Marousa Kouvela is a private practice Pulmonologist. She completed her Residency at “Evangelismos” Hospital which is one of the largest general hospitals in Greece and achieved her speciality Board Degree in 2013. She has completed her Master of Science Degree in Thoracic Oncology. She has participated in many national and international scientific and educational seminars and published in national and international journals. Her special scientific interests are COPD, lung cancer and interventional pulmonology. She has worked as a Medical Manager Respiratory in Boehringer Ingelheim Ellas, Greece. She currently works as a Clinical Fellow at the Oncology Department of the General Hospital of Chest Diseases “Sotiria”, University of Athens, Greece.

Inhalation is the preferred method for medication delivery in COPD and asthma. The choice of the respiratory tract as the drug delivery route over other routes (e.g. per OS or IV) offers not only better lung deposition of the medication but also less side effects. So, by using an inhaler device we can achieve optimal drug efficacy with lower medication doses and a more rapid onset of action. As COPD progresses, breathing becomes difficult as inspiratory capacity is reduced. This is even more perceptible during COPD

exacerbations, when patients need even more efficient and fast acting medications. Aiming at the COPD symptoms’ relief, all the available inhaler devices can achieve an optimal lung deposition, if they are used appropriately. The several inhaler devices that are available nowadays are divided in three main groups (metered dose inhalers, dry powder inhalers and soft mist inhalers), but even within groups there are many differences between the devices. These differences make each device unique for its use and properties.

The optimal use of the inhalers is based on the understanding and the correct demonstration of their use, but also on the fitting to the patient’s needs and preferences. The purpose of this presentation is the understanding of the mode of action of the available inhaler devices and the differences between them, the importance of the demonstration of their use to the patients and the matching of each inhaler to the specific needs of every patient.

Camilo Corbellini is a skilled Respiratory Physiotherapist at Casa di Cura Villa Serena Piossasco, Italy, with experience in the treatment and research of respiratory diseases in adult and elderly patients. He graduated in Brazil in 2002. Since 2010, he is studying and working in Italy. He has an MSc in Medical Sciences (Brazil) and in Respiratory Physiotherapy (Italy) and a PhD in Physiology from Milan University.

COPD causes airway obstruction that is not fully reversible and causes changes in the rib cage structure. These modifications lead to respiratory muscles functional inefficiency that is strongly correlated to lung function loss. Specifically, the diaphragm undergoes a progressive process of muscle fibers shortening, consequence of lung hyperinflation and dead space increase. This results in a chronic mechanical disadvantage that impairs the diaphragm’s mobility. This impairment may worsen in COPD exacerbations, improving after pulmonary rehabilitation. The diaphragmatic mobility (DM) is mostly assessed with techniques that expose the patient to risks. The ultrasonography in M-mode is easy to use, is safe and measures directly the diaphragmatic dome displacement. The study aimed to determine whether the COPD, according to the subjects’ COPD severity, impairs the DM and to verify DM improvements after an inpatient pulmonary rehabilitation. We performed lung function tests and diaphragmatic M-mode ultrasonography in COPD individuals and healthy subjects. Ultrasonography was performed during rest breathing and deep inspirations. The COPD subjects underwent six-minute walk test and arterial blood gas analysis. After initial screening, 46 COPD patients ended the rehabilitation. The mean characteristics in healthy individuals and COPD subjects: The DM during rest breathing and deep inspirations were correlated to FEV1 decrease (r=0.74; p<0.01 and r=-0.8; p<0.01, respectively). The correlation was also positive between the deep inspiration and the inspiratory capacity (r= 0.64 with p<0.001). After the rehabilitation, the DM increases during deep inspiration from 4.58cm ± 1.83cm to 5.45cm ± 1.56cm (p<0.01). It could be concluded that M-mode ultrasonography showed DM impairment is correlated to lung function loss in COPD subjects. The patients who completed the rehabilitation improved the diaphragmatic mobility verified during deep inspirations.

Lyubima Despotova-Toleva MD, PhD is a Medical Doctor with acknowledged specialties in Paedicatics, Family Medicine, Health Care Management and specialization in Paediatric Cardiology. She is a University Professor of Plovdiv Practice/Family Medicine, Scientific Advisor of PhD students, Chairperson of the Bulgarian Long-term and Palliative Care Society. Also, she is the Editor-in-Chief of Folia Palliatrica journal, Board Member of EMA, EGPRN and Lifetime Member of WONCA, IAHPC and WHPCA. She is the Author of more then 150 scientific publications, over 30 monographs, textbooks and manuals. She is the Leader, Coordinator and Senior Researcher in more than 20 international and national research and educational projects and programs (Fulbright, JSPS, mEducator, SmokeFreeBrain etc).

