From Episodic to Continuous Monitoring: The Future of Respiratory Care
October 20th, 2026
Respiratory care has traditionally relied on periodic clinical assessments to understand how a patient's condition changes. Although measurements such as spirometry, oxygen saturation and respiratory rate can provide valuable information, they often provide only a snapshot of respiratory health at a particular point in time.
For respiratory conditions that can fluctuate or deteriorate rapidly, what happens between these assessments can be just as important as what happens during them. Some symptoms and physiological changes can develop gradually or remain unnoticed until a patient becomes sufficiently unwell that they need to seek medical attention.
Recent advances in digital health and remote monitoring are creating an opportunity to change this model. By enabling more frequent measurements outside of traditional clinical settings, continuous monitoring could provide a more complete picture of a patient's respiratory health over time. This blog explores the limitations of episodic assessment, the shift towards continuous monitoring, and how this approach could support earlier and more proactive respiratory care.
The Limitations of Episodic Assessment
Episodic assessments can provide an important clinical reference point; however, their value can be limited. A single measurement may not reflect the variability that occurs in a patient's day-to-day respiratory health, during which symptoms and physiological measures fluctuate significantly. For example, research has found that the symptomatic burden of COPD appears greatest in the morning, particularly upon waking, which can substantially affect patients' ability to carry out daily activities and their quality of life [1]. This variation highlights how the timing of an assessment can influence the picture of respiratory health captured at a given point in time.
Additionally, episodic measurement can make subtle changes harder to identify and may provide limited insight into when deterioration started and how quickly a patient's condition is changing. It may also be difficult to distinguish temporary fluctuations from longer-term trends when measurements are collected only at isolated time points. For healthcare professionals, access to measurements collected over a longer period could therefore provide valuable context alongside traditional clinical assessments, helping to build a more complete picture of a patient's respiratory health.
The Benefits of Continuous Monitoring
Continuous monitoring can extend respiratory assessment beyond the clinical setting, allowing measurements to be collected as patients go about their daily lives. This can also reduce reliance on repeated face-to-face assessments, which is a particular problem for patients who find frequent appointments difficult. Evidence from studies examining home monitoring has found that these approaches can be acceptable to patients, although the effectiveness of such approaches can vary [2].
Continuous monitoring can also help support a more personalised approach to respiratory monitoring. Repeated measurements can help to better establish an individual's typical range and identify changes from their usual pattern, providing information that may be difficult to capture through occasional assessments alone. One longitudinal home-monitoring study involving 13 people with COPD over 4-6 months found substantial short-term within-person variation, with approximately ±210 mL variation for FEV₁ and ±350 mL for inspiratory capacity [3].
Importantly, continuous monitoring is not intended to replace established traditional clinical assessments. Instead, it can complement measures such as spirometry and clinical review by providing additional information. By combining established assessments with longitudinal data, healthcare professionals gain greater insight into how a patient's respiratory health is changing over time.
From Monitoring to Earlier, More Proactive Care
The potential value of continuous monitoring extends beyond measurement itself. By identifying changes earlier, longitudinal data could support healthcare professionals in recognising patients who may require further assessment or intervention before their condition deteriorates further.
Evidence is beginning to demonstrate the potential of this approach. A recent systematic review of 22 studies found that 14 (64%) demonstrated that day-to-day variation in symptoms (e.g. CAAT score), vital signs (e.g. heart rate, respiratory rate and peripheral oxygen saturation) and lung function (e.g. peak expiratory flow and forced oscillation techniques), either alone or in combination, showed promise in differentiating the onset of exacerbations [4]. The review also found that daily monitoring could provide indications of an impending exacerbation up to seven days before onset [4].
This could contribute to a shift from reactive to proactive respiratory care, where changes in a patient's health are identified and addressed earlier rather than waiting for symptoms to become severe enough to prompt a healthcare visit. Over time, this approach could support more timely interventions, better-informed clinical decisions and more personalised care.
A shift from episodic to continuous monitoring could provide a more complete and dynamic view of respiratory health, capturing changes that may be missed between clinical assessments. By combining longitudinal monitoring with established clinical assessments, healthcare professionals could be better placed to identify meaningful changes earlier and support a more proactive, personalised approach to respiratory care.
References
[1] Tsiligianni I, Kocks JWH. Daytime symptoms of chronic obstructive pulmonary disease: a systematic review. NPJ Prim Care Respir Med. 2020;30(1):6.
[2] Nagase FI, Stafinski T, Avdagovska M, et al. Effectiveness of remote home monitoring for patients with Chronic Obstructive Pulmonary Disease (COPD): systematic review. BMC Health Serv Res. 2022;22(1):646.
[3] Holmner Å, Öhberg F, Wiklund U, et al. How stable is lung function in patients with stable chronic obstructive pulmonary disease when monitored using a telehealth system? A longitudinal and home-based study. BMC Med Inform Decis Mak. 2020;20(1):87.
[4] Syam S, Aboelhassan A, Althobiani MA, et al. Differentiating the start of an exacerbation from day-to-day variation in people with COPD: a systematic review. European Respiratory Review. 2026;35(180):250212.