The Prospect of Digital Monitoring, Decentralized Trials in Respiratory Care

Digital health technologies are reshaping respiratory medicine, from home-based monitoring in chronic lung disease to decentralized clinical trials aimed at expanding access in low- and middle-income countries—a focus highlighted at the European Respiratory Society (ERS) Congress 2025.

global doctors and decentralized clincial trials | Image credit: metamorworks - stock.adobe.com

Rethinking Home Monitoring

Respiratory specialist Yet Hong Khor, MD, a physician at the Austin and Alfred Health Interstitial Lung Disease Services in Melbourne, Australia, discussed the growing availability of devices for at-home monitoring, such as peak flow meters, pulse oximeters, and smart sensors. While these technologies are promising, Khor stressed that they must be rigorously evaluated before being fully integrated into clinical practice.

To guide this process, he presented the Panacea framework, a structured model for assessing digital health tools across 5 domains:

• Test performance: Are the tools valid and reliable?
• Disease management: Do they meaningfully support assessment and monitoring?
• Cost: What financial or time burdens do they create for patients and clinicians?
• Experience: How do patients, clinicians, and researchers perceive safety, usability, and accessibility?
• Access: Do patients have the digital literacy and resources needed to use them effectively?

Khor emphasized that success in home monitoring depends not just on technical accuracy but also on how well tools fit into patients’ lives and the workflows of health care teams.

“It's not going to be for everyone digitally. There's always going to be some population of patients that is not suitable... I think it's going to be a hybrid model with digital health. Regardless of which area we're going in with this, there are some patients who are very capable...but there are still going to be some patients that are always going to need more in-person assessment, and this may not be a suitable device for them,” she explained.

Expanding Trials Through Digital Decentralization

Patricia Alupo, MBChB, MMED, turned the focus to the role of digital health in decentralized clinical trials (DCTs), particularly in low- and middle-income countries. Clinical trials, she noted, are critical for developing interventions and shaping regulatory policy, yet participation remains limited in many resource-constrained regions.

Alupo highlighted that decentralized approaches—such as digital data collection and remote participation—could broaden trial access, speed up recruitment, and diversify patient inclusion. However, challenges remain: inadequate infrastructure, inconsistent regulations, limited digital literacy, and unclear funding pathways.

Drawing from her experience at the Lung Institute in Uganda, she shared examples where digital tools had succeeded—and where they had failed. The key, she argued, is to adapt technologies to local realities, involve stakeholders early, and design with cultural and logistical contexts in mind. She noted the importance of remembering regulatory and cultural differences when implementing new technologies in these regions and not just “copy and pasting” processes from high-income nations.

She concluded, “We need concerted and unified efforts to be able to address the barriers that challenge the uptake of digital health technologies and decentralization of clinical trials, and we also need to develop, therefore, context-specific approaches and methods that may yield best results depending on the context and the populations.”

Practical Barriers and Next Steps

During the discussion, both experts agreed that while remote monitoring can extend care, in-person interactions are still essential. Khor noted that tools like spirometry and pulse oximetry still require stronger validation to ensure reliability. Alupo drew attention to gender and age disparities in digital access, stressing the importance of caregiver support, local language adaptation, and strategies to improve digital literacy among older adults and marginalized groups.

Audience members and moderators pointed to the need for standardized regulatory pathways for digital health—similar to the frameworks already established for clinical trials. Such structures, they argued, would help ensure consistency, quality, and safety across settings.

Looking Ahead

As ERS 2025 highlighted, digital health is no longer a futuristic concept—it is becoming central to respiratory medicine. The promise of these tools lies not only in their technical capabilities but also in their ability to reduce barriers, expand access, and improve patient engagement.

Moving forward, clinicians, researchers, and policymakers will need to:

• Engage patients directly to understand their concerns about remote tools
• Develop creative, culturally appropriate strategies to boost digital literacy
• Apply structured frameworks like Panacea to evaluate emerging technologies
• Push for regulations that balance innovation with patient safety.

The consensus among experts was clear: Digital health can transform respiratory care, but only if implementation is patient-centered, equitable, and grounded in local context.