"You're on mute!" Does pediatric CF home spirometry require physiologist supervision?

Emma Fettes1, Mollie Riley1, Stephanie Brotherston1

  • 1Lung Function Laboratory, Great Ormond Street Hospital for Children, HNS Foundation Trust, London, UK.

Pediatric Pulmonology
|September 28, 2021
PubMed

Insights

Remote supervision of home spirometry in children with cystic fibrosis significantly improves test quality. While supervised tests yielded higher quality scores, unsupervised monitoring can be acceptable with proper training and protocol adherence.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Digital Health

Background:

  • The COVID-19 pandemic accelerated the adoption of home spirometry for monitoring pediatric respiratory conditions.
  • Accurate spirometry is crucial for managing conditions like cystic fibrosis.
  • Ensuring the technical quality of home-based spirometry is essential for reliable data.

Purpose of the Study:

  • To evaluate if remote supervision by a physiologist enhances the technical quality of home spirometry in children.
  • To determine the impact of remote supervision on the failure rate of spirometry maneuvers in pediatric patients.

Main Methods:

  • Children with cystic fibrosis were randomized to supervised or unsupervised home spirometry using NuvoAir devices.
  • Spirometry was conducted every two weeks for 12 weeks.
  • Tests were graded using a quality factor (QF) system (A-D, Fail) based on American Thoracic Society/European Respiratory Society standards, with QF A as the primary outcome.

Main Results:

  • Significantly more supervised tests achieved QF A (89%) compared to unsupervised tests (74%; p < 0.001).
  • The proportion of tests achieving acceptable quality (QF A-C) was high in both groups (99% vs. 95%).
  • Observed spirometry declines were primarily clinical, not technical, and patient/family feedback was positive for both groups.

Conclusions:

  • Remote supervision by a physiologist is recommended for optimal home spirometry quality in children.
  • Acceptable spirometry results can be achieved without direct supervision if adequate training and monitoring protocols are in place.
  • Home spirometry is a feasible and well-received monitoring tool for pediatric respiratory conditions.
Abstract

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