Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study.
cystic fibrosis
remote monitoring
remote spirometry
unsupervised spirometry
Journal
Pediatric pulmonology
ISSN: 1099-0496
Titre abrégé: Pediatr Pulmonol
Pays: United States
ID NLM: 8510590
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
revised:
14
06
2023
received:
21
03
2023
accepted:
06
07
2023
medline:
28
9
2023
pubmed:
28
7
2023
entrez:
28
7
2023
Statut:
ppublish
Résumé
Handheld spirometry allows monitoring of lung function at home, of particular importance during the COVID-19 pandemic. Pediatric studies are unclear on whether values are interchangeable with traditional, clinic-based spirometry. We aimed to assess differences between contemporaneous, home (unsupervised) and clinic (supervised) spirometry and the variability of the former. The accuracy of the commercially available spirometer used in the study was also tested. Data from participants in the Clinical Monitoring and Biomarkers to stratify severity and predict outcomes in children with cystic fibrosisc (CLIMB-CF) Study aged ≥ 6 years who had paired (±1 day) clinic and home forced expiratory volume in 1 s (FEV Sixty-seven participants (median [interquartile range] age 10.7 [7.6-13.9] years) provided home and clinic FEV In children and adolescents, home spirometry using hand-held equipment cannot be used interchangeably with clinic spirometry. Home spirometry is moderately variable during clinical stability. New handheld devices underread, particularly at lower volumes of potential clinical significance for smaller patients; this suggests that supervision does not account fully for the discrepancy. Opportunities should be taken to obtain dual device measurements in clinic, so that trend data from home can be utilized more accurately.
Sections du résumé
BACKGROUND
Handheld spirometry allows monitoring of lung function at home, of particular importance during the COVID-19 pandemic. Pediatric studies are unclear on whether values are interchangeable with traditional, clinic-based spirometry. We aimed to assess differences between contemporaneous, home (unsupervised) and clinic (supervised) spirometry and the variability of the former. The accuracy of the commercially available spirometer used in the study was also tested.
METHODS
Data from participants in the Clinical Monitoring and Biomarkers to stratify severity and predict outcomes in children with cystic fibrosisc (CLIMB-CF) Study aged ≥ 6 years who had paired (±1 day) clinic and home forced expiratory volume in 1 s (FEV
RESULTS
Sixty-seven participants (median [interquartile range] age 10.7 [7.6-13.9] years) provided home and clinic FEV
CONCLUSION
In children and adolescents, home spirometry using hand-held equipment cannot be used interchangeably with clinic spirometry. Home spirometry is moderately variable during clinical stability. New handheld devices underread, particularly at lower volumes of potential clinical significance for smaller patients; this suggests that supervision does not account fully for the discrepancy. Opportunities should be taken to obtain dual device measurements in clinic, so that trend data from home can be utilized more accurately.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2871-2880Informations de copyright
© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.
Références
Davies JC. Monitoring respiratory disease severity in cystic fibrosis. Respir Care. 2009;54(5):606-617.
Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. an official American thoracic society and european respiratory society technical statement. Am J Respir Crit Care Med. 2019;200(8):e70-e88.
Konstan MW, Morgan WJ, Butler SM, et al. Risk factors for rate of decline in forced expiratory volume in one second in children and adolescents with cystic fibrosis. J Pediatr. 2007;151(2):134-139.
Kerem E, Reisman J, Corey M, Canny GJ, Levison H. Prediction of mortality in patients with cystic fibrosis. N Engl J Med. 1992;326(18):1187-1191.
Exarchos KP, Gogali A, Sioutkou A, Chronis C, Peristeri S, Kostikas K. Validation of the portable Bluetooth(R) air next spirometer in patients with different respiratory diseases. Respir Res. 2020;21(1):79.
Rebuck DA, Hanania NA, D'Urzo AD, Chapman KR. The accuracy of a handheld portable spirometer. Chest. 1996;109(1):152-157.
Cheng GS, Campbell AP, Xie H, et al. Correlation and agreement of handheld spirometry with laboratory spirometry in allogeneic hematopoietic cell transplant recipients. Biol Blood Marrow Transplant. 2016;22(5):925-931.
Barr RG, Stemple KJ, Mesia-Vela S, et al. Reproducibility and validity of a handheld spirometer. Respir Care. 2008;53(4):433-441.
Du Plessis E, Swart F, Maree D, et al. The utility of hand-held mobile spirometer technology in a resource-constrained setting. SAMJ. 2019;109(4):219-222.
