Adaptive Computerised COPD Exacerbation Self-management Support (ACCESS): a randomised controlled trial

The ACCESS trial, a multicenter randomized controlled study by Lonneke Boer and colleagues, evaluated the clinical effectiveness and safety of a digital self-management support system for patients with Chronic Obstructive Pulmonary Disease (COPD). This mHealth tool, designed to operate independently of healthcare professionals, provided personalized, automated treatment advice based on patient-reported symptoms and physiological data. Participants used the mobile application weekly—or daily during periods of symptom worsening—to record oxygen saturation, FEV₁, body temperature and symptoms. These inputs were processed by a Bayesian decision model that assessed the likelihood of exacerbations and advised patients on appropriate actions, including whether to seek medical attention. The trial followed 87 COPD patients recruited from both primary and secondary care centers over a 12-month period. Participants were randomized into two groups: 43 patients used the ACCESS tool, while the remaining 44 followed a conventional paper-based action plan. Data collection included 1,331 app entries from the intervention group, 4,207 weekly automated telephone assessments of symptoms and rescue medication use, and 492 healthcare visits across both groups. Additionally, standardized questionnaires—such as the Clinical COPD Questionnaire (CCQ), EQ-5D, Exacerbation Self-Efficacy Scale, and Nijmegen Clinical Screening Instrument (NCSI)—were administered at baseline and 12 months to evaluate health status, self-management behaviour, and patient-reported outcomes. CCQ and EQ-5D were also administered after 3, 6 and 9 months.