Telemedicine in the management of chronic respiratory diseases: lessons learned and future perspectives

Chronic respiratory diseases (CRDs), including (pediatric) asthma and chronic obstructive pulmonary disease (COPD), remain a significant global health burden, affecting millions across all age groups. Despite advances in pharmacological therapies and clinical guidelines, challenges persist in achieving optimal disease control. The Special Collection in Therapeutic Advances in Respiratory Disease on Telemedicine in the management of CRD brings together a series of articles that explore how telemedicine can support patients and healthcare providers in managing CRD more effectively.

Managing CRD symptoms is challenging due to a lack of real-time and objective monitoring in patients’ daily life. Traditional care models heavily rely on scheduled consultations, which are often hampered by recall bias, ¹ limited symptom perception, ² and seasonal variability. ³ eHealth technologies, such as telemedicine and communication platforms, remote digital sensors, and home diagnostics, offer the potential to overcome these limitations by enabling continuous, real-time, and longitudinal monitoring in the home setting.

Foppiani et al. ⁴ describe the implementation of the COD19 active home surveillance system for patients with COPD during the COVID-19 pandemic. This telemedicine platform enabled remote monitoring of vital signs and functional parameters, facilitating timely interventions and hospital transfers. With a 92% response rate, the home surveillance system demonstrated strong patient participation and manageable monitoring processes. The surveillance study highlights how telemedicine can ensure continuity of care, support self-management, and reduce unnecessary hospital visits, even in vulnerable populations.

Many eHealth technologies are being evaluated through randomized controlled trials (RCTs). However, as Ruuls et al. ⁵ note, traditional RCT designs struggle to keep pace with the rapid evolution of eHealth innovations. Within the CIRCUS study, they use an innovative methodological approach, a cohort multiple randomized controlled trial (cmRCT), designed to evaluate the short- and long-term effects of eHealth interventions in pediatric asthma. This dynamic cohort integrates longitudinal monitoring, patient-reported outcomes, environmental data, and artificial intelligence (AI)-driven prediction models. The study aims to identify risk factors for asthma exacerbations and personalize interventions based on patient profiles. The cmRCT design allows for a pragmatic evaluation of multiple interventions and supports the development of scalable, personalized eHealth solutions.

A cornerstone of managing CRD is inhaled controller therapy. Poor adherence and inadequate inhalation technique are critical challenges that must be addressed in CRD treatment across all age groups. ⁶ It is, however, difficult to measure adherence and inhalation technique in an objective way. Sportel et al. ⁷ present findings from the IMAGINE study, which examined the relationship between therapy adherence and inhalation technique in children with uncontrolled asthma using a smart inhaler device. Surprisingly, the study found no significant correlation between these two parameters, suggesting that they represent distinct and frequent pitfalls in asthma management. Only 21% of the children demonstrated both good adherence and technique. The poor inhalation technique was associated with younger age, lower height, increased salbutamol use, and more frequent emergency room visits. These findings underscore the importance of targeted interventions and the potential of smart devices to identify risk profiles for patients with poor adherence and/or inhalation technique, and guide personalized care strategies.

Lessons learned and future perspectives

The studies in this Special Collection highlight both the promise and complexity of implementing telemedicine in CRD care. Barriers such as limited digital literacy, concerns around data privacy, and the need for inclusive designs must be addressed to ensure equitable access. The COD19 system tackled these challenges by bridging the digital divide through various communication methods, and overcome cultural barriers by involvement of cultural mediators. The CIRCUS study exemplifies co-design, incorporating patient participation throughout all stages of the research process to improve relevance and usability of telemedicine in CRD management.

The IMAGINE study also revealed that awareness of being monitored may temporarily improve behavior, a phenomenon known as the Hawthorne effect. ⁸ Future research should, therefore, prioritize long-term and frequent monitoring to capture real-world use. While the study showed that objective measurement of therapy adherence and inhalation is crucial, telemedicine can offer more than just monitoring. It enables objective insight into the underlying causes, severity, and patterns of symptoms, which is essential for timely anticipation and prevention of deterioration.

Importantly, more data are not necessarily better. What is needed is actionable insight, data that support both healthcare providers and patients in making informed decisions. The growing volume of longitudinal and multimodal data demands advanced methodological approaches to translate into clinically relevant interpretable information. ⁹ Without this, the potential of telemedicine in the management of CRD cannot be fully realized.

In addition to generating insight, telemedicine plays a vital role in remote care and support. It can actively support patients through education, feedback, and self-management interventions.^10,11 These elements are essential for sustainable behavioral change and patient autonomy. ¹² By combining monitoring, insight, and support, telemedicine can meaningfully contribute to better disease control, prevention of long-term complications or deterioration, reduced healthcare utilization, enhanced patient satisfaction, and improved quality of life for individuals living with CRD.