At-home spirometry could benefit cystic fibrosis patients: Study
Residential approach found to be as reliable as in-hospital recordings
Home-based spirometry — a test to measure how well the lungs are working — provides results that are almost as reliable as those taken in a hospital, and such testing could help people with cystic fibrosis (CF) monitor their condition without as many visits to the doctor, a study found.
Measures of lung function “were relatively comparable between home and hospital,” researchers wrote in the study titled “Remote monitoring of cystic fibrosis lung disease in children and young adults,” which was published in the Journal of Cystic Fibrosis.
CF is caused by a faulty or absent CFTR protein that leads to abnormally thick mucus building up in the body’s organs. In the lungs, thick mucus can block the airways and make breathing difficult. It also can trap microbes such as bacteria, making infections more likely.
100 children in Sweden participated in at-home spirometry
With CFTR modulators, which target the cause of CF, patients can experience fewer exacerbations, or episodes of worsening symptoms, and may need antibiotics less often. As a result, visits to the doctor may not need to be as regular. Instead, care can become more flexible and tailored to what works best for each patient.
Earlier studies showed that at-home testing with spirometry, which measures how much air flows into and out of the lungs, can signal exacerbations in people with CF. Combined with telemedicine, it may help manage symptoms and further reduce the need for regular face-to-face visits to the doctor.
“In the era of highly effective modulator therapy, flexible and individualized CF care has become increasingly necessary,” the researchers wrote. This realization led them to test whether unsupervised, home-based spirometry could help manage CF more effectively.
The study included 110 children and young adults diagnosed with CF, median age 12, from seven centers across Sweden. Over a median of 12 months, patients attended a median of eight appointments with the doctor. In most patients (86%), their airways were “clinically stable.” They used spirometry a median of seven times at home and a median of five in the hospital.
In the era of highly effective modulator therapy, flexible and individualized CF care has become increasingly necessary.
Out of 779 usable records of at-home spirometry, 388 (50%) were of high quality. Of the 95 patients 5 or older, 80 (84%) had at least one high-quality recording. Reasons for recordings being unusable included sessions being halted early.
The mean forced expiratory volume in 1 second (FEV1), which measures the maximum amount of air that can be breathed out in 1 second, from at-home spirometry was similar to that taken in the hospital (89% vs. 88%). The decline in lung function over time was also similar, with a yearly reduction of 0.48% vs. 0.18%.
Patients used antibiotics for an average of 50 days per year, with oral antibiotics being the most common. Patients 13 or younger used both oral and inhaled antibiotics twice as often as older patients ages 14 to 25. Older patients were more likely to receive intravenous (into-the-vein) antibiotics.
Most caregivers (91%) and all patients 13 and older used the Genia mobile app to track the use of antibiotics. Both groups found the app easy to use, giving it a median score of 4 out of 5. “The app helps [them] effectively track the frequency and types of antibiotics used over time,” the researchers wrote.
The use of antibiotics was reported before half of all appointments. Reporting was higher for appointments in CF centers versus local outpatient clinics (56% vs. 18%). Adherence to at-home spirometry within three days before appointments was 55%, with better adherence at CF centers.
“Our study suggests that high-quality home spirometry results, when adjusted for clinical stability, may be used to monitor lung function,” the researchers concluded, adding that “electronically reported antibiotic usage data is essential for understanding lung function trends.”
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