Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study

Claire Edmondson; Nicole Westrupp; Christopher Short; Paul Seddon; Catherine Olden; Colin Wallis; Malcolm Brodlie; Francis Baxter; Jonathan McCormick; Susan MacFarlane; Richard Brooker; Margaret Connon; Salim Ghayyda; Lesley Blaikie; Rebecca Thursfield; Lynsey Brown; April Price; Erin Fleischer; Daniel Hughes; Christine Donnelly; Mark Rosenthal; John Wallenburg; Keith Brownlee; Eric W. F. W. Alton; Andrew Bush; Jane C. Davies

doi:10.1002/ppul.26602

Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study

Claire Edmondson (Lead / Corresponding author), Nicole Westrupp, Christopher Short, Paul Seddon, Catherine Olden, Colin Wallis, Malcolm Brodlie, Francis Baxter, Jonathan McCormick, Susan MacFarlane, Richard Brooker, Margaret Connon, Salim Ghayyda, Lesley Blaikie, Rebecca Thursfield, Lynsey Brown, April Price, Erin Fleischer, Daniel Hughes, Christine DonnellyMark Rosenthal, John Wallenburg, Keith Brownlee, Eric W. F. W. Alton, Andrew Bush, Jane C. Davies

Undergraduate Medicine

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Abstract

Background: Handheld spirometry allows monitoring of lung function at home, of particular importance during the COVID-19 pandemic. Pediatric studies are unclear on whether values are interchangeable with traditional, clinic-based spirometry. We aimed to assess differences between contemporaneous, home (unsupervised) and clinic (supervised) spirometry and the variability of the former. The accuracy of the commercially available spirometer used in the study was also tested.

Methods: Data from participants in the Clinical Monitoring and Biomarkers to stratify severity and predict outcomes in children with cystic fibrosisc (CLIMB-CF) Study aged ≥ 6 years who had paired (±1 day) clinic and home forced expiratory volume in 1 s (FEV1 ) readings were analyzed. Variability during clinical stability over 6-months was assessed. Four devices from Vitalograph were tested using 1 and 3 L calibration syringes.

Results: Sixty-seven participants (median [interquartile range] age 10.7 [7.6-13.9] years) provided home and clinic FEV1 data pairs. The mean (SD) FEV1 % bias was 6.5% [±8.2%]) with wide limits of agreement (-9.6% to +22.7%); 76.2% of participants recorded lower results at home. Coefficient of variation of home FEV1 % during stable periods was 9.9%. Data from the testing of the handheld device used in CLIMB-CF showed a potential underread.

Conclusion: In children and adolescents, home spirometry using hand-held equipment cannot be used interchangeably with clinic spirometry. Home spirometry is moderately variable during clinical stability. New handheld devices underread, particularly at lower volumes of potential clinical significance for smaller patients; this suggests that supervision does not account fully for the discrepancy. Opportunities should be taken to obtain dual device measurements in clinic, so that trend data from home can be utilized more accurately.

Original language	English
Pages (from-to)	2871-2880
Number of pages	10
Journal	Pediatric Pulmonology
Volume	58
Issue number	10
Early online date	28 Jul 2023
DOIs	https://doi.org/10.1002/ppul.26602
Publication status	Published - Oct 2023

Keywords

cystic fibrosis
remote monitoring
remote spirometry
unsupervised spirometry

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Edmondson, C., Westrupp, N., Short, C., Seddon, P., Olden, C., Wallis, C., Brodlie, M., Baxter, F., McCormick, J., MacFarlane, S., Brooker, R., Connon, M., Ghayyda, S., Blaikie, L., Thursfield, R., Brown, L., Price, A., Fleischer, E., Hughes, D., ... Davies, J. C. (2023). Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study. Pediatric Pulmonology, 58(10), 2871-2880. https://doi.org/10.1002/ppul.26602