Paynter A, Khan U, Heltshe SL, Goss CH, Lechtzin N, Hamblett NM. A comparison of clinic and home spirometry as longtudinal outcomes in cystic fibrosis. J Cystic Fibr. 2022;21(1):78-83.
Kruizinga MD, Essers E, Stuurman FE, et al. Technical validity and usability of a novel smartphone-connected spirometry device for pediatric patients with asthma and cystic fibrosis. Pediatr Pulmonol. 2020;55(9):2463-2470.
Avdimiretz N, Wilson D, Grasemann H. Comparison of a handheld turbine spirometer to conventional spirometry in children with cystic fibrosis. Pediatr Pulmonol. 2020;55(6):1394-1399.
Shakkottai A, Kaciroti N, Kasmikha L, Nasr SZ. Impact of home spirometry on medication adherence among adolescents with cystic fibrosis. Pediatr Pulmonol. 2018;53(4):431-436.
Gerzon FLGR, Jöbsis Q, Bannier MAGE, Winkens B, Dompeling E. Discrepancy between lung function measurements at home and in the hospital in children with asthma and CF. J Clin Med. 2020;9(6):1617.
Edmondson C, Course CW, Doull I. Cystic fibrosis transmembrane conductance regulator modulators for cystic fibrosis: a new dawn? Arch Dis Child. 2021;106(10):941-945.
Edmondson C, Westrupp N, Seddon P, et al. The feasibility of home monitoring of young people with cystic fibrosis: results from CLIMB-CF. Journal of Cystic Fibrosis. 2022;21(1):70-77.
Beydon N, Davis SD, Lombardi E, et al. An official American thoracic Society/European respiratory society statement: pulmonary function testing in preschool children. Am J Respir Crit Care Med. 2007;175(12):1304-1345.
Taylor-Robinson D, Whitehead M, Diderichsen F, et al. Understanding the natural progression in %FEV1 decline in patients with cystic fibrosis: a longitudinal study. Thorax. 2012;67(10):860-866.
Nickerson BG, Lemen RJ, Gerdes CB, Wegmann MJ, Robertson G. Within-subject variability and per cent change for significance of spirometry in normal subjects and in patients with cystic fibrosis. Am Rev Respir Dis. 1980;122(6):859-866.
Cooper PJ, Robertson CF, Hudson IL, Phelan PD. Variability of pulmonary function tests in cystic fibrosis. Pediatr Pulmonol. 1990;8(1):16-22.
Sanders DB, Rosenfeld M, Mayer-Hamblett N, Stamey D, Redding GJ. Reproducibility of spirometry during cystic fibrosis pulmonary exacerbations. Pediatr Pulmonol. 2008;43(11):1142-1146.
Fuchs HJ, Borowitz DS, Christiansen DH, et al. Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. N Engl J Med. 1994;331(10):637-642.
van Horck M, Winkens B, Wesseling G, et al. Early detection of pulmonary exacerbations in children with cystic fibrosis by electronic home monitoring of symptoms and lung function. Sci Rep. 2017;7(1):12350.
Robson KS, West AJ. Improving survival outcomes in lung transplant recipients through early detection of bronchiolitis obliterans: daily home spirometry versus standard pulmonary function testing. Can J Respir Ther. 2014;50(1):17-22.
Finkelstein SM, MacMahon K, Lindgren BR, et al. Development of a remote monitoring satisfaction survey and its use in a clinical trial with lung transplant recipients. J Telemed Telecare. 2012;18(1):42-46.
Fadaizadeh L, Najafizadeh K, Shajareh E, Shafaghi S, Hosseini M, Heydari G. Home spirometry: assessment of patient compliance and satisfaction and its impact on early diagnosis of pulmonary symptoms in post-lung transplantation patients. J Telemed Telecare. 2016;22(2):127-131.
Richardson CH, Orr NJ, Ollosson SL, Irving SJ, Balfour-Lynn IM, Carr SB. Initiating home spirometry for children during the COVID-19 pandemic-a practical guide. Paediatr Respir Rev. 2022;42:43-48.
Logie K, Welsh L, Ranganathan SC. Telehealth spirometry for children with cystic fibrosis. Arch Dis Child. 2020;105(12):1203-1205.
Fettes E, Riley M, Brotherston S, et al. You're on mute!” Does pediatric CF home spirometry require physiologist supervision? Pediatr Pulmonol. 2022;57(1):278-84.
Chavasse R, Johnson P, Francis J, Balfour-Lynn I, Rosenthal M, Bush A. To clip or not to clip? Noseclips for spirometry. Eur Respir J. 2003;21(5):876-878.