Remote FEV1 Monitoring in Asthma Patients: A Pilot Study

Abstract

Forced expiratory volume in one second (FEV 1) is a critical parameter for the assessment of lung function for both clinical care and research in patients with asthma. While asthma is defined by variable airflow obstruction, FEV 1 is typically assessed during clinic visits. Mobile spirometry (mSpirometry) allows more frequent measurements of FEV 1 , resulting in a more continuous assessment of lung function over time and its variability. Twelve patients with moderate asthma were recruited in a single-center study and were instructed to perform pulmonary function tests at home twice daily for 28 days and weekly in clinic. Daily and mean subject compliance was summarized. The agreement between clinic and mobile FEV 1 was assessed using correlation and Bland-Altman analyses. The test-retest reliability for clinic and mobile spirometry was assessed by inter-class correlation coefficient (ICC). Simulation was conducted to explore if mSpirometry could improve statistical power over clinic counterparts. The mean subject compliance with mSpirometry was 70% for twice-daily and 85% for at least once-daily. mSpirometry FEV 1 were highly correlated and agreed with clinic ones from the same morning (r=0.993) and the same afternoon (r=0.988) with smaller mean difference for the afternoon (0.0019L) than morning (0.0126L) measurements. The test-retest reliability of mobile (ICC=0.932) and clinic (ICC=0.942) spirometry were comparable. Our simulation analysis indicated greater power using dense mSpirometry than sparse clinic measurements. Overall, we have demonstrated good compliance for repeated at-home mSpirometry, high agreement and comparable test-retest reliability with clinic counterparts, greater statistical power, suggesting a potential for use in asthma clinical research.

Pulmonary Procedures During the COVID-19 Pandemic: A Work Group Report of the AAAAI Asthma Diagnosis and Treatment (ADT) Interest Section

“…In one pilot study specific to asthma, repeated measures with a home spirometry device agreed closely with measurements taken with standard in-clinic spirometry. 26 Home spirometry has also been demonstrated to be feasible and to provide valid data in idiopathic pulmonary fibrosis, 27 although another study found a poor correlation between home and office spirometry. 28 If home spirometry is instituted, results should be frequently correlated with office spirometry to assure reliability during exacerbations.…”

Closer to the patient means better decisions: wearable remote monitoring of patients with COVID‐19 lung disease

“…The practical aspects of clinical measurements are of paramount importance for selection and deployment for research and clinical decision-making. For example, DLCO is an informative parameter, but it requires sophisticated equipment and can be done only during clinic visits, while other PFT parameters, like FVC and FEV1, can be performed remotely by means of mobile spirometry which were demonstrated to be equivalent to clinic measures in a pilot study 10 . Recent guidance from the American Thoracic Society indicates that athome spirometry collection (FEV1 and FVC) can be a viable alternative to in-clinic spirometry tests, though caution remains about remote test accuracy as data continues to accumulate about its measurement properties, of which initial reports appear to be favorable.…”

“…These barriers include technological challenges: not all clinic assessments can be transitioned to a remote mode and a comprehensive monitoring package should include both clinic and at home measures (Figure 1). The abovementioned example of DLCO requires an in clinic assessment while other pulmonary function parameters, like FVC and FEV1, can be collected remotely 10 (Table 1). The biotech/pharmaceutical industry as well as the healthcare and regulatory communities need to get comfortable with this approach.…”

“…For example, DLCO is an informative parameter, but it requires sophisticated equipment and can be done only during clinic visits, whereas other pulmonary function test (PFT) parameters, like FVC and FEV1, can be performed remotely by means of mobile spirometry, which were demonstrated to be equivalent to clinic measures in a pilot study. 10 Recent guidance from the American Thoracic Society indicates that at-home spirometry collection (FEV1 and FVC) can be a viable alternative to in-clinic spirometry tests, although caution remains about remote test accuracy as data continues to accumulate about its measurement properties, of which initial reports appear to be favorable. 11 Consistent with the DLCO data, impaired arterial oxygenation, as measured by pulse oximetry, has been shown to be an important prognostic factor for worse outcomes during the acute phase of COVID-19 illness.…”

Biometric Monitoring Technologies in Cancer: The Past, Present, and Future

“…This is especially true in oncology, even more so than in some other therapeutic areas. [5][6][7] In this article, we describe the current state, potential barriers, and pathways forward for the use of BioMeTs in oncology.…”