Helena Binetskaya is CEO and co-founder of a medical device startup Healthy Networks. LSE alumni and Quality assurance engineer in the past, she ventured into respiratory world after her baby daughter started coughing badly. Worried about pneumonia, she took her to a hospital - only to find out it was a nasal drip. Upon returning home, she discovered dozens of PubMed articles on Computer Lung Sound Analysis outperforming humans. Together with PhDs in Respiratory from Belarus LungPass, a very affordable device for early detection and monitoring of lung conditions was created.

Statement of the Problem: COPD exacerbations contribute significantly to the total COPD burden on the healthcare systems due to considerable morbidity and mortality associated with COPD. At the same time, it is now recognized that many exacerbations are delayed to be reported or are not reported at all to healthcare professionals. This results in significant impact on exacerbation outcomes, hospitalization, and health status. Early detection and prompt treatment of COPD exacerbation can reduce their impact on health status and health care utilization.

Methodology & Theoretical Orientation: LungPass—an innovative device that can be used for early detection and monitoring of lung conditions, including COPD exacerbations. It works on the basis of lung sound detection using a digital stethoscope with a subsequent evaluation of auscultation data and questionnaires (including symptoms, peak expiratory flow rate (PEFR), adherence to therapy, etc.) through a developed mobile application. The first step of our study after the algorithm development was evaluation of its accuracy in lung sounds detection compared with “gold standard” and individual practitioners. The second step will be assessment of the possibility of using the device for early detection COPD exacerbations and managing them in cooperation with healthcare providers.

Findings: 300 audio records from patients with bronchitis, pneumonia, asthma and COPD were classified by the developed diagnostic algorithm and the overall classification accuracy was 90.8% (for normal breathing sensitivity (Sn): 82%, specificity (Sp): 99%, for wheezes+rhonchi Sn: 93%, Sp: 99%, for coarse crackles+fine crackles Sn: 98%, Sp: 90%). To date, a study protocol for second step of our research has been developed.

Conclusion & Significance: The developed device and app demonstrated high lung sound classification accuracy and together with analyzing change of symptoms, daily activity, using of short-acting bronchodilators, PEFR, etc. may be used for monitoring and early detection of COPD exacerbations.

Liam Knox is a Research Officer in Hywel Dda University Health Board and currently a Health Psychology PhD candidate at Aberystwyth University, Wales. His research focuses on the use of technology enabled care services to promote health and self-management abilities in patients with chronic conditions. He supports multiple NHS research projects across a diverse range of conditions, being primarily responsible for study oversight, recruitment, and data collection. Recently, he has joined the team investigating the effectiveness of virtual pulmonary rehabilitation (VIPAR), providing both quantitative and qualitative research methods and data analysis support.

Statement of the Problem: For individuals with a chronic respiratory condition, pulmonary rehabilitation (PR) is very costeffective and hence should be an integral part of their care. National standards state that all eligible patients are offered PR but the UK COPD Audit Programme (2016) highlighted the wide variation in PR provision across Wales and only 31% of eligible patients in our region of 400,000 people received it. This was partly due to funding, recruitment of staff and also the rural environment where disabled people are expected to travel 30–100 miles, twice a week for seven weeks to attend a program.

Methodology & Theoretical Orientation: Investing into telemedicine and video conferencing helped us develop a hub and spoke model where a standard PR course of 10 patients (hub) was transmitted in real-time to a class of eight patients in a rural community hall (hub) using only two extra staff. Standard data was collected pre and post PR programmes. Patient focus groups were held to learn about patient experiences of pulmonary rehabilitation (PR), the video-conferencing (VC) and aspects they would like to see changed/improved.

Findings: Both groups were found to be similar at baseline at typical PR cohorts. Early evaluation (two courses–36 patients) suggests that this is safe, popular and of similar efficacy. Similar improvements were seen in the hub and spoke groups for incremental shuttle walk test, hospital anxiety and depression score and COPD assessment test. Focus groups highlighted that patients were extremely satisfied with the PR programme and the confidence and the abilities they have regained.

Conclusion & Significance: Pilot data show virtual PR is safe and feasible, allows care closer to home and is likely to be costeffective. Our experience so far in delivering PR via video-conferencing between one hub and one spoke site shows virtual PR delivery seems a viable option to improve local delivery of care and reduce waiting times at less cost than a second fully-staffed program.