Telehealth, home spirometry help manage CF in children: Study
Replacing some in-person visits with virtual sessions just as effective
Combining telehealth with home spirometry to assess lung function, along with some in-person visits to the doctor’s office, was as effective as in-person visits only to manage cystic fibrosis (CF) in children, a Swedish study reported.
The findings suggest “that it may be safe to introduce telemedicine and home spirometry in combination with in‐person visits in a pediatric CF setting,” the researchers wrote.
The study, “Telemedicine and home spirometry in cystic fibrosis: A prospective multicenter study,” was published in Pediatric Pulmonology.
The use of telehealth — digital information and communication technologies designed to remotely manage health — increased during the COVID-19 pandemic. But it hasn’t been established whether combining telehealth with in-person visits and home spirometry, a standard way of assessing pulmonary function, is as effective as in-person visits alone. Spirometry involves measuring how much air someone can forcibly exhale in a breath or a set amount of time.
To learn more, researchers followed a group of 59 children with CF (median age 12) from all CF centers in Sweden from May 2020 to December 2021.
Home spirometry results more variable, but similar over time to hospital results
During the study period, patients replaced at least two in-person visits with telehealth visits. The mean number of in-person visits per patient was 3.1, and the mean number of telehealth visits was 2.2. Patients needed to travel a median of 226 kilometers (about 140 miles) to get to a CF center, and patients and caregivers had to take a median of one day off for in-person visits.
The researchers compared the outcomes of the CF children to those obtained prior to the pandemic, defined as Jan. 1, 2019, to Feb. 28, 2020.
Results showed no significant differences in lung function between the pre-pandemic period and the study period, as assessed by the mean annual change in the percentage of forced expiratory volume in one second (FEV1; a measure of how much air can be exhaled in one second after a deep inhaled breath). The same was observed for the lung clearance index, another measure of lung function, and the body mass index, a measure of body fat.
During the study period, patients had a 60% reduction in new infections by Haemophilus influenza bacteria. No differences were seen regarding other disease-causing microbes or the use of antibiotics.
The researchers compared at-home spirometry to spirometry performed at a hospital. Participants were instructed to conduct home spirometry and assess their respiratory symptoms three days before, or on the same day, as their scheduled physical or telehealth visit.
When analyzing a total of 415 at-home spirometry sessions, the team found that although more variable, the results using this approach were similar over time to the lung function scores obtained at the hospital. According to the researchers, the higher variability of at-home spirometry “could be mitigated through more frequent measurements over time.”
Patients’ adherence to at-home testing, set as the proportion of participants performing spirometry within three days of the visit, was low prior to visits but increased after a reminder (70% vs. 42%). Moreover, the use of a home spirometer did not increase anxiety.
The vast majority of patients (93%) and caregivers (96%) expressed a desire to continue with home spirometry and telemedicine.
Both groups reported several benefits of telemedicine and home spirometry. Sixty-three percent of patients cited being able to spend more time spent in school, 61% liked having more time for other activities, and 41% noted less time in hospitals. For caregivers, 92% reported reduced time off work or studies, and 65% mentioned the ability to share health data at any time, not just during visits. Half of caregivers said they benefited from the opportunity for both parents to join a virtual visit, and the possibility of knowing whether antibiotic treatment worked.
Overall, “our results underscore the profound impact of home spirometry and telemedicine on people with CF and their caregivers’ daily lives,” the researchers concluded.
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