Home monitoring for patients with ILD and the COVID-19 pandemic

Nakshbandi, Gizal; Moor, Catharina C.; Wijsenbeek, Marlies

doi:10.1016/s2213-2600(20)30452-5

Cited by 33 publications

(28 citation statements)

References 11 publications

(12 reference statements)

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“…Thus, it is essential to obtain severity markers, especially to predict and prevent the evolution to hospitalization in ICU and death. In this emergency scenario, a consensus has emerged in the literature on the need to institute home monitoring of these patients [ 3 – 5 ], enabling early identification of those who deteriorate acutely and require urgent assessment.…”

Section: Introductionmentioning

confidence: 99%

An emergency system for monitoring pulse oximetry, peak expiratory flow, and body temperature of patients with COVID-19 at home: Development and preliminary application

et al. 2021

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Background COVID-19 is characterized by a rapid change in the patient’s condition, with major changes occurring over a few days. We aimed to develop and evaluate an emergency system for monitoring patients with COVID-19, which may be useful in hospitals where more severe patients stay in their homes. Methodology/Principal findings The system consists of the home-based patient unit, which is set up around the patient and the hospital unit, which enables the medical staff to telemonitor the patient’s condition and help to send medical recommendations. The home unit allows the data transmission from the patient to the hospital, which is performed using a cell phone application. The hospital unit includes a virtual instrument developed in LabVIEW® environment that can provide a real-time monitoring of the oxygen saturation (SpO2), beats per minute (BPM), body temperature (BT), and peak expiratory flow (PEF). Abnormal events may be fast and automatically identified. After the design details are described, the system is validated by a 30-day home monitoring study in 12 controls and 12 patients with COVID-19 presenting asymptomatic to mild disease. Patients presented reduced SpO2 (p<0.0001) and increased BPM values (p<0.0001). Three patients (25%) presented PEF values between 50 and 80% of the predicted. Three of the 12 monitored patients presented events of desaturation (SpO2<92%). The experimental results were in close agreement with the involved pathophysiology, providing clear evidence that the proposed system can be a useful tool for the remote monitoring of patients with COVID-19. Conclusions An emergency system for home monitoring of patients with COVID-19 was developed in the current study. The proposed system allowed us to quickly respond to early abnormalities in these patients. This system may contribute to conserving hospital resources for those most in need while simultaneously enabling early recognition of patients under acute deterioration, requiring urgent assessment.

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Section: Introductionmentioning

confidence: 99%

An emergency system for monitoring pulse oximetry, peak expiratory flow, and body temperature of patients with COVID-19 at home: Development and preliminary application

et al. 2021

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“…Therefore, whilst home spirometry can be a useful tool, the technical and analytical issues experienced in this study highlight a clear need for further optimisation of the technology. It is important to determine the most accurate type of spirometer, improve the algorithms within spirometers to identify and discard implausible lung-function values and ensure proper calibration of home spirometers to prevent inaccurate measurements [ 19 , 20 ], and further explore how to analyse home spirometry data in clinical trials [ 21 ]. The availability of direct helpdesk support for patients in their local language may help to reduce any technical issues and increase compliance with home measurements in future studies [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, many clinical consultations have taken place via videoconferencing, and pulmonary function tests, which have a high risk of spreading infection, have been restricted [ 27 ]. Therefore, optimisation of smartphone technologies, home spirometry technologies and virtual platforms, like the one used in this study, is crucial to maintain or improve the level of care surrounding the diagnosis, monitoring and management of patients with ILD, particularly during the COVID-19 pandemic [ 21 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Disease Behaviour During the Peri-Diagnostic Period in Patients with Suspected Interstitial Lung Disease: The STARLINER Study

