Use of Home Spirometry for Steroid Tapering

Organising pneumonia (OP) is a late, non-infectious pulmonary complication that occurs following haematopoietic cell transplant (HCT) and may be associated with chronic graft-versus-host-disease (cGVHD). Treatment typically involves protracted courses of corticosteroids that are associated with dose-limiting adverse effects and pulmonary exacerbations upon corticosteroid tapering. Here, we describe the case of a 43-year-old male with OP associated with cGVHD who experienced difficulty tapering prednisone, complicated by frequent OP exacerbations. Weekly home spirometry was used to closely monitor trends in pulmonary function and help successfully guide the prednisone taper. Ultimately, prednisone dose was reduced by 80% while maintaining clinical and functional stability.