JMIR Publications

ABSTRACT

Background:

Chronic Obstructive Pulmonary Disease (COPD) is currently the 3rd leading cause of death globally, and exacerbations are responsible for hospitalizations, cost, and mortality. The Internet of Medical Things (IoMT) is an enabling technology that could revolutionize care from reactive hospital-based care to proactive home care for those with COPD by combining sensor networks, wearables, smart inhalers, and cloud computing. Given the dynamism of evidence, no systematic review has yet to capture the clinical, economic, patient, and implementation perspectives of IoMT interventions used in COPD home care in under-resourced areas such as the Gulf Cooperation Council (GCC) region and low- and middle-income countries (LMICs).

Objective:

To synthesize evidence from the last five years (2020–2025) to discuss clinical, economic, engagement, and adoption outcomes of home-based COPD IoMT, highlighting inequities in LMICs.

Methods:

PRISMA 2020 guidelines and a PICOTS-SD framework guided a systematic review. PubMed and the Imam Abdulrahman Bin Faisal University (IAU) E-Library (which includes Embase, CINAHL, and Scopus) were searched from 2020 to 2025. Studies included were peer-reviewed empirical studies that assessed IoMT or telemonitoring systems for the home management of COPD, including randomized controlled trials, observational and cohort studies, feasibility studies, economic studies, and qualitative studies. The methodological quality of the studies was assessed independently by two reviewers using the Mixed Methods Appraisal Tool (MMAT 2018). The results were thematically synthesized into five thematic areas.

Results:

655 records were identified for 28 empirical studies from 13 countries. A total of 13 (76%) of 17 clinical effectiveness studies reported significant benefits, including reduced hospitalizations and exacerbations and improved quality of life, while one large real-world study reported a survival benefit. Three economic analyses were presented: two showing cost savings and one showing increased costs, with survival benefits. Adoption was fairly high, while digital illiteracy and physical discomfort were prevalent, especially with older adults. Scepticism was not the main barrier to the uptake of healthcare providers; it was governance, infrastructural, and role ambiguity. In particular, the literature primarily focuses on high-income countries in the West, with limited information from the GCC, LMICs, and the Global South, where the burden of COPD is disproportionate and rising.

Conclusions:

IoMT has been shown to have clinically and economically valuable home-based COPD management benefits. Collaborative solutions are needed to address governance, infrastructure, workforce, and patient education issues to achieve success. There is a significant literature gap in the equity literature, and only scarce evidence from health systems in the GCC and LMICs. To fill this gap, it is essential that research and policy align with national digital health policies and strategies, such as Saudi Arabia's Vision 2030. Clinical Trial: A protocol has not been prospectively registered, but it is pre-designed and can be requested from the corresponding author. The project is recommended for registration in PROSPERO in the future.