This pilot study shows that a home monitoring program integrated with real-time wireless home spirometry is feasible in patients with IPF. In line with other studies, home-based measurements were slightly lower than hospital-based FVC, which may partly be equipment-related, but also effort-related [2, 4]. We tried to minimize the risk for ‘underperforming’ at home by motivating patients through graphically displaying their personal target value and prior results, a six seconds countdown and advices to technically improve the measurements. However, home and hospital readings are highly correlated and the relative variability of home-based FVC is low, indicating that home spirometry is a reliable tool to monitor patients at a distance. In a patient population with progressive breathlessness and decreasing mobility this enables close monitoring, while lowering the burden of hospital visits, especially in countries with long distances to the hospital. Moreover, real-time uploading of results and automated email alerts not only allow quality review of measurements, it also enables real-time detection of FVC decline. For example, we already observed a decrease in FVC two days before a patient reported symptoms of a respiratory tract infection. Early detection may potentially improve efficiency and quality of care for patients. Besides spirometry, patients also recorded symptoms and validated questionnaires online, which could be important additional features for future studies.
All patients in our study supported the usefulness of home monitoring, and appreciated being actively involved in monitoring their disease. One patient experienced technical problems with spirometry, highlighting the importance of good instruction. No effects on anxiety or quality of life were observed, however, we believe that the duration of the study is too short to draw definite conclusions on this. We found no major barriers regarding use of real-time wireless home spirometry; relatively easy solutions were suggested by patients and investigators for potential issues.
A limitation of this study is that it is a single center study, with 10 out of 12 consecutive patients willing to participate. In the Netherlands, use of internet amongst elderly people is rather high, however, also in other countries internet use among people over the age of 65 is steadily growing . With worldwide increasing internet use and technological advances, we envision that relatively simple and low-cost systems like this, will facilitate access to care and research for a wider group of patients, also in remote areas and lower socio-economic settings. Further limitations of this pilot are the small sample size and short duration. Although this was sufficient to evaluate reliability and potential barriers of a home monitoring program with real-time wireless home spirometry, larger studies are required to assess whether it improves care, allows for earlier detection of exacerbations, and enhances data collection in clinical trials.