Telenursing pp 107-118 | Cite as

Telenursing in Chronic Respiratory Diseases

  • Carlos Zamarrón
  • Emilio Morete
  • Francisco Gonzalez
Part of the Health Informatics book series (HI)


Patients with long-term conditions such as chronic pulmonary diseases represent a major health-care problem for the public health-care systems. Among these conditions are the sleep apnea syndrome (SAS), neuromuscular diseases with respiratory involvement, and chronic obstructive pulmonary disease (COPD). A recent study showed that over 27,000 people died from COPD in 2004 in the UK, and that caring for these patients represented a cost of 6.6 billion pounds for the UK national health-care system.7,8 The spiraling health-care budgets and the economic downturn we are facing in our days are forcing health-care providers to look for new cost-effective solutions to provide the best possible care. Information technology (IT) and particularly the new ways of delivering care remotely through telecare interventions seem to be a pivotal aspect in this question.19 IT can be implemented as web-based applications,9,10 mobile phone and alert systems,17,23 or telephone and videoconferencing to be used with chronic patients who are at their homes.5,13


Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Pulse Oximeter Neuromuscular Disease Chronic Respiratory Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Chronic Obstructive Pulmonary Disease


File Transfer Protocol


Health-related Quality of Life


Information Technology


Primary Care Centers


Personal Digital Assistant


Sleep Apnea Syndrome


Systems Based on Knowledge


Medical Outcomes Study Short Form-36


Saint George Respiratory Questionnaire



This work was partially supported by grants BFU2007-61034 (MEC), BFU2010-14968 (MICINN), FEDER, NanoBioMed Consolider-Ingenio 2010, Fondo Investigación Sanitaria PI08/90769, and Rede Galega de Nanomedicina.


Chronic obstructive pulmonary disease –

A pulmonary condition caused by a combination of diseases including chronic bronchitis, emphysema, and chronic obstructive airways disease. The main symptom is an inability to breathe in and out properly.

Cost-effective –

When related to health represents the relationship between a gain in health and the cost associated with the health gain.

Dyspnoea –

Breathing discomfort. It is a common symptom of many medical disorders, particularly those related to the respiratory or cardiovascular systems.

Homecare –

Health care or supportive care provided in the patient’s home by health-care professionals.

Medical Outcomes Study Short Form-36 –

A widely used, generic, patient-report measure created to assess health-related quality of life (HRQoL) in the general population.

Neuromuscular disease –

A broad term that includes many diseases that involve muscle and/or nerves.

Oximetry –

Monitoring the oxygenation of a patient’s hemoglobin.

Oxygen saturation –

The relative amount of oxygen that is carried in the blood.

Polygraph –

Instrument that records several physiological events.

Polysomnography –

A comprehensive recording of biomedical parameters during sleep.

Pulse oximeter –

Medical device used to measure the oxygen saturation of a patient’s blood.

Saint George Respiratory Questionnaire –

A standardized self-completed questionnaire for measuring impaired health and perceived well-being (“quality of life”) in airways disease.

Sleep apnea syndrome –

A disorder characterized by pauses in breathing during sleep. In obstructive sleep apnea, breathing is interrupted by a physical block to airflow, despite the effort to breathe.

Sphygmomanometer –

A device used to measure the blood pressure.

Spirometry –

Measurement of the volume and/or glow of air that can be inhaled or exhaled. It is the most common pulmonary function test.

Systems based on knowledge –

Intelligent tools working in a narrow domain to provide intelligent decisions with justification. Knowledge is acquired and represented using various knowledge representation techniques rules, frames, and scripts.

Telehealth –

Delivery of health-related services by means of telecommunication technologies.


