Electronic home monitoring can help boost lung function in CF children
Home spirometry may also have beneficial effects on life quality, survival: study
Electronic home monitoring using a spirometry device may help improve lung function in children with cystic fibrosis (CF), according to a recent study.
Specifically, a standard measure of lung function called forced expiratory volume in one second (FEV1) was found significantly improved in children who used the device, compared with those on usual care.
Pulmonary exacerbations also tended to be detected earlier among the children, which may help with early treatment and better lung function outcomes.
“Home spirometries can also be effectively used in low resource settings and may have beneficial effects on lung function, quality of life and survival,” researchers wrote in the study “Electronic home monitoring of children with cystic fibrosis to detect and treat acute pulmonary exacerbations and its effect on 1-year FEV1,” which was published in the Journal of Cystic Fibrosis.
Home spirometry may help with early detection of worsening lung function
CF is caused by mutations in the CFTR gene, leading to the accumulation of thick and sticky mucus in several organs, particularly in the lungs. This is responsible for most CF symptoms, such as shortness of breath, persistent cough, and recurrent lung infections.
Episodes of worsening lung function, or exacerbations, are frequent among people with CF and may decrease health-related quality of life and survival.
Several studies have indicated that home-based spirometry, a test that measures how much air a person can exhale in one forced breath, may detect pulmonary exacerbations at an early stage when treatment outcomes are more favorable.
To know more, researchers in Turkey conducted a study of 60 children with CF, 6 to 18 years old, who were randomly assigned to home spirometry or usual care (30 children in each group). Both groups underwent outpatient visits every three months and received standard daily treatments.
In addition to routine therapy, the home spirometry group used a portable device twice a week, with a dedicated smartphone application. The device communicates with the phone via Bluetooth, and results are kept in the cloud. Adherence to the measurement was 73.3% (22 children).
Home spirometries can also be effectively used in low resource settings and may have beneficial effects on lung function, quality of life and survival.
Home spirometry measurements were used for follow-up, but were not used in lung function comparisons between groups. Both groups performed conventional spirometry in the clinical visits.
The median age was 13.1 in the home spirometry group and 14 in the other group. At the time of the study, no participant was on CFTR modulator therapy.
The primary goal of the study was to evaluate changes after one year in FEV1pp (percentage predicted), a measure of how much air is exhaled in one second.
Compared to baseline (start of the study), FEV1 increased by a median of 1% in children on home spirometry and decreased by 2.5% in those on usual care. Sensitivity analysis, including only the children adherent to home spirometry, demonstrated a FEV1pp increase of 5% in these children, a statistically significant difference relative to the usual care group.
The relative change in FEV1pp from baseline to one year improved by a median of 1.2% in the home spirometry group and worsened by 2.46% with usual care. Sensitivity analysis with children who adhered to home spirometry showed an increase of 5.56%, which was significantly different compared with children on usual care.
A total of 29 (96.7%) children on home spirometry and 23 (76.7%) children in normal care had pulmonary exacerbations during the study period, which were treated with oral antibiotics.
The median time from baseline to the first exacerbation was shorter for children in the home spirometry group than those in the usual care group (67 vs. 144 days), although this difference was not statistically significant. The median number of days between the end of the first exacerbation to the start of the second was 90 in both groups.
Significant improvement in lung clearance index seen in both groups
Results also showed a significant improvement in lung clearance index in both groups. The index is another test of lung function that measures how long it takes for a tracer gas to be cleared from the lungs.
All participants and parents of children younger than 14 answered the Cystic Fibrosis Questionnaire-Revised, a health-related quality of life questionnaire for people with CF, at baseline and one year.
The only statistically significant difference was an increase in the social domain of the questionnaire for children on home spirometry. In this group, 10 children (33.3%) and 15 parents (50%) answered that they wished to continue using the home spirometry device.
“This … study revealed that follow-up of children with CF with home spirometry has a positive effect on FEV1 and [pulmonary exacerbations] can be detected at an early stage,” the researchers wrote.
The small number of participants at a single center and the fact that the study could not be blinded (meaning that investigators and participants knew whether home spirometry or usual care were being used in each case) were pointed out by the researchers as limitations.
“Multicenter implementation of this process, including a wider variety of people with CF may confirm the efficacy of home spirometry monitoring on lung function,” they wrote.
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