Remote Spirometry, Education, and Action for COPD Diagnosis and Management in Rural and Medically Underserved Settings in South Carolina: Protocol for an Observational Feasibility Study
Authors: Miller Sarah N. , McCabe Susan , Morgan Emily , Al Hourany Ramzy , Nichols Michelle , Fowler Terri , Smith Whitney , Durham Cathy , Pittman MaryChris , Madisetti Mohan , Teufel Ronald , Swartz Andrea , Strange Charlie 
Published: February 2025

Individuals living in rural or medically underserved areas (MUA) with chronic obstructive pulmonary disease (COPD) face significant barriers to specialised pulmonary care, including pulmonologists, diagnostic spirometry, and pulmonary rehabilitation. Remote spirometry for diagnostic screening and disease monitoring may mitigate access barriers and contribute to improved COPD management in this population. This study protocol describes the proposed implementation of a Mobile Health (mHealth) intervention using Bluetooth‐enabled portable spirometry combined with a mobile disease management platform.

Objective

The purpose of this study is to evaluate the acceptability and feasibility of an mHealth intervention with Bluetooth‐enabled remote spirometry for remote patient monitoring of patients with COPD who are living in rural and/or medically underserved areas of South Carolina. Our exploratory aim is to investigate the potential benefits of remote monitoring and telehealth education on disease symptoms, dyspnoea, and COPD management. Our long‐term goal is to expand access, employ evidence‐based data, and support shared decision‐making in diagnosing and managing underserved patients with COPD.

Methods

This is a 2‐stage prospective observational study. In stage 1, healthcare providers who care for this population will participate in a focus group to explore provider perspectives and preferences toward implementation of remote spirometry in a medically underserved setting. Potential barriers and facilitators will be identified, and if needed, study implementation procedures will be refined based on provider feedback. In stage 2, a target of 120 adults with COPD will be recruited using a combination of direct study referrals, cold contact methods, community partners' recruitment, flyers, and social media posts. Screened and consented subjects will receive training on using the mHealth application and remote spirometer. Survey measures will be collected at baseline and repeated at months 1, 3, and 6, followed by an exit survey at the study conclusion. Using end‐of‐study questionnaire and repeated measures, we will evaluate feasibility by obtaining variability estimates for secondary outcome measures. Semi‐structured key informant interviews will be conducted to explore patient preferences, potential barriers, acceptability, and recommendations for future intervention refinement.

Conclusion

An mHealth intervention using Bluetooth‐enabled remote portable spirometry is a potential solution to expanding healthcare access and improving outcomes in under‐resourced populations at risk for increased morbidity and mortality. This study will evaluate the acceptability and feasibility of mHealth and remote monitoring, including symptom reporting among at‐risk under‐resourced adults with COPD.