  1.  1.
    Bourbeau J, Julien M, Maltais F, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease. Arch Intern Med. 2003;163:585-591.PubMedCrossRefGoogle Scholar
  2.  2.
    Bruderman I, Abboud S. Telespirometry: novel system for home monitoring of asthmatic patients. Telemed J. 1997;3:127-133.PubMedCrossRefGoogle Scholar
  3.  3.
    De Lusignan S, Althans A, Wells S, et al. A pilot study of radiotelemetry for continuous cardiopulmonary monitoring of patients at home. J Telemed Telecare. 2000;6(Suppl 1):119-122.CrossRefGoogle Scholar
  4.  4.
    Escourrou P, Luriau S, Rehel M, et al. Needs and costs of sleep monitoring. Stud Health Technol Inform. 2000;78:69-85.PubMedGoogle Scholar
  5.  5.
    Finkelstein SM, Lindgren B, Prasad B, et al. Reliability and validity of spirometry measurements in a paperless home monitoring diary program for lung transplantation. Heart Lung. 1993;22:523-533.PubMedGoogle Scholar
  6.  6.
    Gagnadoux F, Pelletier-Fleury N, Philippe C, et al. Home unattended vs hospital telemonitored polysomnography in suspected obstructive sleep apnea syndrome: a randomized crossover trial. Chest. 2002;121:753-758.PubMedCrossRefGoogle Scholar
  7.  7.
    Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of COPD; 2006. Available from
  8.  8.
    GOLD. The burden of lung disease, 2nd ed. A Statistics Report from the British Thoracic Society; 2006.Google Scholar
  9.  9.
    Gonzalez F, Iglesias R, Suarez A, et al. Teleophthalmology link between a primary health care center and a reference hospital. Med Inform Internet Med. 2001;26:251-263.PubMedCrossRefGoogle Scholar
  10. 10.
    Hernandez C, Casas A, Escarrabill J, et al. Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients. Eur Respir J. 2003;21:58-67.PubMedCrossRefGoogle Scholar
  11. 11.
    Izbicki G, Abboud S. Telespirometry for home monitoring of pulmonary function. J R Soc Med. 1999;92:154-155.PubMedGoogle Scholar
  12. 12.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540-545.PubMedGoogle Scholar
  13. 13.
    Johnston B, Wheeler L, Deuser J, et al. Outcomes of the Kaiser Permanente tele-home health research project. Arch Fam Med. 2000;9:40-45.PubMedCrossRefGoogle Scholar
  14. 14.
    Kristo DA, Andrada T, Eliasson AH, et al. Telemedicine in the sleep laboratory: feasibility and economic advantages of polysomnograms transferred online. Telemed J E Health. 2001;7:219-224.PubMedCrossRefGoogle Scholar
  15. 15.
    Kristo D, Eliasson AH, Netzer NC, et al. Application of telemedicine to sleep medicine. Sleep Breath. 2001;5:97-99.PubMedCrossRefGoogle Scholar
  16. 16.
    Langsetmo L, Platt RW, Ernst P, et al. Under reporting exacerbation of chronic obstructive pulmonary disease in a longitudinal cohort. Am J Respir Crit Care Med. 2008;177:396-401.PubMedCrossRefGoogle Scholar
  17. 17.
    Lee RG, Chen KC, Haiso C, et al. Mobile care system with an alert mechanism. IEEE Trans Inf Technol Biomed. 2007;11:507-517.PubMedCrossRefGoogle Scholar
  18. 18.
    Mair FS, Wilkinson M, Bonnar SA, et al. The role of telecare in the management of exacerbations of chronic obstructive pulmonary disease in the home. J Telemed Telecare. 1999;5(Suppl 1):66-67.CrossRefGoogle Scholar
  19. 19.
    McLean S, Sheikh A. Does telehealthcare offer a patient-centred way forward for the community-based management of long-term respiratory disease? Prim Care Respir J. 2009;18:125-126.PubMedGoogle Scholar
  20. 20.
    Mykytyn IJ, Sajkov D, Neill AM, et al. Portable computerized polysomnography in attended and unattended settings. Chest. 1999;115:114-122.PubMedCrossRefGoogle Scholar
  21. 21.
    Pelletier-Fleury N, Gagnadoux F, Philippe C, et al. A cost-minimization study of telemedicine. The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome. Int J Technol Assess Health Care. 2001;17:604-611.PubMedGoogle Scholar
  22. 22.
    Pelletier-Fleury N, Lanoe JL, Philippe C, et al. Economic studies and ‘technical’ evaluation of telemedicine: the case of telemonitored polysomnography. Health Policy. 1999;49:179-194.PubMedCrossRefGoogle Scholar
  23. 23.
    Pinnock H, Slack R, Paglairi C, et al. Understanding the potential role of mobile phone-based monitoring and asthma self management of asthma: qualitative study. Clin Exp Allergy. 2007;37:794-802.PubMedCrossRefGoogle Scholar
  24. 24.
    Rodriguez De Castro C, Ordonez AJ, Navarrete P, et al. Usefulness of telemedicine in chronic diseases: home tele-care of patient with chronic obstructive pulmonary disease. Med Clin (Barc). 2002;119:301-303.Google Scholar
  25. 25.
    Skwarska E, Cohen G, Skwarski KM, et al. Randomised controlled trial of supported discharge in patients with exacerbations of chronic obstructive pulmonary disease. Thorax. 2002;55:907-912.CrossRefGoogle Scholar
  26. 26.
    Vontetsianos T, Giovas P, Katsaras 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):86-88.PubMedCrossRefGoogle Scholar
  27. 27.
    Wilkinson T, Donaldson GC, Hurst JR, et al. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169:­1298-1303.PubMedCrossRefGoogle Scholar
  28. 28.
    Zamarrón C, Gude F, Barcala J, et al. Utility of oxygen saturation and heart rate spectral analysis obtained from pulse oximetric recordings in the diagnosis of sleep apnea syndrome. Chest. 2003;123:1567-1576.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Carlos Zamarrón
    • 1
  • Emilio Morete
  • Francisco Gonzalez
  1. 1.Service of NeumologyComplejo Hospitalario Universitario de Santiago de CompostelaSantiago de CompostelaSpain

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