated that smartphone-scanned wearable stickers provided accurate and reliable sweat chloride readings across a cohort of 20 CF patients, comparable to gold-standard laboratory methods. This approach offers a promising alternative for frequent biomarker assessment in outpatient and home environments. ⁶³

3.4.2. Optimising physical activity

Wearable technology has also shown promise in promoting physical activity among individuals with CF. ⁶⁴ A pilot randomised controlled trial by Curran et al. combined wearables (Fitbit Charge 2) with goal setting and text message feedback over 12 weeks. Participants in the intervention group demonstrated significant improvements in both physical activity levels and aerobic capacity compared to controls. These findings align with similar interventions in other chronic respiratory diseases, highlighting the potential of remotely supervised, personalised programmes to drive meaningful behavioural change. ⁶⁴

3.4.3. Home spirometry

Home spirometry enables frequent monitoring of lung function outside clinical settings. Nash et al. conducted a 12-month mixed-methods trial in adults with CF, using twice-weekly spirometry and symptom tracking. The intervention group detected more pulmonary exacerbations than routine care, although no significant differences were observed in hospitalisation rates or overall quality of life. Qualitative feedback revealed that patients valued the increased insight into their condition but expressed concerns about the emotional burden and potential over-reliance on technology. ⁶⁵

3.4.4. Supporting self-management

Wearable technologies also play a growing role in education and self-management, particularly among adolescents and young adults transitioning to independent care. ⁶⁶ Tools that promote health literacy, treatment ownership, and goal setting have been well received. However, recent qualitative research by Mattison et al. revealed a more nuanced perspective. While wearables were seen as motivational, some patients reported increased anxiety due to over-monitoring and difficulty interpreting real-time data without clinical context. ⁶⁷

In summary, wearable technology is reshaping CF care by enabling personalised, home-based monitoring and promoting self-management. Future integration efforts must address emotional burden, data overload, and the need for expert interpretation to ensure these tools are supportive rather than overwhelming.

3.5. Pulmonary hypertension

PH is a progressive and life-threatening condition characterised by elevated pulmonary arterial pressure and right ventricular dysfunction. These pathophysiological changes lead to reduced exercise tolerance, impaired functional capacity, and diminished quality of life. ⁶⁸

Wearable technology is increasingly being used to support PH management by enabling continuous monitoring of physical activity, sleep patterns, and oxygen saturation. These tools offer valuable insights into disease progression, treatment response, and patient behaviour in real-world settings.

3.5.1. Monitoring physical activity and sleep

Physical activity is a key prognostic marker in PH. Consumer-grade wearables, such as Fitbit devices, have been used to assess daily step counts and sedentary behaviour. One study reported that PH patients averaged 5,100 steps/day and spent over 13 hours per day in sedentary activity, with metrics declining over a one-year period. These findings highlight the importance of longitudinal monitoring to inform personalised interventions.

While the six-minute walk test (6MWT) remains a standard clinical tool for assessing functional capacity, wearable-derived activity metrics offer complementary insights. Fitbit data has shown only modest correlation with 6MWT results (R² = 0.1–0.35), suggesting that wearable technology captures broader lifestyle factors not reflected in clinic-based assessments.

Mobile health interventions that combine wearables with behavioural support have demonstrated improvements in physical activity (e.g., +1,400 steps/day) and quality of life, even in the absence of changes in 6MWT distance. These findings reinforce the value of wearable data in guiding patient-centred care. ⁶⁹

Wearables also enable objective assessment of sleep patterns, which are often disrupted in PH. Traditional methods rely on self-reported surveys or single-night studies, whereas wearable devices allow for continuous, real-world sleep monitoring. Recent evidence suggests that PH patients experience reduced REM sleep compared to matched controls, a concern given the association between low REM sleep and increased cardiovascular and all-cause mortality.

3.5.2. Real-time oxygen saturation monitoring

Hypoxemia is a common complication in PH, particularly during exertion and sleep. Conventional pulse oximeters provide only intermittent measurements, whereas wearable SpO₂ monitors offer continuous, real-time tracking. These devices can detect desaturation events, support emergency alerts, and facilitate timely clinical intervention. This functionality is especially valuable for patients engaging in daily activities or exposed to altitude, where oxygen levels may fluctuate unpredictably.