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title = "Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study",

abstract = "Background: Handheld spirometry allows monitoring of lung function at home, of particular importance during the COVID-19 pandemic. Pediatric studies are unclear on whether values are interchangeable with traditional, clinic-based spirometry. We aimed to assess differences between contemporaneous, home (unsupervised) and clinic (supervised) spirometry and the variability of the former. The accuracy of the commercially available spirometer used in the study was also tested.Methods: Data from participants in the Clinical Monitoring and Biomarkers to stratify severity and predict outcomes in children with cystic fibrosisc (CLIMB-CF) Study aged ≥ 6 years who had paired (±1 day) clinic and home forced expiratory volume in 1 s (FEV1 ) readings were analyzed. Variability during clinical stability over 6-months was assessed. Four devices from Vitalograph were tested using 1 and 3 L calibration syringes.Results: Sixty-seven participants (median [interquartile range] age 10.7 [7.6-13.9] years) provided home and clinic FEV1 data pairs. The mean (SD) FEV1 % bias was 6.5% [±8.2%]) with wide limits of agreement (-9.6% to +22.7%); 76.2% of participants recorded lower results at home. Coefficient of variation of home FEV1 % during stable periods was 9.9%. Data from the testing of the handheld device used in CLIMB-CF showed a potential underread.Conclusion: In children and adolescents, home spirometry using hand-held equipment cannot be used interchangeably with clinic spirometry. Home spirometry is moderately variable during clinical stability. New handheld devices underread, particularly at lower volumes of potential clinical significance for smaller patients; this suggests that supervision does not account fully for the discrepancy. Opportunities should be taken to obtain dual device measurements in clinic, so that trend data from home can be utilized more accurately.",

keywords = "cystic fibrosis, remote monitoring, remote spirometry, unsupervised spirometry",

author = "Claire Edmondson and Nicole Westrupp and Christopher Short and Paul Seddon and Catherine Olden and Colin Wallis and Malcolm Brodlie and Francis Baxter and Jonathan McCormick and Susan MacFarlane and Richard Brooker and Margaret Connon and Salim Ghayyda and Lesley Blaikie and Rebecca Thursfield and Lynsey Brown and April Price and Erin Fleischer and Daniel Hughes and Christine Donnelly and Mark Rosenthal and John Wallenburg and Keith Brownlee and Alton, {Eric W. F. W.} and Andrew Bush and Davies, {Jane C.}",

note = "Copyright: {\textcopyright} 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.",

year = "2023",

month = oct,

doi = "10.1002/ppul.26602",

language = "English",

volume = "58",

pages = "2871--2880",

journal = "Pediatric Pulmonology",

issn = "8755-6863",

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Edmondson, C, Westrupp, N, Short, C, Seddon, P, Olden, C, Wallis, C, Brodlie, M, Baxter, F, McCormick, J, MacFarlane, S, Brooker, R, Connon, M, Ghayyda, S, Blaikie, L, Thursfield, R, Brown, L, Price, A, Fleischer, E, Hughes, D, Donnelly, C, Rosenthal, M, Wallenburg, J, Brownlee, K, Alton, EWFW, Bush, A & Davies, JC 2023, 'Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study', Pediatric Pulmonology, vol. 58, no. 10, pp. 2871-2880. https://doi.org/10.1002/ppul.26602

Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study. / Edmondson, Claire (Lead / Corresponding author); Westrupp, Nicole; Short, Christopher et al.
In: Pediatric Pulmonology, Vol. 58, No. 10, 10.2023, p. 2871-2880.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis

T2 - Results from the CLIMB-CF study

AU - Edmondson, Claire

AU - Westrupp, Nicole

AU - Short, Christopher

AU - Seddon, Paul

AU - Olden, Catherine

AU - Wallis, Colin

AU - Brodlie, Malcolm

AU - Baxter, Francis

AU - McCormick, Jonathan

AU - MacFarlane, Susan

AU - Brooker, Richard

AU - Connon, Margaret

AU - Ghayyda, Salim

AU - Blaikie, Lesley

AU - Thursfield, Rebecca

AU - Brown, Lynsey

AU - Price, April

AU - Fleischer, Erin

AU - Hughes, Daniel

AU - Donnelly, Christine

AU - Rosenthal, Mark

AU - Wallenburg, John

AU - Brownlee, Keith

AU - Alton, Eric W. F. W.

