Home Spirometry in Children with Cystic Fibrosis

Abstract

We report the implementation of a pediatric home spirometry program at our institution. A respiratory therapist provided either a virtual or an in-person initiation visit that included a coached spirometry session. Families were instructed to perform daily uncoached spirometry sessions for 5 days. The program’s quality assurance component was deemed not to be human research by the local IRB. In total, 52 subjects completed an initiation visit (34 with at least 3 additional uncoached spirometry sessions). The clinic spirometry and coached (same-day) sessions and uncoached (same-week) sessions were completed by 12 and 17 subjects, respectively. The median (99% CI) coefficients of variation for FEV1% of the uncoached maneuvers were 3.5% (2.9–5.9%). The median (IQR) FEV1% and FEV1 (mL) absolute differences between coached and uncoached home spirometry were −2% (−4 and +3%) and −25 mL (−93 and +93 mL), respectively. The median (IQR) absolute differences in FEV1% and FEV1 (mL) between coached or uncoached home spirometry and clinic spirometry were −6% (−10 and −2%) and −155 mL (−275 and −88 mL), and −4% (−10 and +5%), and −110 mL (−280 and +9 mL), respectively. Differences in absolute FEV1 (L) and FEV1% were found among different modalities of spirometry performed by people with cystic fibrosis. Understanding the variability of uncoached home spirometry and the differences among coached and uncoached home spirometry, hospital and coached home spirometry, and hospital and uncoached home spirometry for any given individual is crucial to effectively utilize this tool in clinical care.

How to Enhance the Diagnosis of Early Stages of Chronic Obstructive Pulmonary Disease (COPD)? The Role of Mobile Spirometry in COPD Screening and Diagnosis—A Systematic Review

“…The analyzed studies also do not include data on the time and quality of training of individuals performing spirometry, both for portable spirometers, as well as conventional ones, which could have influenced the results. According to the results of the Chinese metaanalysis [14], the effectiveness of portable spirometers in diagnosing airway obstruction, among other factors, depended on the proper technical execution of spirometry. As demonstrated in previous publications [54]; the percentage of correctly performed spirometry tests leading to the diagnosis of airway obstruction using a portable spirometer increased with the experience of the person conducting the test and the duration of training.…”

“…This systematic review included 28 articles, of which 11 concerned COPD targeted screening with the use of portable spirometers. To compare, in their metaanalysis, Zhou et al [14] identified 31 studies that systematically evaluated the diagnostic value of portable spirometers for detecting COPD. However, a different aim of this study was chosen and a different approach was applied, as in included articles, portable devices were used to determine airway obstruction, not necessarily a COPD diagnosis.…”

“…A portable spirometer should meet basic standards. Although it has been demonstrated that the FEV1/FEV6 can be regarded as a viable surrogate indicator for diagnosing COPD [14], a portable spirometer, according to its definition, must be able to measure at least FEV1, FVC, and FEV1/FVC. Portable spirometry also needs to be performed under strict quality control.…”

“…Nowadays, portable spirometers are used at patients' homes to assess the control of asthma [12]. Portable spirometry can also be performed and supervised remotely in cystic fibrosis patients to monitor disease progression [13,14]. Other examples of the use of small spirometers also include spirometry at home to assess the efficacy of pirfenidone in patients with lung interstitial diseases [15] or the early detection of pulmonary complications in an allogeneic hematopoietic cell transplant recipients [16].…”

Pilot Feasibility of Web-Based Implementation of Respiratory Therapist Supervised At-Home Telespirometry in Amyotrophic Lateral Sclerosis

“…The internet-based clinical dashboard and software mobile application [ZephyRx], under FDA Enforcement Discretion, was the implemented platform used for collecting respiratory data from the MIR Spirobank Smart spirometer [Ong 2021, Berlinski 2023].…”