Chest
Volume 116, Issue 1, July 1999, Pages 120-126
Journal home page for Chest

Clinical Investigations
Transplants
Staging of Bronchiolitis Obliterans Syndrome Using Home Spirometry

https://doi.org/10.1378/chest.116.1.120Get rights and content

Objectives

To compare the detection of bronchiolitis obliterans syndrome (BOS) in lung transplant recipients by clinic pulmonary function laboratory measurement and home spirometry.

Design

The subjects served as their own control group.

Setting

A university-based thoracic transplant center.

Subjects

Forty-five lung transplant recipients (26 women and 19 men; average ± SD age, 47.7 ± 11.4 years old at the time of transplantation). Lung function declined to at least BOS stage 1 in 17 of the 45 subjects.

Measurements

All subjects were participants in a home monitoring program utilizing home spirometry measurements. Clinic spirometry and home spirometry measurements were collected concurrently. The determinations of BOS staging were based on home and clinic FEV1 values using retrospective analysis and development of the home-based BOS staging algorithm.

Results

BOS stage 1 was detected an average of 341 to 276 days earlier with home spirometry than with clinic pulmonary function testing in the 17 subjects who had a pulmonary decline to BOS stage 1, depending on the persistence of the decline (1 day or 3 days, respectively). The difference in BOS detection time was statistically significant for both persistence requirements (p < 0.001).

Conclusions

Home spirometry detects pulmonary decline earlier than clinic spirometry; home spirometry can be a reliable and safe alternative to frequent pulmonary function testing in lung recipients.

Section snippets

Materials and Methods

At the time the BOS staging algorithm was developed, there were 45 subjects who were enrolled in the home monitoring program for at least 1 year and had submitted home monitoring data consistently for a minimum of 8 months. At the conclusion of the data collection period, the measurements provided by these subjects were used to develop the BOS staging algorithm based on home measurement of FEV1 and to compare its performance with measurements obtained in the clinic. There were 26 women and 19

Results

The 45 subjects began home monitoring from 19 to 174 days after transplant surgery, depending on their recovery progress. The average± SD time to the start of home monitoring was 59 ± 36 days. These subjects had an average ± SD of 26.5 ± 10.9 and 16.3 ± 9.2 clinic visits per year, respectively, for the 2 years after starting home spirometry. An average ± SD of 9.3 ± 3.7 and 4.1 ± 2.0 PFTs, respectively, were performed by these subjects during these clinic visits over the two years. Seventeen

Discussion

This study has demonstrated that regular home spirometry can detect the progression of BOS earlier than clinic-based spirometry. In a group of 45 lung transplant recipients following a home measurement protocol of daily spirometry for a minimum of 8 months, all 17 subjects with clinic-assessed BOS stage 1 were detected by home FEV1 an average of 341 days earlier than that afforded by clinic measurement. The progression to BOS stage 2 and stage 3 was also detected earlier using home measurement,

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Supported in part by NIH Grant R01 NR02128.

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