Assessing the utility of home spirometry for managing children with cystic fibrosis during COVID-19 pandemic

Abstract

Background: The coronavirus pandemic has accelerated the change to e-health services. Home spirometry has been rolled out to facilitate remote monitoring, but accurate measurements are essential.

Aims: This study compares the technology for home spirometry (using Nuvoair) with that used for standard spirometry in hospital (using EasyOne).

Methods: Spirometry data of 81 children with CF (Cystic Fibrosis) were collected prospectively over a period of 9 months. All patients had paired spirometer measurements taken on the same day and time in clinic, prior to Nuvoair spirometers being given out for home use. A survey was sent to all participants included in the study.

Results: Of 81 children, 54 provided interpretable measurements, 27 were excluded due to poor quality results. Mean age was 13.2 years (range 7.3 - 17.2). The mean difference between paired measurements in FEV1 (L) was 55 ml, 95% CI (29ml, 80 ml), FEV1% was 2.4%, 95% CI (1.5%, 3.4%) and FEV1 Z score was 0.22, 95% CI (0.14, 0.3). The Bland-Altman of FEV1 Z-score shows a degree of agreement between the methods with a bias of 0.22, limits of agreement (-0.3, 0.8). All the survey respondents (n=11) found home spirometer easy to use. 81% of the respondents preferred a combination of home and hospital testing.

Conclusions: The study shows comparable results between the two methods of spirometry with no significant statistical or clinical difference. Feedback from families was positive. Home spirometers (Nuvoair) provide acceptable results when used with professional supervision and can be used as a resource in managing children with CF. Separate evaluation is needed for unsupervised home spirometry.