AU - Bush, Andrew

AU - Davies, Jane C.

PY - 2023/10

Y1 - 2023/10

N2 - Background: Handheld spirometry allows monitoring of lung function at home, of particular importance during the COVID-19 pandemic. Pediatric studies are unclear on whether values are interchangeable with traditional, clinic-based spirometry. We aimed to assess differences between contemporaneous, home (unsupervised) and clinic (supervised) spirometry and the variability of the former. The accuracy of the commercially available spirometer used in the study was also tested.Methods: Data from participants in the Clinical Monitoring and Biomarkers to stratify severity and predict outcomes in children with cystic fibrosisc (CLIMB-CF) Study aged ≥ 6 years who had paired (±1 day) clinic and home forced expiratory volume in 1 s (FEV1 ) readings were analyzed. Variability during clinical stability over 6-months was assessed. Four devices from Vitalograph were tested using 1 and 3 L calibration syringes.Results: Sixty-seven participants (median [interquartile range] age 10.7 [7.6-13.9] years) provided home and clinic FEV1 data pairs. The mean (SD) FEV1 % bias was 6.5% [±8.2%]) with wide limits of agreement (-9.6% to +22.7%); 76.2% of participants recorded lower results at home. Coefficient of variation of home FEV1 % during stable periods was 9.9%. Data from the testing of the handheld device used in CLIMB-CF showed a potential underread.Conclusion: In children and adolescents, home spirometry using hand-held equipment cannot be used interchangeably with clinic spirometry. Home spirometry is moderately variable during clinical stability. New handheld devices underread, particularly at lower volumes of potential clinical significance for smaller patients; this suggests that supervision does not account fully for the discrepancy. Opportunities should be taken to obtain dual device measurements in clinic, so that trend data from home can be utilized more accurately.

AB - Background: Handheld spirometry allows monitoring of lung function at home, of particular importance during the COVID-19 pandemic. Pediatric studies are unclear on whether values are interchangeable with traditional, clinic-based spirometry. We aimed to assess differences between contemporaneous, home (unsupervised) and clinic (supervised) spirometry and the variability of the former. The accuracy of the commercially available spirometer used in the study was also tested.Methods: Data from participants in the Clinical Monitoring and Biomarkers to stratify severity and predict outcomes in children with cystic fibrosisc (CLIMB-CF) Study aged ≥ 6 years who had paired (±1 day) clinic and home forced expiratory volume in 1 s (FEV1 ) readings were analyzed. Variability during clinical stability over 6-months was assessed. Four devices from Vitalograph were tested using 1 and 3 L calibration syringes.Results: Sixty-seven participants (median [interquartile range] age 10.7 [7.6-13.9] years) provided home and clinic FEV1 data pairs. The mean (SD) FEV1 % bias was 6.5% [±8.2%]) with wide limits of agreement (-9.6% to +22.7%); 76.2% of participants recorded lower results at home. Coefficient of variation of home FEV1 % during stable periods was 9.9%. Data from the testing of the handheld device used in CLIMB-CF showed a potential underread.Conclusion: In children and adolescents, home spirometry using hand-held equipment cannot be used interchangeably with clinic spirometry. Home spirometry is moderately variable during clinical stability. New handheld devices underread, particularly at lower volumes of potential clinical significance for smaller patients; this suggests that supervision does not account fully for the discrepancy. Opportunities should be taken to obtain dual device measurements in clinic, so that trend data from home can be utilized more accurately.

KW - cystic fibrosis

KW - remote monitoring

KW - remote spirometry

KW - unsupervised spirometry

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U2 - 10.1002/ppul.26602

DO - 10.1002/ppul.26602

M3 - Article

C2 - 37503909

SN - 8755-6863

VL - 58

SP - 2871

EP - 2880

JO - Pediatric Pulmonology

JF - Pediatric Pulmonology

IS - 10

ER -

Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study

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