Evaluation of a Home Monitoring Application for Follow Up after Lung Transplantation—A Pilot Study

Abstract

Home spirometry after lung transplantation is common practice, to monitor graft function. However, there is little experience with online home monitoring applications with direct data transfer to the hospital. We evaluated the feasibility and patient experiences with a new online home monitoring application, integrated with a Bluetooth-enabled spirometer and real-time data transfer. Consecutive lung transplant recipients were asked to evaluate this home monitoring application for three months in a pilot study. Home spirometry measurements were compared with in-hospital lung function tests (the forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC)) at the end of the study. Ten patients participated. The home and hospital spirometry measurements showed a high correlation, for both the FEV1 (r = 0.99, p < 0.01) and FVC (r = 0.99, p < 0.01). The adherence and patient satisfaction were high, and the patients preferred the home monitoring application over the current home spirometer, with a difference of 1.4 ± 1.5 points on a scale from 0 to 10 (p = 0.02). Online home monitoring with direct data transfer is feasible and reliable after lung transplantation and results in high patient satisfaction. Whether the implementation of online home monitoring enables the earlier detection of lung function decline and improves patient and graft outcomes will be the subject of future research.

Home-Based Spirometry in Patients with Interstitial Lung Diseases: A Real-Life Pilot “FACT” Study from Serbia

“…However, in other studies with a similar methodology, higher percentages of compliance with home spirometry were obtained, mostly above 90% [ 13 , 14 , 15 , 16 ]. In one pioneering study from 2017, adherence to home spirometry was observed to decrease over time [ 9 ], and the same was seen in several studies following lung transplant patients [ 5 ] or patients with Duchenne Muscular Dystrophy [ 30 ]. One of the potential reasons for this result, as well as for the slightly lower-than-expected compliance rate in our study, is that some patients forgot to perform the spirometry every day, with the majority of them being elderly and unfamiliar with the daily use of modern technology.…”

“…However, one of the basic questions that needed to be addressed at the start of the use of home spirometers was the reliability of the results obtained, in comparison to those obtained during office-based spirometry. In a large number of studies conducted thus far, it was determined that there are no statistically significant differences in the values of parameters measured during spirometry in office and home conditions [ 5 , 13 , 14 , 15 , 16 , 27 ]. According to the findings of our study, there were no statistically significant differences between FVC values at the beginning and end of the study for both office- and hospital-based spirometry, with a statistically significant positive correlation between them.…”

“…The proposed application of home-based spirometry (twice per week with an integrated alarm within the mobile application reminding them to perform spirometry and additional tests in case of respiratory symptoms) may increase patient motivation to utilize a home spirometer. In a study of lung transplant recipients, adherence to daily pulmonary function testing was 80%, while adherence to weekly measurement was 100% [ 5 ].…”

“…On the other hand, all patients that participated in our pilot study expressed positive experiences and high satisfaction regarding the home spirometry program. Positive experiences were recorded in the majority of other studies that addressed this issue, where different questionnaires were used to analyze patients’ satisfaction [ 5 , 13 , 14 , 15 , 16 , 27 ]. Although our patients had no significant problems during the study and did not find home spirometry burdensome, other studies have identified potential barriers to home-based spirometry [ 13 , 28 ], such as a lack of internet access, poor quality control of the spirometry, difficult manipulation ofthe handheld spirometer, a lack of motivation, home spirometry being burdensome for some patients, the occurrence of side effects after spirometry (cough, dyspnea), anxiety after seeing slightly worse results, increased frequency of depression and anxiety, poor compliance, etc.…”

“…Using telemedicine, patients were able to receive advice from their physician about the treatment of their disease, and the possibility of them being exposed to the virus during their stay in health institutions was also reduced. There are several examples of the use of information technology in respiratory medicine, such as portable pulse oximeters, physical activity trackers, and cough monitors; however, one of the most recent developments is the use of home-based spirometers in patients with chronic respiratory diseases [ 1 ] or after lung transplantation [ 5 ].…”