Chronic obstructive pulmonary disease drug titration and management

• US 9,814,424 B2
• Filed: 11/13/2014
• Issued: 11/14/2017
• Est. Priority Date: 12/06/2013
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Zhang, Yi, Thakur, Pramodsingh Hirasingh, Beck, Kenneth C., Clark, Bryan Allen
• Primary Examiner(s): Natnithithadha, Navin
• Application Number:
  US14/540,623
• Publication Number:
  US 20150157260A1
• Time in Patent Office: 1,097 Days
• Field of Search: 600481, 600483, 600508, 600509, 600513, 600529, 600537
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0245 by using sensing means generating electric signals, i.e. ECG signals
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/082 Evaluation by breath analysis, e.g. determination of the chemical composition of exhaled breath A61B5/083, A61B5/091 take precedence
• CPC Class Codes: A61B 5/091 Measuring volume of inspired or expired gases, e.g. to determine lung capacity
• CPC Class Codes: A61B 5/14542 for measuring blood gases A61B5/14551 takes precedence
• CPC Class Codes: A61B 5/14552 Details of sensors specially adapted therefor
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/4848 Monitoring or testing the effects of treatment, e.g. of medication
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61M 5/172 electrical or electronic A61M5/16804, A61M5/16831 take precedence
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/13 delivered from dispensers
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A system may include a port, at least one sensing circuit, and at least one processor. The port is configured to receive an indication of dosing of medication to treat a pulmonary condition of a heart failure (HF) subject and the at least one sensing circuit configured to sense at least one physiological signal, wherein the physiological signal includes physiological information of the HF subject. The at least one processor includes a parameter module configured to extract values of at least one physiological parameter indicative of health status of the HF subject, and a trending module configured to trend extracted values of the at least one physiological parameter and detect an effect of the dosing of the medication on the HF subject using the trending of the extracted values of the at least one physiological parameter.

Claims

1. A system comprising:

a port configured to receive an indication of dosing of medication to treat a pulmonary condition of a heart failure (HF) subject;

at least one sensing circuit configured to sense at least one physiological signal, wherein the physiological signal includes physiological information of the HF subject;

at least one processor including;

a parameter module configured to extract values of at least one physiological parameter indicative of health status of the HF subject; and

a trending module configured to trend extracted values of the at least one physiological parameter, to detect a side effect of the dosing of the medication on the HF subject when detecting that a value of the physiological parameter exceeds a specified threshold value of the at least one physiological parameter, and to output an indication of the detected side effect of dosing; and

an alert unit configured to notify the detected side effect of dosing to a user.

2. The system of claim 1, wherein the sensing circuit includes a respiration sensing circuit configured to sense a respiration signal that includes respiration information of the HF subject,

wherein the parameter module is configured to extract a value of a respiration parameter of the HF subject using the respiration signal, and

wherein the trending module is configured to trend values of the respiration parameter and generate an indication of effectiveness of the dosing of the medication on the HF subject using the trend of values of the respiration parameter.

3. The system of claim 1, wherein the at least one physiological signal includes at least one of a cardiac activity signal, a thoracic impedance signal, a heart sound signal, and a blood pressure signal, and

wherein the parameter module is configured to extract values of at least one of heart rate, heart contractility, arrhythmia burden, thoracic impedance, at least one heart sound parameter, and blood pressure from the at least one physiological signal, and

wherein the trending module is configured to trend values of at least one of heart rate, heart contractility, arrhythmia burden, thoracic impedance, at least one heart sound parameter, and blood pressure, and detect a side effect of the dosing of the medication on the HF subject using the trending.

4. The system of claim 1, wherein the at least one physiological signal includes thoracic impedance information of the HF subject, wherein the parameter module configured to extract values of thoracic impedance from the physiological signal, and wherein the trending module is configured to trend values of thoracic impedance and generate an indication of effectiveness of the dosing of the medication on the HF subject using the trend of the measure of thoracic impedance.

5. The system of claim 1, wherein the trending module is configured to detect a side effect of the dosing of the medication on the HF subject when detecting that a value of the integral of values of the physiological parameter exceeds a specified threshold integral value of the at least one physiological parameter.

6. The system of claim 1, wherein the system includes a first ambulatory medical device and a second medical device, wherein the ambulatory medical device includes a first processor that includes the parameter module and a communication circuit configured to communicate information with the second device, wherein the second device includes a second processor that includes the trending module and a communication circuit configured to communicate information with the ambulatory device.

