Monitoring respiratory function with telemedicine devices in asthmatic children

Pediatric asthma requires continuous monitoring, traditionally reliant on in-person assessments. Home-based telespirometry offers a promising approach, enabling regular lung function testing, early exacerbation detection, and improved disease management while reducing the burden of in-person visits. However, its effectiveness and accuracy compared to clinical measurements need further evaluation. This study aimed to assess the feasibility and reliability of home spirometry in children with moderate asthma and to compare home-based lung function measurements with those obtained under clinical supervision.

Eleven children (aged 8-17 years) with moderate asthma were trained to use a handheld spirometer and an associated mobile app. Participants performed home spirometry at least four times per week over a 12-month period, following ERS/ATS standards. Key respiratory parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), FEV₁/FVC ratio (Tiff), peak expiratory flow (PEF), and forced mid-expiratory flow (FEF_25-75), were recorded. Data was transmitted to a clinical cloud system for real-time monitoring. Measurement reliability was assessed based on ERS/ATS acceptability criteria, and statistical analyses included mixed ANOVA model, and Bland-Altman analysis with confidence intervals to compare home and clinical measurements.

Home spirometry demonstrated a high rate of reliable measurements, with no significant decline in reliability over time. A positive correlation was observed between the number of home spirometry recordings and the reliability of FEV₁ and FVC measurements. Comparisons between clinical and first home spirometry measurements showed strong correlations, particularly for FVC. Bland-Altman analyses confirmed good agreement between home and clinical assessments, with narrow limits of agreement for FVC, FEV₁, and Tiff, whereas PEF and FEF_25-75 showed greater variability. When expressed as percentage predicted values, similar trends were observed, with FVC% showing the strongest correlation.

The difference in peak flow indices measured at home and lung function labs in asthmatic children highlights the importance of patient education, and the reliabilities indicate the need for frequent assessments. The strong agreement with clinical measurements supports its potential integration into routine asthma care, enabling more accessible and continuous disease management.