By: Jane Turner1,2, Qianchuan He3, Kelsey Baker1, Lisa Chung4, Adrian Lazarevic-Fogelquist5, Danika Bethune5, Jesse Hubbard1, Margaret Guerriero6, Ajay Sheshadri7, Karen L. Syrjala1,8, Paul J. Martin1,9, Michael Boeckh1,4,10, Stephanie J. Lee1,9, Ted Gooley1, Mary E. Flowers1,9, Guang-Shing Cheng1,6,*
1 Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 2 Division of Respirology, McMaster University, Hamilton, Ontario, Canada 3 Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 4 Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 5 University of Washington School of Medicine, Seattle, Washington 6 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 7 Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 8 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 9 Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, Washington 10 Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
Early detection of bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic cell transplantation (HCT) depends on recognition of subclinical spirometric changes, which is possible only with frequent interval spirometry. We evaluated the feasibility of home monitoring of weekly spirometry via a wireless handheld device and a web monitoring portal in a cohort of high-risk patients for the detection of lung function changes preceding BOS diagnosis. In this observational study, 46 patients with chronic graft-versus-host disease or a decline in forced expiratory volume in 1 second (FEV1) of unclear etiology after allogeneic HCT were enrolled to perform weekly home spirometry with a wireless portable spirometer for a period of 1 year.
Measurements were transmitted wirelessly to a Cloud-based monitoring portal. Feasibility evaluation included adherence with study procedures and an assessment of the home spirometry measurements compared with laboratory pulmonary function tests.
Thirty-six patients (78%) completed 1 year of weekly monitoring. Overall adherence with weekly home spirometry measurements was 72% (interquartile range, 47% to 90%), which did not meet the predetermined threshold of 75% for high adherence. Correlation of home FEV1 with laboratory FEV1 was high, with a bias of 0.123 L (lower limit, -0.294 L; upper limit, 0.541 L), which is within acceptable limits for reliability.
Of the 12 patients who were diagnosed with BOS or suspected BOS during the study period, 9 had an antecedent FEV1 decline detected by home spirometry. Our data indicate that wireless handheld spirometry performed at home in a high-risk HCT cohort is feasible for close monitoring of pulmonary function and appears to facilitate early detection of BOS.