Currently submitted to: JMIR mHealth and uHealth
Date Submitted: Jul 26, 2026
Open Peer Review Period: Jul 28, 2026 - Sep 22, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness of web-based digital interventions on acute exacerbations in elderly patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis
ABSTRACT
Background:
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the leading cause of hospitalization and mortality, imposing a disproportionate burden on elderly patients. While web-based digital interventions offer promising strategies for remote management, their specific efficacy in reducing exacerbation frequency and healthcare utilization in the geriatric population remains uncertain.
Objective:
Objective To evaluate the effectiveness of web-based digital interventions on acute exacerbations, hospitalizations, and safety outcomes in elderly patients with COPD.
Methods:
Methods We systematically searched PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science up to February 2nd, 2026 for randomized controlled trials (RCTs) evaluating web-based digital interventions in patients aged ≥60 years with COPD. Primary outcomes were the frequency of acute exacerbations and hospitalization rates. Data were pooled using random-effects models.
Results:
Results Seventeen RCTs involving 2,595 elderly participants were included. Meta-analysis revealed a time-dependent effect on acute exacerbation frequency: interventions significantly reduced exacerbations at 6 months (MD = 0.63, 95% CI [0.43, 0.83]; P < 0.00001) but not at 12 months (MD = 0.16, 95% CI [-0.09, 0.41]; P = 0.20), with no significant difference in the overall frequency (MD = 0.21, P = 0.26). Crucially, despite the transient effect on frequency, interventions significantly reduced the risk of any hospitalization (OR = 0.71, 95% CI [0.51, 0.99]; P = 0.05) and readmissions (OR = 0.76, 95% CI [0.61, 0.96]; P = 0.02), with benefits sustained at 12 months for readmissions. While all-cause hospitalization frequency at 6 months decreased significantly (MD = -0.34, P = 0.004), no significant differences were found in COPD-specific hospitalization rates, length of stay, emergency visits, or mortality (OR = 0.89, P = 0.55).
Conclusions:
Conclusion Web-based digital interventions for elderly COPD patients demonstrate a dissociation between total exacerbation frequency and hospitalization rates. While the reduction in overall exacerbation frequency may attenuate over time, these interventions significantly reduce the risk of hospitalization and readmission, suggesting they are particularly effective in preventing severe exacerbations. Future implementation should prioritize hybrid models combining web-based tools with proactive human support to sustain long-term benefits in this vulnerable population. Clinical Trial: The protocol for this study was registered in PROSPERO, the international prospective register for systematic reviews (CRD420261298413).
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