et al. 2021

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Introduction Disease behaviour may guide diagnosis and treatment decisions in patients with interstitial lung disease (ILD). STARLINER aimed to characterise disease behaviour in patients with suspected ILD during the peri-diagnostic period using real-time home-based assessments. Methods STARLINER (NCT03261037) was an international, multicentre study. Patients ≥ 50 years old with suspected ILD were followed throughout the peri-diagnostic period, consisting of a pre-diagnostic period (from enrolment to diagnosis) and a post-diagnostic period (from diagnosis to treatment initiation). Study length was variable (≤ 18 months). The primary endpoint was time-adjusted semi-annual forced vital capacity (FVC) change measured during the peri-diagnostic period using daily home spirometry in patients with idiopathic pulmonary fibrosis (IPF). Secondary outcomes included changes in FVC (home spirometry) in patients with non-IPF ILD, changes in FVC (site spirometry), changes in physical functional capacity measured by daily home accelerometry and site 6-min walk distance (6MWD), and changes in patient-reported outcomes (PROs) in IPF or non-IPF ILD. Results Of the 178 patients enrolled in the study, 68 patients were diagnosed with IPF, 62 patients were diagnosed with non-IPF ILD, 9 patients received a non-ILD diagnosis and 39 patients did not receive a diagnosis. Technical and analytical issues led to problems in applying the prespecified linear regression model to analyse the home FVC data. Time-adjusted median (quartile [Q]1, Q3) semi-annual FVC change during the peri-diagnostic period measured using home and site spirometry, respectively, was – 147.7 (– 723.8, 376.2) ml and – 149.0 (– 314.6, 163.9) ml for IPF and 19.1 (– 194.9, 519.0) ml and – 23.4 (– 117.9, 133.5) ml in non-IPF ILD. A greater decline in steps per day was observed for IPF versus non-IPF ILD, whereas an increase in 6MWD was observed for patients with IPF versus a decline in 6MWD for patients with non-IPF ILD. No clear patterns of disease behaviour were observed for IPF versus non-IPF ILD for PROs. Conclusions Despite home spirometry being feasible for most patients and centres, technical and analytical challenges in the home-based assessments prevented firm conclusions regarding disease behaviour. This highlights that further optimisation of the technology and analysis methods is required before widespread implementation. Trial Registration NCT03261037. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01790-y.

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“…Despite the obvious challenges, the COVID-19 pandemic has also accelerated digital ways of care and enhanced self-monitoring. This can stimulate patient empowerment, facilitate insights in disease course, and improve access to information and low-threshold communication with the hospital via online consultations [ 62 ].…”

Section: Introductionmentioning

confidence: 99%

Educational aspects of rare and orphan lung diseases

et al. 2021

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People with rare lung diseases often suffer the burden of delayed diagnosis, limited treatment options, and difficulties in finding expert physicians. One of the reasons for the delay in diagnosis is the limited training for healthcare practitioners on rare diseases. This review explores the main concerns and needs for education on rare lung diseases from the perspectives of both patients and professionals. Despite the increasing interest in rare lung disorders and some recent breakthrough developments on the management of several diseases, healthcare professionals, including general practitioners and hospital workers, receive little education on this topic. Nonetheless, many healthcare professionals show much interest in receiving further training, especially on diagnosis. Patients and families want easier access to high-quality education materials to help them manage their own disease. Well-educated patients are better equipped to deal with chronic diseases, but patient education can be challenging as patients’ individual health issues, and diverse backgrounds can create significant barriers. Raising more awareness for rare lung diseases and further development of patient-centred international expert networks like the European Reference Network on Rare Lung Diseases (ERN-LUNG), which includes both experts and patient representatives, are essential for improving care and education on rare lung diseases. Initiatives such as the Rare Disease Day, have been successful in increasing awareness for rare conditions. The development of online tools for accessing information has had positive effects and should be further supported and extended in the future.

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Home monitoring for patients with ILD and the COVID-19 pandemic

Cited by 33 publications

References 11 publications

An emergency system for monitoring pulse oximetry, peak expiratory flow, and body temperature of patients with COVID-19 at home: Development and preliminary application

An emergency system for monitoring pulse oximetry, peak expiratory flow, and body temperature of patients with COVID-19 at home: Development and preliminary application

Disease Behaviour During the Peri-Diagnostic Period in Patients with Suspected Interstitial Lung Disease: The STARLINER Study

Educational aspects of rare and orphan lung diseases

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