Implementing digital respiratory technologies for people with respiratory conditions: scoping review

Background: Digital health offers opportunities for safe, equitable, and accessible care, and its integration into respiratory care is a strategic priority for the European Respiratory Society. However, sustainable implementation remains complex, and guidance for health care systems is limited.

Objective: This study aimed to undertake a scoping review of the published initiatives that have implemented digital respiratory technologies into real-world routine clinical practice over the past decade, identify the technologies used, implementation strategies used, the challenges and supports they encountered, and the lessons they reported for making care more equitable, strengthening patient-professional relationships, improving the patient journey, and reducing environmental impact.

Methods: Following Arksey and O’Malley’s methodology, we searched ten databases (December 2013‐2023 [updated April 2025 and February 2026]): MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, Scopus, IEEE Xplore, CABI Global Health, and WHO Medicus; and used key domains in the commonly used implementation frameworks such as the Consolidated Framework for Implementation Research (CFIR), Nonadaptation, Abandonment, and Challenges to the Scale-up, Spread, and Sustainability of Health and Care Technologies (NASSS), and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to categorize results and understand methodologies used. As a scoping review, we mapped the available evidence, rather than synthesizing outcomes, appraising study quality, or estimating effectiveness. To broaden coverage and strengthen interpretation, we crowdsourced additional studies and sought feedback on our preliminary findings from a network of respiratory experts across 17 countries.

Results: Overall, 24,672 studies were identified; after deduplication, 14,811 were screened; 84 studies from 31 countries were included in the final review. The digital respiratory technologies comprised apps, platforms, chatbots, and smart devices. Reported technological functionalities encompassed remote consultation, clinician monitoring, video directly observed therapy, remote rehabilitation training, self-management support, education, monitoring medication adherence, and a school-based remote clinic. CFIR, RE-AIM, and the plan-do-study-act (PDSA) cycle were the most widely used frameworks. Successful implementation used simple technologies that fitted existing workflows and avoided additional workload. Co-development and trust-building with end-users influenced motivation and adoption, while leadership, team cohesion, and communication facilitated success. Barriers included insufficient resources, poor interoperability, lack of funding and reimbursement, and limited technical support.

Conclusions: This scoping review provides a cross-condition review of digital respiratory technologies implemented in routine clinical practice. Unlike previous disease-specific or experimental-focused reviews, our innovative approach used established implementation Theories, Models, and Frameworks (TMFs) to identify shared barriers and enablers across diverse populations and health care systems. We summarize key implementation domains in state-of-the-art digital respiratory care and identify major gaps related to health equity, patient–clinician trust, continuity of support, and environmental sustainability. These findings emphasize the value of using implementation TMFs for scaling effective, patient-centered digital respiratory care in real-world settings.

International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0314914