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Observational Study
. 2025 Jan 9:27:e60689.
doi: 10.2196/60689.

The Long-Term Uptake of Home Spirometry in Regular Cystic Fibrosis Care: Retrospective Multicenter Observational Study

Pia Bertram #  1 , Martinus C Oppelaar #  1 , Michiel Age Bannier  2 , Monique He Reijers  3 , Hester van der Vaart  4 , Renske van der Meer  5 , Josje Altenburg  6 , Lennart Conemans  7   8 , Bart L Rottier  9   10 , Marianne Nuijsink  11 , Lara S van den Wijngaart  1 , Peter Jfm Merkus  1 , Jolt Roukema  1
Affiliations
Observational Study

The Long-Term Uptake of Home Spirometry in Regular Cystic Fibrosis Care: Retrospective Multicenter Observational Study

Pia Bertram et al. J Med Internet Res. .

Abstract

Background: Home spirometers have been widely implemented in the treatment of people with cystic fibrosis (CF). Frequent spirometry measurements at home could lead to earlier detection of exacerbations. However, previous research indicates that the long-term use of home spirometry is not well maintained by people with CF.

Objective: We aimed to gain insight into the long-term uptake of home spirometry in regular multicenter CF care.

Methods: Home spirometers combined with a remote monitoring platform were introduced in the treatment of people with CF in 5 Dutch CF centers starting in April 2020. Usage data from April 2020 to December 2022 were analyzed retrospectively. Survival analyses were conducted to assess use consistency over time, and t tests were used to evaluate the impact of increased pulmonary symptoms on home spirometry frequency. The effect of the initiation of a new treatment, Elexacaftor/Tezacaftor/Ivacaftor, on use frequency over time was assessed in a subgroup of participants with repeated measures ANOVA.

Results: During the observation period, a total of 604 people with CF were enrolled in the remote monitoring platform and 9930 home spirometry measurements were performed. After the initiation of home spirometry use, the number of users declined rapidly. One year after the initiation, 232 (54.2%) people with CF stopped using home spirometry. During the observation period, 67 (11.1%) users performed more than 20 measurements. Furthermore, the number of consistent home spirometry users decreased over time. After 600 days, only 1% of users had measured their lung function consistently every 31 days. Use frequency slightly increased during periods with increased pulmonary symptoms (ΔMean=0.45, t497.278=-4,197; P<.001) and showed an initial rise followed by a decrease after starting treatment with Elexacaftor/Tezacaftor/Ivacaftor (ΔMean=0.45, t497.278=-4,197; P<.001).

Conclusions: Consistent uptake of home spirometry in people with CF is low but increases around periods of changing symptoms. A clear strategy for the organization of remote care seemed to improve the long-term uptake of home spirometry. Nevertheless, home spirometry and its intensity are not a goal on their own but should be used as a tool to reach individual goals within local contexts.

Keywords: adherence; autosomal disease; cystic fibrosis; digital health; eHealth; frequency; home spirometers; pulmonary medicine; remote monitoring; spirometry; survival analyses; telehealth; telemonitoring; treatment.

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Conflict of interest statement

Conflicts of Interest: MO, LvdW, JR, and PM are involved in the development of the software used in this study. The software is the property of the Radboud University Medical Center and hence does not generate any profits for the authors.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curve of the consistency of home spirometry use (n=365). Upper panel: Consistent users with every FEV1 measurement performed with a maximum time-to-next lung function of 31, 62, or 93 days. Lower panel: consistent users with a more lenient approach, where one FEV1 measurement can be performed with a longer time-to-next lung function if two subsequent measurements are taken with a maximum time-to-next lung function of 31, or 62 days. People with cystic fibrosis who are consistent users at the end of the observation period are censored with dots. Yellow: 93-day interval; green: 62-day interval; blue: 31-day interval.
Figure 2
Figure 2
Mean number and 95% CI values of home spirometry measurements per user in the month before and months after initiation of Elexacaftor/Tezacaftor/Ivacaftor treatment. N indicates the number of users who measured their lung function at least once during the intervals.
See this image and copyright information in PMC

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