Technologies Working Group ERS 2017

1. ERS 2017
Milan, 9th September 2017
Technology Working Group Meeting

2. Agenda
• Working group progress update
• Priorities for future research
o Review potential studies
– Are they still relevant, feasible, valid and a priority
o Other research ideas
o Setting priorities
• Additional items

3. Attendees
John Blakey (chair – dial in)
K F Chung
Nicholas Roche
Ron Dandurand
Danny McBryan
Heather Hoch

4. Progress update
• Published papers
o Effective deployment of technology-supported management of chronic
respiratory conditions: a call for stakeholder engagement, Pragmat Obs
Res 2017
o Use of electronic medical records and biomarkers to manage risk and
resource efficiencies, Eur Clin Respir J 2017

5. • REG_P41: Predicting the risk of future asthma exacerbations in a
claims-based healthcare system
o Protocol complete
Active study update (1)
Objective
Use claims-based healthcare data to
• Characterise the frequent exacerbator subgroup of
asthma patients.
• Identifying individual risk factors (demographic and
clinical) and exploring clusters of risk factors
associated with increased future exacerbation risk
• Validate REG’s UK Asthma Risk Prediction model,
using administrative health data to identify patients
at increased risk of future exacerbations.

6. • Historical cohort study
using population based
clinical records from the
BC Ministry of Health
• 3 year study period
Clinical and demographic
characterisation of patients
Univariate analysis to identify
individual baseline factors
associated with risk of recurrent
exacerbations in the outcome period
Multivariate analysis to identify
composite groups of risk factors
predictive of future risk
Develop an individualised risk
scoring tool
Compare and contrast tool with UK
clinical tools
Methods
Value
Study concept
Findings
Interpretation
Study Design
Validation of the UK model in an
administrative healthcare data system.
Independent predictors
(demographic and clinical)
associated with future attacks

7. Suggested areas for research
Adherence
Replacing annual reviews
Early detection of deterioration
Education

8. Future interests with draft proposals
• REG_P025: Identify and prioritise multi-stakeholder end-user
needs for TBS in respiratory and allergic airway disease
• REG_P026: Guidance to standardise the development of TBS
with utility for respiratory and allergic airway diseases
• REG_P028: Systematic review of behavioural change theory in
the context of TBS for respiratory and allergic airways disease

9. Working title
Optimizing the Delivery of Triple Therapy in the Real-
World Management of Patients with Chronic Obstructive
Pulmonary Disease.
Objective
To develop a series of end user specific checklists to guide
developers in their creation of meaningful and relevant
respiratory technologies.
Rationale
• Technology based solutions in respiratory medicine
must be “needs-focussed” and address an end user’s
need in order to ensure their engagement and
persistence.
• there is a need for consideration of specific subgroups
as the needs of patients differ depending on their
primary diagnosis and change depending on the
current clinical scenario of the patient, their stage of
disease and their age and attitude to technologies.
Identify and prioritise multi-stakeholder end-user needs for
TBS in respiratory and allergic airway disease (REG_P025)
Proposed methodology
Design: Parallel Delphi procedures to capture and
prioritise different stakeholder specific needs
Population: Non-selective real-life COPD population
Exposures: Triple therapy compared to other treatment
options
Outcomes: Exacerbations, adherence

10. • Similar approach:
Identify and prioritise multi-stakeholder end-user needs for
TBS in respiratory and allergic airway disease (REG_P025)

11. Objective
1. To examine published literature
AND/OR available solutions from a
communication and behavioral
perspective to identify the content and
format of the intervention delivered
2. To investigate the relationships
between these characteristics and
intervention success (defined in terms
of user satisfaction, behavior change
and health outcomes)
Proposed methodology
Design: Systematic review of existing literature with coding of communication
and behavioural content and format
Inclusion criteria: peer reviewed articles describing m-health solutions,
focusing on self-management and used in respiratory conditions
Systematic review of behavioural change theory in the
context of TBS for respiratory and allergic airways disease
(REG_P028)
Working title
M-health solutions for self-
management in respiratory health:
what are their active ingredients and
how are they delivered?
Rationale
• Long-term respiratory condition requires continuous self-management
• Numerous m-health solutions have been developed to support self-
management, however they are often developed with minimal input from
communication or behavioral science and limited testing, with mixed success
• Clinicians and health technology developers would benefit from clear
guidelines for using these conceptual tools in developing m-health solutions
• A first step in developing these recommendations is to assess the current
state-of-the-art in m-health interventions in order to identify how behavior
change support is delivered by available technology.

12. Future interests
• Advertising/promoting the asthma risk tool on the REG website
• Device optimisation for improved adherence and outcomes (Novartis study)
o Phase 1 - Develop a standard setting piece by means of a Delphi exercise to identify and
detail what all new types of technologies must do/gather in order to deliver relevant and
necessary information.
o Phase 2 - Study design that could be used to test all new technologies/combination of
technologies.
• Meta-analysis of existing data on effectiveness of SMART-inhalers
o Link with Asthma UK
• Varying the length between a patient’s asthma review based on risk profile
o Using the work on asthma risk prediction, determine patient-specific review schedules,
rather than an annual review

13. Other research ideas?

14. Setting priorities
• Are these projects still:
o Relevant?
o Feasible?
o Valid?
o A priority?
• How do we set priorities in technologies research?
• How to we ensure these priorities are pursued?
o Grant submissions? Commercial funding? How to bridge the gap from small start ups to
large-scale studies
• What are the two most important projects to push forwards?

15. Any other business?