RT Journal Article
SR Electronic
T1 Justification for statistical process control in daily home spirometry for COPD patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P820
VO 42
IS Suppl 57
A1 Worawan Sirichana
A1 Milan H. Patel
A1 Michael S. Taylor
A1 Chi-Hong Tseng
A1 Igor Barjaktarevic
A1 Eric C. Kleerup
A1 Christopher B. Cooper
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P820.abstract
AB IntroductionRemote monitoring (RM) for patients with chronic pulmonary disease is desirable but there is uncertainty about test feasibility, validity, cost and patient adherence. ATS/ERS recommendations for performing forced spirometry require 3 acceptable and repeatable tests. Whilst appropriate for one-time testing, these recommendations are not practicable for daily RM.Aims and ObjectivesOur aims were to use statistical process control and a new algorithm (SPC) for the interpretation of serial spirometry obtained from RM, to reduce the required number of daily manoeuvres and to reduce the burden on patients whilst not compromising test validity.MethodsThe CLEAR study at UCLA enrolls patients with moderate to severe COPD for 12 months of RM. Subjects perform daily slow and forced spirometry(SpiroPro). They also measure pulse oximetry and complete daily electronic questionnaires. Data are transferred by modem and secure internet protocol to UCLA servers.ResultsFrom 12 subjects in RM, aged 72.6 (7.3) years, mean(SD), FEV1 51.1 (16.0)%, we accumulated 1,063 days of spirometry using ATS/ERS criteria. Subjects performed 4.5 (0.5) manoeuvres/day (range 3-5) spending 14:11 (5:51) min/day with 71.6% adherence. Best FEV1 from first 2 manoeuvres, 0.940 (0.419) L, was clinically equivalent to that from 5 manoeuvres, 0.954 (0.424) L, (difference 14.2 ml; P<0.001). Using SPC for 205 days, (1-2 manoeuvres) measurement time decreased to 5:59 (1:47) min/day and adherence improved to 91.7%.ConclusionWe demonstrated the feasibility of using SPC for RM of COPD patients and reduced monitoring time to less than 6 min/day with >90% adherence. We also showed that 2 manoeuvres are sufficient for daily spirometry.