Telehealth in Pulmonary Rehabilitation

  • Michele VitaccaEmail author
  • Anne Holland


A wide range of telehealth interventions could be used to optimize pulmonary rehabilitation delivery and patient outcomes. This includes monitoring of physiological signals or symptoms, early notification of clinical deterioration, telephone support, web-based education programmes; case management via videoconferencing and direct supervision of rehabilitation sessions. Telehealth interventions could enhance the delivery of comprehensive care, as well as improving access to pulmonary rehabilitation services for those cannot travel to centre-based programmes. This chapter reviews current evidence and existing models for telemonitoring, tele-assistance and telerehabilitation in chronic respiratory conditions. Tele-assistance has proved most successful for long-term, intensive management of the sickest patients, using sophisticated monitoring systems with high level support from an experienced clinical team. Effects of telemonitoring alone have been inconsistent across studies and the clinical, economic and organizational benefits are not yet clear. Telerehabilitation shows promise for delivery of effective pulmonary rehabilitation either to satellite centres or directly into the patient’s home, using a variety of approaches including telephone calls, videoconferencing, internet platforms and smart phones, although well controlled data are lacking. Future challenges include identifying the best candidates for telehealth-enhanced pulmonary rehabilitation across the spectrum of chronic lung disease; deciding when it should be delivered and for how long; standardizing models of telehealth to allow consistent implementation and meaningful comparison of outcomes; and articulating the health economic benefits of telehealth services.


  1. 1.
    International Organisation for Standardization. ISO Strategy for Services—Case study 1: International SOS (ISO/TS 13131, Telehealth services); 2016.Google Scholar
  2. 2.
    Kairy D, et al. A systematic review of clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation. Disabil Rehabil. 2009;31(6):427–47.CrossRefPubMedGoogle Scholar
  3. 3.
    Spruit MA, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine. 2013;188(8):e13–64.CrossRefPubMedGoogle Scholar
  4. 4.
    Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.
  5. 5.
    Australian Institute for Health and Welfare. Monitoring pulmonary rehabilitation and long-term oxygen therapy for people with chronic obstructive pulmonary disease (COPD) in Australia: a discussion paper. Canberra: AIHW; 2013.Google Scholar
  6. 6.
    Yohannes AM, Connolly MJ. Pulmonary rehabilitation programmes in the UK: a national representative survey. Clin Rehabil. 2004;18(4):444–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Brooks D, et al. Characterization of pulmonary rehabilitation programs in Canada in 2005. Can Respir J. 2007;14(2):87–92.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Johnston CL, et al. How prepared are rural and remote health care practitioners to provide evidence-based management for people with chronic lung disease? Aust J Rural Health. 2012;20(4):200–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis. 2011;8(2):89–99.CrossRefPubMedGoogle Scholar
  10. 10.
    Tougaard L, et al. Economic benefits of teaching patients with chronic obstructive pulmonary disease about their illness. The PASTMA Group. Lancet. 1992;339(8808):1517–20.CrossRefPubMedGoogle Scholar
  11. 11.
    Haggerty MC, Stockdale-Woolley R, Nair S. Respi-Care. An innovative home care program for the patient with chronic obstructive pulmonary disease. Chest. 1991;100(3):607–12.CrossRefPubMedGoogle Scholar
  12. 12.
    Littlejohns P, et al. Randomised controlled trial of the effectiveness of a respiratory health worker in reducing impairment, disability, and handicap due to chronic airflow limitation. Thorax. 1991;46(8):559–64.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Cockcroft A, et al. Controlled trial of respiratory health worker visiting patients with chronic respiratory disability. Br Med J (Clin Res Ed). 1987;294(6566):225–8.CrossRefGoogle Scholar
  14. 14.
    Johnston B, et al. Outcomes of the Kaiser Permanente Tele-Home Health Research Project. Arch Fam Med. 2000;9(1):40–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Farrero E, et al. Impact of a hospital-based home-care program on the management of COPD patients receiving long-term oxygen therapy. Chest. 2001;119(2):364–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Agha Z, Schapira RM, Maker AH. Cost effectiveness of telemedicine for the delivery of outpatient pulmonary care to a rural population. Telemed J E Health. 2002;8(3):281–91.CrossRefPubMedGoogle Scholar
  17. 17.
