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

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

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

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

Active study update (1) REG_P41: Predicting the risk of future asthma exacerbations in a claims-based healthcare system Protocol complete 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.

Study concept Value Study Design Methods Findings Interpretation 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 Historical cohort study using population based clinical records from the BC Ministry of Health 3 year study period Value Findings Independent predictors (demographic and clinical) associated with future attacks Interpretation Validation of the UK model in an administrative healthcare data system.

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

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

Identify and prioritise multi-stakeholder end-user needs for TBS in respiratory and allergic airway disease (REG_P025) Working title Rationale Optimizing the Delivery of Triple Therapy in the Real- World Management of Patients with Chronic Obstructive Pulmonary Disease. 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. Objective To develop a series of end user specific checklists to guide developers in their creation of meaningful and relevant respiratory technologies.  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

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

Systematic review of behavioural change theory in the context of TBS for respiratory and allergic airways disease (REG_P028) Working title Rationale M-health solutions for self- management in respiratory health: what are their active ingredients and how are they delivered? 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. Objective To examine published literature AND/OR available solutions from a communication and behavioral perspective to identify the content and format of the intervention delivered To investigate the relationships between these characteristics and intervention success (defined in terms of user satisfaction, behavior change and health outcomes) This may compliment the Novartis study well. 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

Future interests Advertising/promoting the asthma risk tool on the REG website Device optimisation for improved adherence and outcomes (Novartis study) 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.  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 Link with Asthma UK Varying the length between a patient’s asthma review based on risk profile Using the work on asthma risk prediction, determine patient-specific review schedules, rather than an annual review Varying length of review: Different types of intervention, based on risk profile. E.g. questionnaires for low risk.

Other research ideas?

Setting priorities Are these projects still: Relevant? Feasible? Valid? A priority? How do we set priorities in technologies research? How to we ensure these priorities are pursued? 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?

Any other business?