QUESTION: Does telehealth reduce the hospital admission rate and cost for people with chronic obstructive pulmonary disease (COPD)? DESIGN: Randomised controlled trial with concealed allocation. SETTING: The participants' homes in Aalborg, Denmark. Participants were linked with healthcare professionals at primary and secondary healthcare facilities using telehealth technology. PARTICIPANTS: Adults were included if they had severe or very severe COPD, lived in Aalborg, and were free from other diseases that limited function (eg, heart disease). Randomisation allocated 60 to the intervention group and 51 to the control group. INTERVENTIONS: Participants in the intervention group had a telehealth monitoring device installed in their home for four months and were taught how to monitor their symptoms, measure clinical data (eg, spirometry), use a step counter, and given instructions about home exercise. Healthcare professionals accessed the data to monitor their disease and provide advice. Once a month, the telehealth team met via video to co-ordinate and discuss each participant's rehabilitation program. Those in the control group were instructed regarding home exercises but had no planned contact with healthcare professionals. OUTCOME MEASURES: Hospital admission rate and cost of hospitalisation over a 10-month period. RESULTS: A total of 105 participants completed the study. Over the follow-up period, the admission rate per patient was lower in the intervention group compared with the control group (0.49 vs 1.17, p = 0.041). The cost of hospitalisations appeared to be lower in the intervention group. CONCLUSION: Telehealth strategies that promote rehabilitation and early detection of an acute exacerbation reduced hospital admission rates in people with severe and very severe COPD.