This report is a summary of a workshop focusing on using telemedicine to facilitate the integrated care of chronic obstructive pulmonary disease (COPD). Twenty-five invited participants from 8 countries met for one and one-half days in Stresa, Italy on 7-8 September 2017, to discuss this topic. Participants included physiotherapists, nurses, a nurse practitioner, and physicians. While evidence-based data are always at the center of sound inference and recommendations, at this point in time the science behind telemedicine in COPD remains under-developed; therefore, this document reflects expert opinion and consensus. While telemedicine has great potential to expand and improve the care of our COPD patients, its application is still in its infancy. While studies have demonstrated its effectiveness in some patient-centered outcomes, the results are by no means consistently positive. Whereas this tool may potentially reduce health care costs by moving some medical interventions from centralized locations in to patient's home, its cost-effectiveness has had mixed results and telemonitoring has yet to prove its worth in the COPD population. These discordant results should not be unexpected in view of patient complexity and the heterogeneity of telemedicine. This is reflected in the very limited support offered by the National Health Services to a wider application of telemedicine in the integrated care of COPD patients. However, this situation should challenge us to develop the necessary science to clarify the role of telemedicine in the medical management of our patients, providing a better and definitive scientific basis to this approach.

Despite remarkable advances in medicine and technology, the management of the patient with COPD is often inefficient and fragmented. Optimizing care for these individuals requires that a proactive, patient-centered, defragmented and integrated plan of care. Integrated care, which draws heavily from the chronic care model, incorporating holistic, self-management and care coordination principles to meet the needs of the complex COPD patient, is a desirable approach to improving medical management. The relationship of integrated care to other, similar conceptual models, including self-management, disease management, care coordination, and patient centered medical home is discussed.

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In hospitalized COPD patients, risk stratification for subsequent readmission or mortality might prove useful in focusing resources. In a recent pilot study we had found that 3 variables-dyspnea score, COPD exacerbations in the preceeding year and chronic prednisone use predicted risk of 30-month readmission.The objectives of this study were to identify if a score using these three varaibles would predict 180-day all-cause hospital readmissions in COPD patients. METHODS:We evaluated the utility of the MEP in predicting hospital readmission or mortality (grouped as "events") out to 180 days in 50 patients admitted with COPD exacerbations. The MEP is composite score based on three variables: Medical Research Council (MRC) dyspnea score (MRC 0-3, score = 0, MRC 4, score =1); hospitalized Exacerbations in the preceding year (1 or more, score = 1); and chronic Prednisone use at the initial hospitalization (yes, score = 1). MEP scores, therefore, can range for 0-3.A ROC model was used to predict the likelihood of readmission by means of a 3-point scoring systems, incorporating these three variables. RESULTS:Mean age was 69 AE 12 years, FEV1 47 AE 19%, and MRC 2.7 AE 1.1; 60% had been hospitalized for an exacerbation in the preceding year and 26% were taking prednisone at the time of the index hospitalization. MEP score distribution at the index hospitalization was: 0 (32%), 1 (32%), 2 (28%), 3 (8%). Five patients died; the remainder of events was hospitalizations. Event rates by MEP score were as follows 30 day events-