Continuous characterisation of exacerbation pathophysiology using wearable technologies in free-living outpatients with COPD: a prospective observational cohort study
Bibliographic record
Abstract
Background The most recent exacerbation of COPD (ECOPD) classification criteria relies in part on changes in respiratory rate (RR), heart rate (HR) and oxygen saturation (SpO 2 ). Despite this paradigm shift, a thorough understanding of exacerbation patterns is still lacking, as is the identification of physiological exacerbation biomarkers. Methods Using a convenience sampling approach, this prospective observational cohort study was conducted between February 2023 and January 2024. Continuous measurements of daytime/overnight respiratory (primary outcome), cardiovascular, autonomic, activity and sleep-related parameters were collected by a wearable biometric wristband and ring over 21 consecutive days in free-living outpatients experiencing and receiving treatment (≤3 days) for a current exacerbation from the home environment. The EXACT-PRO questionnaire served as the validated reference for daily symptom burden and to identify ‘recovered' versus ‘persistent worsening' participants. Unadjusted and adjusted (for age, sex, FEV 1 ) linear mixed-effects models were fitted to estimate associations between each physiological parameter with daily EXACT-PRO score (points, pts), in all, ‘recovered', and ‘persistent worsening' participants. Results are presented as point estimates with 95% CIs. Findings In 21 participants with COPD (43% female, mean age 66.8, BMI 27.7 kg/m 2 , FEV 1 36.3% predicted; 85.7% with GOLD 3–4 disease), significant associations in unadjusted models with daily EXACT-PRO score included RR variability (−1.45 [−2.84, −0.073] pts/breath/min) but not RR, daily step count (−0.56 [−0.82, −0.31] pts/1000 steps), and sleep efficiency (−0.12 [−0.20, −0.037] pts/%asleep). In ‘recovered' participants (n = 10), significant associations included nighttime HR, movement intensity and nightly SpO 2 . In ‘persistent worsening' participants (n = 11), significant associations included HR variability, nightly RR variability, nightly SpO 2 , sleep efficiency, and skin temperature. Similar results were found in adjusted models. Interpretation This study provides a prospective continuous characterisation of exacerbations of COPD using remotely collected, ambulatory/free-living data. The physiological patterns presented may contribute to the understanding of exacerbations and may enhance the development of effective remote monitoring solutions. Funding University hospital (MUHC-CAS) grant.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".