    Hernandez C, et al. Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients. Eur Respir J. 2003;21(1):58–67.CrossRefPubMedGoogle Scholar
  18. 18.
    Bourbeau J, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. Arch Intern Med. 2003;163(5):585–91.CrossRefPubMedGoogle Scholar
  19. 19.
    Pare G, et al. Cost-minimization analysis of a telehomecare program for patients with chronic obstructive pulmonary disease. Telemed J E Health. 2006;12(2):114–21.CrossRefPubMedGoogle Scholar
  20. 20.
    Casas A, et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Respir J. 2006;28(1):123–30.Google Scholar
  21. 21.
    Miyasaka K, et al. Interactive communication in high-technology home care: videophones for pediatric ventilatory care. Pediatrics. 1997;99(1):E1.CrossRefPubMedGoogle Scholar
  22. 22.
    Vitacca M, et al. Tele-assistance in patients with amyotrophic lateral sclerosis: long term activity and costs. Disabil Rehabil Assist Technol. 2012;7(6):494–500.CrossRefPubMedGoogle Scholar
  23. 23.
    Vitacca M, et al. A pilot trial of telemedicine-assisted, integrated care for patients with advanced amyotrophic lateral sclerosis and their caregivers. J Telemed Telecare. 2010;16(2):83–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Zamith M, et al. Home telemonitoring of severe chronic respiratory insufficient and asthmatic patients. Rev Port Pneumol. 2009;15(3):385–417.CrossRefPubMedGoogle Scholar
  25. 25.
    Bertini S, et al. Telemonitoring in chronic ventilatory failure: a new model of survellaince, a pilot study. Monaldi Arch Chest Dis. 2012;77(2):57–66.PubMedGoogle Scholar
  26. 26.
    Vontetsianos T, et al. Telemedicine-assisted home support for patients with advanced chronic obstructive pulmonary disease: preliminary results after nine-month follow-up. J Telemed Telecare. 2005;11(Suppl 1):86–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Trappenburg JC, et al. Effects of telemonitoring in patients with chronic obstructive pulmonary disease. Telemed J E Health. 2008;14(2):138–46.CrossRefPubMedGoogle Scholar
  28. 28.
    Segrelles Calvo G, et al. A home telehealth program for patients with severe COPD: the PROMETE study. Respir Med. 2014;108(3):453–62.CrossRefPubMedGoogle Scholar
  29. 29.
    Jodar-Sanchez F, et al. Implementation of a telehealth programme for patients with severe chronic obstructive pulmonary disease treated with long-term oxygen therapy. J Telemed Telecare. 2013;19(1):11–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Maiolo C, et al. Home telemonitoring for patients with severe respiratory illness: the Italian experience. J Telemed Telecare. 2003;9(2):67–71.CrossRefPubMedGoogle Scholar
  31. 31.
    Moreira J, et al. Compliance with home non-invasive mechanical ventilation in patients with chronic respiratory failure: telemonitoring versus usual care surveillance—a randomized pilot study. Eur Respir J. 2014;44(Suppl 58):447.Google Scholar
  32. 32.
    Pinnock H, et al. Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial. BMJ. 2013;347:f6070.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Pedone C, et al. Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial. BMC Health Serv Res. 2013;13:82.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Vitacca M, et al. Tele-assistance in chronic respiratory failure patients: a randomised clinical trial. Eur Respir J. 2009;33(2):411–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Cartwright M, et al. Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomised controlled trial. BMJ. 2013;346:f653.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Chatwin M, et al. Analysis of home support and ventilator malfunction in 1211 ventilator-dependent patients. Eur Respir J. 2010;35(2):310–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Chatwin M, et al. Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial). Thorax. 2016;71(4):305–11.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Lloyd-Owen SJ, et al. Patterns of home mechanical ventilation use in Europe: results from the Eurovent survey. Eur Respir J. 2005;25(6):1025–31.CrossRefPubMedGoogle Scholar
  39. 39.
    King AC. Long-term home mechanical ventilation in the United States. Respir Care. 2012;57(6):921–30. discussion 930-2CrossRefPubMedGoogle Scholar
  40. 40.
