Safety and Feasibility of an Asynchronous AI-Integrated Tele-Pulmonary Rehabilitation Application Among Patients with COPD

Purpose: Pulmonary rehabilitation (PR) is an effective intervention for patients with chronic obstructive pulmonary disease (COPD), yet its utilization remains very limited. Tele-pulmonary rehabilitation (TPR) may improve access, but the safety and feasibility of asynchronous, app-based programs remain insufficiently studied, especially for patients with severe disease. Patients and methods: This is a retrospective study of patients with COPD who participated in an asynchronous AI-supported TPR program using the ActiveLungs© mobile application between 2022 and 2025. Patients were included if they had spirometry-validated COPD and completed ≥ 10 training sessions in the application. Safety, feasibility, and adherence with the app trainings were evaluated. Results: A total of 124 patients were included (median age 74 years, 54% female, median FEV1 50%predicted), of whom 55% used long-term oxygen therapy. During the study period, 17,399 trainings and 61,706 exercise sessions were completed. No serious adverse events were reported. Self-reported respiratory worsening occurred in 23% of patients and was associated only with chronic oxygen use (HR 2.68, 95% CI 1.08– 6.65, p=0.033). Median (IQR) program use was 129 days (65– 433), with trainings performed in 49% (31– 64) of the days, and 79% completing more than 24 trainings. All four exercise sessions (2 aerobic and 2 resistance) were completed in 82% of the trainings. Conclusion: An asynchronous, AI-integrated TPR mobile application demonstrated a favorable safety profile and good patient engagement, even in patients with severe COPD. Prospective studies are warranted to evaluate its effectiveness on clinical outcomes.