Online home spirometry in national pulmonary fibrosis care: insights from daily practice

Background Monitoring lung function course in patients with pulmonary fibrosis is crucial to guide treatment decisions. Online home spirometry holds great potential for close monitoring and improving care access in times of pressured healthcare systems. However, little data is available on its large-scale use in daily practice. We evaluated the clinical applicability of online home spirometry in pulmonary fibrosis care. Methods We analysed data of a nationwide Dutch cohort of patients with idiopathic pulmonary fibrosis (IPF) and other forms of pulmonary fibrosis (PF) that used a home monitoring programme with home spirometry (forced vital capacity (FVC)) as part of daily practice. Changes in FVC were evaluated with a joint model. Within-patient variability was measured using coefficient of variation. Home spirometry use over time and patient experiences were assessed. Results Online home spirometry data of 334 patients (IPF 73.1%) were analysed. Patients with IPF had a mean baseline FVC of 3.02 L (95% CI: 2.27–3.79), with a mean annualised decline of 170 mL (4.0%). Patients with PF had a mean baseline FVC of 2.81 L (95% CI: 2.07–3.55) with a mean annualised decline of 88 mL (1.2%). Mean±SD within-patient variability was 5.6±4.6%. Overall patient satisfaction was high, and after 1 year 63.4% still performed online home spirometry. Conclusion Online home spirometry is feasible on a large scale in daily clinical practice to monitor disease trajectories in patients with IPF and PF. Online home spirometry could guide management decisions and improve care access for a majority of patients with pulmonary fibrosis.