Background: Evidence is needed to determine the role of telehealth (TH) in COPD management. Methods: PROMETE II was a multicentre, randomized, 12-month trial. Severe COPD patients in stable condition were randomized to a specific monitoring protocol with TH or routine clinical practice (RCP). The primary objective was to reduce the number of COPD exacerbations leading to ER visits/hospital admissions between groups. Results: Overall, 237 COPD patients were screened, and 229 (96.6%) were randomized to TH (n = 115) or RCP (n = 114), with age of 71 ± 8 years and 80% were men. Overall, 169 completed the full follow-up period. There were no statistical differences at one year between groups in the proportion of participants who had a COPD exacerbation (60% in TH vs. 53.5% in RCP; p = 0.321). There was, however, a marked but non-significant trend towards a shorter duration of hospitalization and days in ICU in the TH group (18.9 ± 16.0 and 6.0 ± 4.6 days) compared to the RCP group (22.4 ± 19.5 and 13.3 ± 11.1 days). The number of all-cause deaths was comparable between groups (12 in TH vs. 13 in RCP) as was total resource utilization cost (7912€ in TH vs. 8918€ in RCP). Telehealth was evaluated highly positively by patients and doctors. Conclusions: Remote patient management did not reduce COPD-related ER visits or hospital admissions compared to RCP within 12 months.

Introduction Tobacco use remains a major public health concern. Cigarette smoking is the single most preventable cause of death worldwide and has been linked to countless illnesses, chief among them cancer, cardiovascular and respiratory diseases [1-6]. As many as 9% of all deaths are attributable to tobacco consumption, making smoking cessation the most cost-effective strategy for reducing morbidity and mortality [7-9]. According to the World Health Organization (WHO), global tobacco use kills nearly 6 million people annually, more than the human immunodeficiency virus (HIV), tuberculosis and malaria combined. Unfortunately, despite recent favorable trends in developed nations, more than 8 million people are expected to die every year by 2030 [10]. Tobacco smoking has spread globally, and is currently increasing in many low-and middle-income countries. It is slowly but steadily decreasing in several high-income countries [11]. Paradoxically, death rates due to smoking-related illness are lower in low than in middle and high-income countries because of the delayed effects of cigarette smoking on health outcomes. Mortality in low and middle-income countries, especially for women, will therefore continue to rise in the foreseeable future, even if efforts to reduce smoking are successful [11]. The reduction of tobacco smoking over the past half century in most industrialized nations has not been evenly distributed among all smokers. Specifically, young adults, disadvantaged individuals, and women have experienced proportionally smaller declines [12, 13]. Many factors influence smoking trends, including individual-level variables such as socioeconomic status and education, as well as system-level factors such as regional economic development and tobacco control policies [14, 15]. Sociodemographic vulnerabilities may provide important clues for improving policy initiatives for tobacco control and regulation [16]. Smoking Prevalence Around the World Worldwide, approximately 23% of adults, including more than 1 billion males and 250 million females, smoke tobacco products. This gender gap is narrowing as the number of female smokers has been increasing. Unfortunately, smoking prevalence tends to be highest among those with the lowest levels of education and income. Nearly 80% of the world's smokers live in low and middle-income countries [17, 18]. Current projections indicate that globally the number of smokers will increase to 1.6 billion over the next 25 years. As a consequence, the number of tobacco-related deaths will surpass the combined mortality from AIDS, tuberculosis, automobile accidents, maternal deaths, homicide and suicide [19]. Consumption of tobacco products is increasing worldwide but unevenly; although it is decreasing in some high and upper middle-income countries, it is markedly increasing in developing regions [20]. Such a pattern reflects the commercial strategy of tobacco companies; as smoking becomes less acceptable and profitable in the developed world, countries with fewer public health warnings...

Background: Obstructive sleep apnea (OSA) has been linked to tumorigenesis and tumor progression. Objectives: The Sleep Apnea in Lung Cancer (SAIL) study (NCT02764866) was designed to determine the prevalence of OSA in patients with lung cancer. Methods: Cross-sectional study including consecutive patients with newly diagnosed lung cancer. All patients were offered home sleep apnea testing (HSAT) and administered a sleep-specific questionnaire prior to initiating oncologic treatment. Sleep study-related variables, symptoms, and epidemiologic data as well as cancer related variables were recorded. Results: Eighty-three patients were enrolled in the SAIL study. Sixty-six completed HSAT. The mean age was 68 ± 11 years and 58% were male with a mean body mass index of 28.1 ± 5.4. Forty-seven percent were current smokers, 42% former smokers, and 11% never smokers with a median tobacco consumption of 51 pack-years. Fifty percent had COPD with a mean FEV1 of 83 ± 22.6% of predicted and a mean DLCO of 85.5 ± 20.1%. Adenocarcinoma was the most common histologic type (46.7%), followed by squamous cell (16.7%) and small cell (16.7%). Most patients were diagnosed at an advanced stage (65% in stages III–IV). The vast majority (80%) had OSA (apnea-hypopnea index [AHI] > 5), and 50% had moderate to severe OSA (AHI > 15) with a mean Epworth Sleepiness Score of 7.43 ± 3.85. Significant nocturnal hypoxemia was common (Median T90: 10.9% interquartile range 2.4–42.2). Conclusions: Sleep apnea and nocturnal hypoxemia are highly prevalent in patients with lung cancer.

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