7. The system of claim 6, including a third medical device that includes a spirometer and a communication circuit configured to communicate information with the second device, wherein the third medical device is configured to communicate a measurement of one or more of lung capacity and forced expiratory volume (FEV1) to the second device, and wherein the trending module is configured to trend values of the at least one physiological parameter and values of the measurement by the spirometer and detect the side effect of the dosing of the medication on the HF subject using the trending.

8. The system of claim 6, including a third medical device that includes an exhaled gas sensing circuit and a communication circuit configured to communicate information with the second device, wherein the third medical device is configured to communicate a measurement of a breath gas inflammatory indicator to the second device, and wherein the trending module is configured to trend values of the at least one physiological parameter and values of the measurement by the exhaled gas sensing and detect the side effect of the dosing of the medication on the HF subject using the trending.

9. The system of claim 1, wherein the system includes a first implantable medical device and a second ambulatory medical device, wherein the implantable device includes the sensing circuit and a communication circuit configured to communicate information with the ambulatory device, and wherein the ambulatory medical device includes the processor having the parameter module and the trending module and includes a communication circuit configured to communicate information with the implantable medical device.

10. The system of claim 1, including a therapy circuit configured to control delivery of drug therapy to the HF subject, and wherein the at least one processor is configured to initiate at least one of delivery of drug therapy or a change in a parameter of the drug therapy in response to detection of the effect of the dosing of the medication on the HF subject.

11. The system of claim 1, including a therapy circuit configured to provide electrical cardiac therapy to the HF subject, wherein the at least one processor is configured to initiate at least one of the electrical cardiac therapy or a change in a parameter of the electrical cardiac therapy in response to detection of the effect of the dosing of the medication on the HF subject.

12. The system of claim 1, wherein the sensing circuit includes at least one of an impedance sensing circuit, a blood gas sensing circuit or breath gas sensing circuit, and the physiological signal includes information of at least one of thoracic impedance or blood oxygen saturation level, wherein the parameter module is configured to extract a value of at least one of thoracic impedance or blood oxygen level, and wherein the trending module is configured to trend values of at least one of thoracic impedance or blood oxygen level and generate an indication of effectiveness of the dosing of the medication on the HF subject using the trend of values.

13. A method of operating a medical device, the method comprising:

receiving, into the medical device, an indication of dosing of medication to treat a pulmonary condition of a heart failure (HF) subject;

sensing at least one physiological parameter indicative of health status of the HF subject using the medical device and trending values of the at least one physiological parameter; and

detecting, using a processor, a side effect of the dosing of the medication on the HF subject when a value of the physiological parameter exceeds a specified threshold value of the at least one physiological parameter; and

providing an indication, using an alert unit, of the effect to a user.

14. The method of claim 13, wherein detecting an effect of the dosing of the medication on the HF subject includes at least one of detecting a side effect of the dosing or detecting effectiveness of the dosing.

15. The method of claim 13,

wherein sensing the at least one physiological parameter includes sensing a respiration parameter of the HF subject, and

wherein the method includes trending values of the respiration parameter and generating an indication of effectiveness of the dosing of the medication on the HF subject using the trend of the respiration parameter.

16. The method of claim 15, wherein sensing at least one physiological parameter includes sensing at least one of heart rate of the HF subject, heart contractility of the HF subject, arrhythmia burden of the HF subject, thoracic impedance of the HF subject, amplitude of at least one heart sound of the HF subject, and blood pressure of the HF subject, and

wherein trending values of the at least one physiological parameter includes trending at least one of heart rate, heart contractility, arrhythmia burden, intra-thoracic impedance, heart sound amplitude, or blood pressure, and detecting a side effect of the dosing using the trending.

17. The method of claim 13, wherein the at least one physiological parameter includes a measure of thoracic impedance, and wherein the method further includes generating an indication of effectiveness of the dosing of the medication on the HF subject using the trend of the measure of thoracic impedance.

18. A system comprising:

a port configured to receive an indication of dosing of medication to treat a pulmonary condition of a heart failure (HF) subject;

at least one sensing circuit configured to sense at least one physiological signal wherein the physiological signal includes physiological information of the HF subject;

at least one processor including;

a parameter module configured to extract values of at least one physiological parameter indicative of health status of the HF subject; and

a trending module configured to trend extracted values of the at least one physiological parameter, to detect a side effect of the dosing of the medication on the HF subject when detecting that a change in value of the physiological parameter exceeds a specified threshold change value of the at least one physiological parameter within a specified time duration, and to output an indication of the detected side effect of dosing; and

a therapy circuit to control therapy to the HF subject based on the indication of the detected side effect of dosing.