Unburdening healthcare systems through telenursing in chronic respiratory disease management: a systematic review

Background/objectives: Chronic respiratory diseases represent a major cause of morbidity/mortality and healthcare expenditure due to disease exacerbations, emergency department (ED) presentations, hospitalizations, and length of stay (LOS). This systematic review primarily aimed to evaluate the impact on the healthcare system of telenursing vs. traditional nursing care in the management of adults (≥18 years) with chronic respiratory diseases; secondarily, on treatment adherence, acceptability, and satisfaction. Methods: Electronic (PubMed, Scopus, Web of Science) and manual searches were performed until April 6, 2025, following PRISMA statement (PROSPERO CRD420251175395). Data were qualitatively synthesized; studies included were judged using dedicated tools. Results: 39 studies including 4,340 patients (2,731 telenursing vs. 1,609 comparison), 3,231 with COPD and 888 with asthma, were included. Telenursing reduced exacerbation rates per patient: means 1.2 in telenursing vs. 0.9 in the comparison group at six months and 2.1 vs. 5.8 at twelve months. ED presentations remained similar (1.2 at twelve months in both groups). Hospital admissions were lower with telenursing (0.65 vs. 0.8 at six months; 0.7 vs. 1.25 at twelve months). LOS showed minimal differences (5.2 vs. 5.7 days at six months; 9.1 vs. 9.2 days at twelve months). Conclusions: Telenursing potentially slightly unburdens healthcare systems, reducing exacerbation and hospitalization rates, but did not shorten LOS once patients required inpatient care. This lack of consistency across all outcomes may suggest that telenursing may have a prevention/early detection role for clinical exacerbations, but may have limited influence on the clinical course once hospitalization becomes necessary. Further studies with standardized assessment methods are needed to evaluate treatment adherence, acceptability, and satisfaction. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251175395, PROSPERO CRD420251175395.