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Assessment of Home-based Monitoring in Adults with Chronic Lung Disease: An Official American Thoracic Society Research Statement

Yet H Khor et al. Am J Respir Crit Care Med. 2025 Feb.

Abstract

Background: There is increasing interest in the use of home-based monitoring in people with chronic lung diseases to improve access to care, support patient self-management, and facilitate the collection of information for clinical care and research. However, integration of home-based monitoring into clinical and research settings requires careful consideration of test performance and other attributes. There is no published guidance from professional respiratory societies to advance the science of home-based monitoring for chronic lung disease. Methods: An international multidisciplinary panel of 32 clinicians, researchers, patients, and caregivers developed a multidimensional framework for the evaluation of home-based monitoring in chronic lung disease developed through consensus using a modified Delphi survey. We also present an example of how the framework could be used to evaluate home-based monitoring using spirometry and pulse oximetry in adults with asthma, bronchiectasis/cystic fibrosis, chronic obstructive pulmonary disease, and interstitial lung disease. Results: The PANACEA framework includes seven domains (test Performance, disease mANAgement, Cost, patient Experience, clinician Experience, researcher Experience, and Access) to assess the degree to which home-based monitoring assessments meet the conditions for clinical and research use in chronic lung disease. Knowledge gaps and recommendations for future research of home spirometry and pulse oximetry in asthma, bronchiectasis/cystic fibrosis, chronic obstructive pulmonary disease, and interstitial lung disease were identified. Conclusions: The development of the PANACEA framework allows standardized evaluation of home-based monitoring in chronic lung diseases to support clinical application and future research.

Keywords: chronic lung disease; home spirometry; home-based monitoring; pulse oximetry.

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Figures

Figure 1.
Figure 1.
Steps in developing the multidimensional evaluation framework for assessment of home-based monitoring tests in chronic lung disease. *Two desirable items were considered overlapped with an essential item. After discussion, it was decided to combine into a single essential item. †Ten items under the health outcome domain were discarded (see Online Supplement 2 for details).
Figure 2.
Figure 2.
The multidimensional evaluation framework for home-based monitoring tests in chronic lung disease.
Figure 3.
Figure 3.
Key characteristics of devices used in studies of (A) home spirometry and (B) pulse oximetry in chronic lung disease. Only home spirometry and pulse oximetry devices used in completed published studies were included. In addition, several studies did not provide device names for home spirometry and pulse oximetry used. Device information was obtained from publications and developers’ websites. *Provision of feedback when the finger is not placed properly in the device and/or pulse quality. †Nonin 9500 Onyx has been replaced by Nonin Onyx Vantage 9590. FEF 25–75 = forced expiratory flow between 25% and 75% of vital capacity; FEV6 = forced expiratory volume in 6 seconds; PEF = peak expiratory flow.
Figure 4.
Figure 4.
Studies evaluating the PANACEA framework essential items for (A) home spirometry and (B) pulse oximetry in asthma, bronchiectasis/CF, COPD, and ILD. Presented as percentages of the total number of studies for each disease area. CF = cystic fibrosis; COPD = chronic obstructive pulmonary disease; ILD = interstitial lung disease.
Figure 5.
Figure 5.
Factors affecting health equity in home-based monitoring.
See this image and copyright information in PMC

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