    Rose L, et al. Home mechanical ventilation in Canada: a national survey. Respir Care. 2015;60(5):695–704.CrossRefPubMedGoogle Scholar
  41. 41.
    Garner DJ, et al. Home mechanical ventilation in Australia and New Zealand. Eur Respir J. 2013;41(1):39–45.CrossRefPubMedGoogle Scholar
  42. 42.
    Farre R, et al. Performance of mechanical ventilators at the patient’s home: a multicentre quality control study. Thorax. 2006;61(5):400–4.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Pinto A, et al. Home telemonitoring of non-invasive ventilation decreases healthcare utilisation in a prospective controlled trial of patients with amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry. 2010;81(11):1238–42.CrossRefPubMedGoogle Scholar
  44. 44.
    Hazenberg A, et al. Initiation of home mechanical ventilation at home: a randomised controlled trial of efficacy, feasibility and costs. Respir Med. 2014;108(9):1387–95.CrossRefPubMedGoogle Scholar
  45. 45.
    Janssens JP, et al. Nocturnal monitoring of home non-invasive ventilation: Contribution of simple tools such as pulse-oximetry, capnography, built-in ventilator software and autonomic markers of sleep fragmentation. Rev Mal Respir. 2014;31(2):107–18.CrossRefPubMedGoogle Scholar
  46. 46.
    Georges M, et al. Reliability of apnea-hypopnea index measured by a home bi-level pressure support ventilator versus a polysomnographic assessment. Respir Care. 2015;60(7):1051–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Pasquina P, et al. What does built-in software of home ventilators tell us? An observational study of 150 patients on home ventilation. Respiration. 2012;83(4):293–9.CrossRefPubMedGoogle Scholar
  48. 48.
    Borel JC, et al. Parameters recorded by software of non-invasive ventilators predict COPD exacerbation: a proof-of-concept study. Thorax. 2015;70(3):284–5.CrossRefPubMedGoogle Scholar
  49. 49.
    Rabec C, et al. Ventilator modes and settings during non-invasive ventilation: effects on respiratory events and implications for their identification. Thorax. 2011;66(2):170–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Gonzalez-Bermejo J, et al. Proposal for a systematic analysis of polygraphy or polysomnography for identifying and scoring abnormal events occurring during non-invasive ventilation. Thorax. 2012;67(6):546–52.CrossRefPubMedGoogle Scholar
  51. 51.
    Berry RB, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597–619.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Isetta V, et al. A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial. Thorax. 2015;70(11):1054–61.CrossRefPubMedGoogle Scholar
  53. 53.
    Wozniak DR, Lasserson TJ, Smith I. Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines in adults with obstructive sleep apnoea. Cochrane Database Syst Rev. 2014;1:CD007736.Google Scholar
  54. 54.
    Bruyneel M, Ninane V. Unattended home-based polysomnography for sleep disordered breathing: current concepts and perspectives. Sleep Med Rev. 2014;18(4):341–7.CrossRefPubMedGoogle Scholar
  55. 55.
    Coma-Del-Corral MJ, et al. Reliability of telemedicine in the diagnosis and treatment of sleep apnea syndrome. Telemed J E Health. 2013;19(1):7–12.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Isetta V, et al. Telemedicine-based approach for obstructive sleep apnea management: building evidence. Interact J Med Res. 2014;3(1):e6.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Dellaca R, et al. Telemetric CPAP titration at home in patients with sleep apnea-hypopnea syndrome. Sleep Med. 2011;12(2):153–7.CrossRefPubMedGoogle Scholar
  58. 58.
    Taylor Y, et al. The role of telemedicine in CPAP compliance for patients with obstructive sleep apnea syndrome. Sleep Breath. 2006;10(3):132–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Fox N, et al. The impact of a telemedicine monitoring system on positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. Sleep. 2012;35(4):477–81.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Sparrow D, et al. A telemedicine intervention to improve adherence to continuous positive airway pressure: a randomised controlled trial. Thorax. 2010;65(12):1061–6.CrossRefPubMedGoogle Scholar
  61. 61.
