Further studies are required to consider:  The added value of the daily telephone call from the virtual nurse combined with remote home monitoring over a less intensive telephone support.  Identification of the predictive variables or combinations of variables that predispose, or relate to acute escalations in COPD patients.  The clinical and cost effectiveness of using 24-hour NICRAM monitoring on a larger scale.  Which other groups of patients are likely to make most clinical and cost-effective use of the service.