Home monitoring of physiology and symptoms to detect interstitial lung disease exacerbations and progression: a systematic review

Abstract

BackgroundAcute exacerbations and disease progression in interstitial lung disease (AE-ILD) pose important challenges to clinicians and patients. AE-ILD are variable in presentation but may result in rapid progression of ILD, respiratory failure and death. However, in many cases AE-ILD may go unrecognised so that their true impact and response to therapy is unknown. The potential for home monitoring to facilitate early, and accurate, identification of AE and/or ILD progression has gained interest. With increasing evidence available, there is a need for a systematic review on home monitoring of patients with ILD to summarise the existing data.AimTo systematically evaluate the evidence for use of home monitoring for early detection of exacerbations and/or progression of ILD.MethodWe searched Ovid-EMBASE, MEDLINE, and CINAHL using MeSH terms in accordance with the PRISMA guidelines. PROSPERO registration number (CRD42020215166).ResultsThirteen studies comprising 968 patients have demonstrated that home monitoring is feasible and of potential benefit in patients with ILD. Nine studies reported that mean adherence to home monitoring was greater than 75%, and where spirometry was performed there was a significant correlation (r=0.72–0.98, p<0.001) between home and hospital-based readings. Two studies suggested that home monitoring of Forced Vital Capacity (FVC) might facilitate detection of progression in idiopathic pulmonary fibrosis (IPF).ConclusionDespite the fact that individual studies in this systematic review provide supportive evidence suggesting the feasibility and utility of home monitoring in ILD, further studies are necessary to quantify the potential of home monitoring to detect disease progression and/or acute exacerbations.

Present and future perspectives in early diagnosis and monitoring for progressive fibrosing interstitial lung diseases

“…A systematic review has shown that patient adherence to home spirometry was satisfactory (> 75%) and values measured at home correlated significantly with those measured in-hospital ( 26 ) Interestingly, the variability in home-measured FVC values may actually be an independent predictor for fibrotic ILD progression ( 27 ) Increasing adherence can be achieved by setting up automated email reminders when a measurement is not performed when expected ( 28 ), providing comprehensive initial and refresher training to patients, or using a spirometry schedule which is more acceptable (rather than daily measurements) ( 29 ). The optimal timing and frequency of testing to account for diurnal variation has not yet been established ( 30 ).…”

“…Home spirometry allows for trends in lung function decline to be generated, which is of great importance in monitoring and increasing diagnostic accuracy for PF-ILD. Additionally, as many patients could not be seen often enough during the pandemic, a role emerged for home spirometry to aid with early diagnosis of acute exacerbations of ILD ( 26 ).…”

Home monitoring to detect progression of interstitial lung disease: A prospective cohort study

“…3 Evidence for home-monitoring in managing ILD has increased in recent years, with home-spirometry gaining attention. 4,5 Despite technical issues, 5 studies have demonstrated that home-spirometry can predict outcomes by monitoring the rate of decline in FVC, and its measures correlate with hospital-spirometry. 2,4,6 A significant gap remains in the current literature; specifically, there is scant evidence supporting the benefit of continuous monitoring of both physiological parameters and symptoms in detecting progression or response to treatment.…”

“…These findings agree with previously published studies, which indicated that cardiovascular parameters, including HR, can reflect changes in physiological conditions. 4 A future area of interest will be to explore the relationship of physiological, imaging and serum biomarkers with home spirometry to ensure early and accurate stratification of patients and prediction of outcomes. When assessing fatigue, the progressed group showed an increased mean FSS.…”

“…4,5 Despite technical issues, 5 studies have demonstrated that home-spirometry can predict outcomes by monitoring the rate of decline in FVC, and its measures correlate with hospital-spirometry. 2,4,6 A significant gap remains in the current literature; specifically, there is scant evidence supporting the benefit of continuous monitoring of both physiological parameters and symptoms in detecting progression or response to treatment. 2,3,6 The potential of this approach to augment or replace in-hospital spirometry offers an interesting possibility.…”