    Mendelson M, et al. CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial. Sleep. 2014;37(11):1863–70.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Fraysse JL, et al. Home telemonitoring of CPAP: a feasibility study. Rev Mal Respir. 2012;29(1):60–3.CrossRefPubMedGoogle Scholar
  63. 63.
    Mokhlesi B, Tulaimat A. Recent advances in obesity hypoventilation syndrome. Chest. 2007;132(4):1322–36.CrossRefPubMedGoogle Scholar
  64. 64.
    Benditt JO, Boitano LJ. Pulmonary issues in patients with chronic neuromuscular disease. Am J Respir Crit Care Med. 2013;187(10):1046–55.CrossRefPubMedGoogle Scholar
  65. 65.
    Hess DR. The growing role of noninvasive ventilation in patients requiring prolonged mechanical ventilation. Respir Care. 2012;57(6):900–18. discussion 918-20CrossRefPubMedGoogle Scholar
  66. 66.
    Piper AJ. Nocturnal hypoventilation—identifying & treating syndromes. Indian J Med Res. 2010;131:350–65.PubMedGoogle Scholar
  67. 67.
    Piper AJ, Grunstein RR. Big breathing: the complex interaction of obesity, hypoventilation, weight loss, and respiratory function. J Appl Physiol 1985. 2010;108(1):199–205.CrossRefPubMedGoogle Scholar
  68. 68.
    Kitsiou S, Pare G, Jaana M. Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases: a critical assessment of their methodological quality. J Med Internet Res. 2013;15(7):e150.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Lujan M, Pomares X. Noninvasive mechanical ventilation. Reflections on home monitoring. Arch Bronconeumol. 2014;50(3):85–6.CrossRefPubMedGoogle Scholar
  70. 70.
    Wootton R. Twenty years of telemedicine in chronic disease management--an evidence synthesis. J Telemed Telecare. 2012;18(4):211–20.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Hall WJ, ACP Journal Club. Telemonitoring did not reduce hospitalizations or ED visits in high-risk elderly patients. Ann Intern Med. 2012;157(6):JC3–8.CrossRefPubMedGoogle Scholar
  72. 72.
    Spruit MA, et al. Differences in content and organisational aspects of pulmonary rehabilitation programmes. Eur Respir J. 2014;43(5):1326–37.CrossRefPubMedGoogle Scholar
  73. 73.
    Holland AE, et al. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial. Thorax. 2017;72(1):57–65.CrossRefPubMedGoogle Scholar
  74. 74.
    Maltais F, et al. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008;149(12):869–78.CrossRefPubMedGoogle Scholar
  75. 75.
    Stickland M, et al. Using Telehealth technology to deliver pulmonary rehabilitation in chronic obstructive pulmonary disease patients. Canadian Respiratory Journal. 2011;18(4):216–20.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Tsai, L.L., et al., Home-based telerehabilitation via real-time videoconferencing improves endurance exercise capacity in patients with COPD: The randomized controlled TeleR Study. Respirology, 2016.Google Scholar
  77. 77.
    Paneroni M, et al. Is telerehabilitation a safe and viable option for patients with COPD? A Feasibility Study. COPD. 2015;12(2):217–25.CrossRefPubMedGoogle Scholar
  78. 78.
    Tousignant M, et al. In-home telerehabilitation for older persons with chronic obstructive pulmonary disease: a pilot study. International Journal of Telerehabilitation. 2012;4(1):7–13.CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Burkow TM, et al. Comprehensive pulmonary rehabilitation in home-based online groups: a mixed method pilot study in COPD. BMC Res Notes. 2015;8:766.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Marquis N, et al. In-home pulmonary telerehabilitation for patients with chronic obstructive pulmonary disease: a pre-experimental study on effectiveness, satisfaction, and adherence. Telemed J E Health. 2015;21(11):870–9.CrossRefPubMedGoogle Scholar
  81. 81.
    Tabak M, et al. A telerehabilitation intervention for patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot trial. Clinical Rehabilitation. 2013;28(6):582–91.CrossRefPubMedGoogle Scholar
  82. 82.
    Bernocchi P, et al. A multidisciplinary telehealth program in patients with combined chronic obstructive pulmonary disease and chronic heart failure: study protocol for a randomized controlled trial. Trials. 2016;17(1):462.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Holland AE, et al. Telerehabilitation for people with chronic obstructive pulmonary disease: feasibility of a simple, real time model of supervised exercise training. Journal of Telemedicine and Telecare. 2013;19(4):222–6.CrossRefPubMedGoogle Scholar
  84. 84.
