IntroductionNeuromuscular diseases cause a number of limitations which may be improved by using a telemedicine system. These include functional impairment and dependence associated with muscle weakness, the insidious development of respiratory failure and episodes of exacerbation.Material and methodsThe present study involved three patients with severe neuromuscular disease, chronic respiratory failure and long-term mechanical ventilation, who were followed up using a telemedicine platform. The telemedicine system is based on videoconferencing and telemonitoring of cardiorespiratory variables (oxygen saturation, heart rate, blood pressure and electrocardiogram). Two different protocols were followed depending on whether the patient condition was stable or unstable.ResultsOver a period of 5 years, we analyzed a series of variables including use of the system, patient satisfaction and clinical impact. Overall we performed 290 videoconference sessions, 269 short monitoring oximetry measurements and 110 blood pressure measurements. With respect to the clinical impact, after enrolment in the telemedicine program, the total number of hospital admissions fell from 18 to 3.ConclusionsOur findings indicate that the system was user friendly for patients and care givers. Patient satisfaction scores were acceptable. The telemedicine system was effective for the home treatment of three patients with severe neuromuscular diseases and reduced the need for hospital admissions.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients present functional and structural changes of the respiratory system that have a profound influence on cardiac autonomic dysfunction. OBJETIVE: To analyse heart rate variability in COPD patients under stable condition and during acute exacerbation episodes (AECOPD). METHODS: Twenty three severe COPD male patients, 69.6 ± 7.3 years, in stable condition were followed up for two years. Home visits were carried out by a nurse every month, and home or hospital visits were arranged on demand. Every three months an ECG, oxygen saturation and spirometric recording was obtained for each patient. If the patient presented AECOPD compatible clinical data the same measurements were performed before any change of treatment. Spectral parameters of heart rate variability in time and frequency domains were obtained from ECG. The time evolution of power in low frequency (LF) and high frequency (HF) bands were obtained from the spectrogram. In addition, we calculated the LF/HF ratio and total heart rate variability power (POW). RESULTS: We analysed 154 patient-visit records during the follow up, pertaining to 23 patients and 8 controls; 19 of the patients had experienced at least one AECOPD. Stable COPD patients had higher HF values than control subjects. No significant differences were found in LF, LF/HF ratio or POW variables. AECOPD patients had higher LF, HF and POW than the stable COPD and control groups. CONCLUSION: AECOPD patients exhibited signs of increased autonomic activity compared with stable COPD.

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