The study participants were evaluated through telemedicine visits at specific intervals after the baseline visit, with the following schedule:

• 1st visit: At day 10 post-baseline
• 2nd visit: At the end of the 1st month
• 3rd visit: At the end of the 3rd month

These visits were conducted by the principal investigator using telemedicine. Additional telemedicine visits were arranged for patients in the telemedicine group as required.

The visits for the control group, due to being conducted face-to-face in the outpatient clinic, were carried out by the routine attending physician at the clinic, who was not aware of the study. As suggested in the discharge recommendations during the baseline visit (0th visit) for the control group, they were advised to return for a follow-up visit on the 10th day and to schedule these follow-up appointments through the hospital's system. No intervention was made to facilitate the scheduling of these appointments.

Video calls were made with the telemedicine group.

At the end of 3 months, inhaler adherence was compared. A 6-item Inhaler Adherence Scale (IAS) was used to evaluate inhaler treatment compliance. If the patient answered "yes" to even one of the items, they were deemed non-compliant.

The questions:

''During the last 3 months;

• have you at times been careless about using your inhaler or nebulizer?,
• have you ever forgotten to use your inhaler or nebulizer?
• have you ever stopped using your inhaler because you felt better?
• have you ever stopped using your inhaler or nebulizer because you felt worse?
• have you ever used your inhaler or nebulizer less than the doctor prescribed because you felt better?
• have you ever used your inhaler or nebulizer more than the doctor prescribed because you felt you were having an attack?''.

The aim of the investigator's study is to test whether telemedicine is a safe and effective method for the follow-up of patients with advanced-stage COPD after exacerbations, to see if there is a difference in treatment adherence after 3 months of observation compared to face-to-face healthcare services, and to evaluate if there is a difference in CAT scores.

The COPD Assessment Test (CAT) is a questionnaire for people with COPD. It is designed to measure the impact of COPD on a person's life, and how this changes over time.

Range of CAT scores from 0-40. Higher scores denote a more severe impact of COPD on a patient's life.