    Hoaas H, et al. Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study. BMC Med Inform Decis Mak. 2016;16:26.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Crotty M, et al. Telerehabilitation for older people using off-the-shelf applications: acceptability and feasibility. J Telemed Telecare. 2014;20(7):370–6.CrossRefPubMedGoogle Scholar
  86. 86.
    Zanaboni P, et al. Long-term integrated telerehabilitation of COPD Patients: a multicentre randomised controlled trial (iTrain). BMC Pulm Med. 2016;16(1):126.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Oh EG. The effects of home-based pulmonary rehabilitation in patients with chronic lung disease. Int J Nurs Stud. 2003;40(8):873–9.CrossRefPubMedGoogle Scholar
  88. 88.
    Bauer KA. The ethical and social dimensions of home-based telemedicine. Crit Rev Biomed Eng. 2000;28(3–4):541–4.CrossRefPubMedGoogle Scholar
  89. 89.
    Stanberry B. Legal and ethical aspects of telemedicine. J Telemed Telecare. 2006;12(4):166–75.CrossRefPubMedGoogle Scholar
  90. 90.
    Brahams D. The medicolegal implications of teleconsulting in the UK. J Telemed Telecare. 1995;1(4):196–201.CrossRefPubMedGoogle Scholar
  91. 91.
    E-Health and Its Impact on Medical Practice. Position Paper. 2008, Available from American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.Google Scholar
  92. 92.
    Kaufman DR, et al. Usability in the real world: assessing medical information technologies in patients’ homes. J Biomed Inform. 2003;36(1-2):45–60.CrossRefPubMedGoogle Scholar
  93. 93.
    Doherty ST, Oh P. A multi-sensor monitoring system of human physiology and daily activities. Telemed J E Health. 2012;18(3):185–92.CrossRefPubMedGoogle Scholar
  94. 94.
    Sevick MA, et al. A confirmatory factor analysis of the Caregiving Appraisal Scale for caregivers of home-based ventilator-assisted individuals. Heart Lung. 1997;26(6):430–8.CrossRefPubMedGoogle Scholar
  95. 95.
    Fields AI, et al. Home care cost-effectiveness for respiratory technology-dependent children. Am J Dis Child. 1991;145(7):729–33.CrossRefPubMedGoogle Scholar
  96. 96.
    Geiseler J, et al. Invasive home mechanical ventilation, mainly focused on neuromuscular disorders. GMS Health Technol Assess. 2010;6. Doc08Google Scholar
  97. 97.
    Henderson C, et al. Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ. 2013;346:f1035.CrossRefPubMedGoogle Scholar
  98. 98.
    Stoddart A, et al. Telemonitoring for chronic obstructive pulmonary disease: a cost and cost-utility analysis of a randomised controlled trial. J Telemed Telecare. 2015;21(2):108–18.CrossRefPubMedGoogle Scholar
  99. 99.
    Communication from the commission to the European Parliament, the council, the European economic and social committee and the committee of the regions. eHealth Action Plan. 2012–2020;6(12):2012.Google Scholar
  100. 100.
    Pare G, Jaana M, Sicotte C. Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc. 2007;14(3):269–77.CrossRefPubMedPubMedCentralGoogle Scholar
  101. 101.
    Jaana M, Pare G, Sicotte C. Home telemonitoring for respiratory conditions: a systematic review. Am J Manag Care. 2009;15(5):313–20.PubMedGoogle Scholar
  102. 102.
    Polisena J, et al. Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Telemed Telecare. 2010;16(3):120–7.CrossRefPubMedGoogle Scholar
  103. 103.
    Vitacca M. Telemonitoring in patients with chronic respiratory insufficiency: expectations deluded? Thorax. 2016;71(4):299–301.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Respiratory Rehabilitation DivisionIstituti Clinici Scientifici Maugeri, IRCSSBresciaItaly
  2. 2.Alfred Health and Institute for Breathing and SleepLa Trobe UniversityMelbourneAustralia

Personalised recommendations