In summary, wearable technology offers promising opportunities to enhance PH management through continuous monitoring, personalised feedback, and remote care delivery. Future research should focus on validating device accuracy, integrating wearable data into clinical workflows, and addressing cost and accessibility barriers to ensure equitable adoption.

4. Challenges and barriers to adoption

Despite the growing integration of wearable technology into chronic CRD management, several challenges continue to limit its widespread adoption and long-term sustainability. These barriers span technical, clinical, patient-related, and systemic domains, and must be addressed to realise the full potential of wearable innovations.

4.1. Technical limitations and data reliability

Many commercially available wearables lack medical-grade validation, raising concerns about data accuracy and reliability.^70,71 Measurements such as SpO₂, respiratory rate, and physical activity can be affected by sensor placement, motion artefacts, and environmental interference, causing missed clinical deterioration or false alarms. Additionally, poor interoperability with electronic health records restricts seamless data integration, reducing the clinical utility of wearable-derived insights. ⁷²

4.2. Patient-related barriers

Older adults represent a significant proportion of the CRD population, yet digital literacy and usability remain major obstacles. Cognitive decline, sensory impairments, and limited prior exposure to technology contribute to poor engagement and adherence. Psychological factors—such as anxiety related to constant health monitoring or fear of stigma—may further deter use. Device comfort, aesthetics, and battery life also influence sustained engagement, with many patients discontinuing use due to inconvenience or perceived burden.^73,74

4.3. Economic and equity considerations

The cost of wearable devices and associated subscription fees pose significant barriers, particularly for patients in low-resource settings. Limited access to broadband connectivity and smartphones further restricts adoption in rural and underserved populations. Without targeted strategies to address these disparities, wearable technology risks exacerbating existing health inequalities rather than alleviating them. ⁷⁵

4.4. Privacy, security, and trust

Concerns around data privacy and cybersecurity are consistently reported by patients, particularly when wearable devices are integrated with smartphones and cloud-based platforms. Many users express apprehension about unauthorised access to personal health data and potential misuse by third parties. While most patients are willing to share data with healthcare providers, trust in commercial technology companies remains low. Robust governance frameworks and transparent consent processes are essential to build user confidence and ensure ethical data handling. ⁷⁶

4.5. Clinical workflow and evidence gaps

The integration of continuous wearable data into clinical workflows presents logistical challenges. Healthcare professionals face increased data volumes without standardised protocols for interpretation or decision-making. This can lead to information overload and reduced efficiency. ⁷⁷ Furthermore, evidence on long-term clinical outcomes, cost-effectiveness, and impact on exacerbation rates remains limited, leaving policymakers uncertain about scalability and economic viability. ⁷⁸

5. Discussion and future directions

Wearable technology is increasingly transforming the management of CRDs by enabling continuous physiological monitoring, remote rehabilitation, and personalised care delivery. Evidence suggests that these innovations can improve clinical outcomes, enhance patient engagement, and reduce dependence on in-person healthcare services. A summary of which is provided in Table 2.

Table 2.

Future prospects for the use of wearable technology in CRDs.

Future trend	Enabling technologies	Anticipated clinical benefits	Implementation considerations
Multimodal Continuous Monitoring	Advanced sensors (SpO2, RR, HRV).	Early detection of exacerbations; comprehensive patient profiling; improved safety during exertion.	Validation under free-living conditions; battery optimisation; integration with home oxygen systems.
	Environmental monitors (air quality, pollen).
AI-Driven Predictive Analytics	Machine learning	Proactive interventions; reduced hospitalisation; personalised alerts.	Algorithms transparency; bias mitigation; regulatory approval for clinical decision support.
	Cloud computing
	Federated learning
Integration into Digital Therapeutics	Telehealth platforms	Scalable home-based rehabilitation; improved adherence and engagement; reduced travel burden	Workflow redesign; clinician training; reimbursement and funding models
	HER interoperability
	Mobile health applications
Personalised and Precision Care	Wearable-derived patient profiling	Tailored rehabilitation intensity; optimisation of medication plans; individualised oxygen therapy adjustments	Data governance; interoperability with prescribing and monitoring systems.
	Adaptive algorithms
Equity and Global Access	Low-cost sensors	Improved access in rural and low-resource settings; reduced health disparities	Subsidy programs; digital literacy initiatives; infrastructure investments
	Offline functionality
	Multilingual applications
Regulatory and Ethical Frameworks	Secure data pipelines	Enhanced trust, compliance, and safe clinical integration; protection of patient autonomy	Harmonised global standards; liability frameworks; patient consent models
	Privacy-preserving AI
	Interoperability standards

