Implant tech offers new hope for COPD treatment

Wearable and implantable technology could give hope to some three million people living with COPD, but there remain key questions around safety, reliability and cost. This is why more clinical research studies are crucial, write Prof Guang-Zhong Yang and Dr Anthony De Soyza.

Wearable technologies could well be the next wave of technology after smartphones that transform our society and daily life. The new generation of wearable technologies may no longer be wristbands or glasses, and instead be fabrics, patches or even tattoo papers. And, it’s expected that wearable products will soon be widely adopted by the health care services.

For the three million people living in the UK with chronic obstructive pulmonary disease (COPD) this can’t come soon enough. Implantable and wearable devices – set out in a new report by the National Institute for Health Research (NIHR) in collaboration with the Hamlyn Centre, Imperial College London – could hand greater control to patients and their carers, and empower them to better manage what can be such a debilitating condition.

COPD describes a group of lung conditions that make it difficult to empty air out of the lungs because the airways have been narrowed. The main symptoms are breathlessness, frequent chest infections, a stubborn chesty cough and persistent wheezing. In the UK alone 1.2 million people live with diagnosed COPD yet millions of people still remain undiagnosed – the ‘missing millions’ range between 1.8–2 million in the UK alone.

The potential for technology to improve the quality of a patient’s life is huge but more tech doesn’t necessarily mean better care. There are still key challenges around safety, long-term reliability and device cost before these technologies can be more widely translated into clinical use.

COPD can't be cured or reversed. But for many people the right treatment can help keep it under control, so it doesn't severely stop them from going about their daily lives. This is where wearable technology can help.

COPD patients experience episodic flare-ups, a common worsening of the condition. These are caused by triggers such as bacteria, viruses and pollutants which inflame the airways. A simple portable device could allow patients to identify when their condition is worsening and receive treatment at home. The benefits are obvious in that patients are supported to self manage their condition with the device alerting patients to changes much more than the usual day to day variation in symptoms.

In the case of smart textiles, where vests or t-shirt have circuits and sensors weaved into the fabric, recent studies have proposed the use of textile sensing to estimate the amount of air inhaled, exhaled and stored within the lungs at any given time for patients with COPD. Any changes in the amount could help spot an imminent flare-up, alerting patients or carers that an emergency medication pack, consisting of steroids and antibiotics, may be needed.

Further new technologies are being developed as implantables. Endobronchial valves and coils now being used offer better lung mechanics and improve a patient’s symptoms. These are inserted into the lungs via flexible bronchoscope (an instrument that is threaded through the nose or mouth and down the throat to reach the lungs), often without the need for a full anaesthetic. The benefit? They remove the effect of trapped air in ineffective lungs, without the need for highly invasive surgery.

Implantable and wearable medical devices for monitoring the condition could see patients treated earlier at home, reducing the decline in their lung function and improving their quality of life, and cutting the cost of hospital stays. COPD is one of the most costly inpatient conditions that the NHS treats, with a direct healthcare cost of COPD estimated at over £800 million a year.

Wearable technologies have been widely used in medical and healthcare applications for many decades. The Holter monitor, first introduced in 1970s, is still being used as a main medical device to assess condition of cardiac patients. But these early wearable healthcare devices tended to be bulky. It’s only the recent advances in the semiconductor and wireless technologies that have allowed for the miniaturisation of devices. And this is key.

In order to maximise their clinical potential and impact, COPD medical devices need to be comfortable to wear, easy to use and cost effective. They also need to be reliable and provide relevant and accurate information that improves diagnosis and treatment.

Then there is the issue of compliance. Medical devices have to conform to rigorous FDA and EU regulations and must have the CE-mark to base clinical decisions on their measurements. Some critical challenges in translating these technologies include safety aspects, long-term reliability and stability of device performance, minimising follow-up calibration and maintenance, as well as cost of device production and of the surgical procedure (in the case of implantable devices).

It is clear that implantable and wearable medical devices are the future of medicine. Yet concrete evidence of patient benefit remains a major hurdle. If we are to reap the rewards of emerging technology, more patient research is crucial: improving the health of COPD patients and saving the NHS money depend on it.