Abbreviations: SpO2 - Oxygen saturation; RR – Respiratory rate; HRV – Heart rate variability; AI – Artificial intelligence.

Looking ahead, the future of wearable technology in respiratory care will be shaped by several key developments. The integration of multimodal sensing, combining physiological, biomechanical, and environmental data, will offer a more comprehensive understanding of disease status and daily functioning. Devices capable of simultaneously tracking heart rate, respiratory rate, SpO₂, air quality, and activity levels will support early detection of exacerbations and improve safety during exertion.

AI and predictive analytics will play a central role in transforming longitudinal data into actionable insights. Machine learning models can stratify risk, forecast exacerbations, and guide personalised interventions, potentially reducing hospitalisations and improving long-term outcomes. These capabilities will be further enhanced by cloud computing and federated learning, allowing for scalable and secure data processing.

Wearable technologies will also become increasingly integrated with digital therapeutics, including telehealth platforms, electronic health records, and mobile health applications. This will enable adaptive exercise prescription, tele-coaching, and medication optimisation, support scalable, home-based rehabilitation and expanding access to care.

Personalised and precision care will be facilitated by wearable-derived patient profiling and adaptive algorithms. These tools will allow for tailored treatment plans, including individualised oxygen therapy, medication adjustments, and rehabilitation intensity, based on real-time feedback and patient-specific trends.

To fully realise these benefits, several foundational challenges must be addressed. Device validation must extend beyond controlled environments to real-world conditions, ensuring accuracy during rest, exertion, and sleep. Standardised data formats and secure pipelines are essential for integrating wearable data into clinical workflows without overwhelming healthcare providers. Clinician training and workflow redesign will be critical to support adoption.

Regulatory and ethical oversight must evolve to address algorithm transparency, software updates, and clinical safety. Clear guidelines for liability, informed consent, and data governance will be essential to protect patient autonomy and ensure ethical deployment. Equity and access must remain central to future implementation strategies. Affordability, offline functionality, and digital literacy initiatives are vital to prevent widening health disparities. Subsidy programmes, infrastructure investment, and multilingual applications can support adoption in underserved communities. As AI and predictive models become increasingly embedded in care delivery, ongoing attention to data privacy, algorithmic fairness, and inclusive design will be imperative. With thoughtful implementation, wearable technology has the potential to support a more proactive, personalised, and equitable future for respiratory care.

6. Conclusion

The integration of wearable technology into CRD management marks a pivotal shift toward proactive, personalised, and data-driven care. Across conditions such as COPD, asthma, ILD, CF, and PH, wearable devices have demonstrated the capacity to enhance physical activity, predict exacerbations, support remote monitoring, and empower patient self-management. These innovations offer a promising complement to traditional clinical approaches, bridging gaps in access, continuity, and responsiveness.

However, the path to widespread adoption is not without challenges. Technical limitations, patient-related barriers, privacy concerns, and systemic issues such as workflow integration and health equity must be addressed to ensure sustainable and inclusive implementation. The future of respiratory care will depend on the thoughtful convergence of validated wearable technologies, AI-driven analytics, and digital therapeutics, underpinned by robust ethical and regulatory frameworks.

By embracing these advancements and overcoming current limitations, healthcare systems can move toward a more holistic, efficient, and equitable model of CRD management—one that places patients at the centre and leverages technology to improve outcomes across diverse populations and settings.