Provision of home spirometry in a physiologist-led service: experiences from a large adult cystic fibrosis centre

Objectives: Spirometry is an important marker of lung health in people with cystic fibrosis (pwCF). During the SARS-CoV-2 pandemic, the aerosol-generating nature of spirometry coupled with service user shielding disrupted its routine monitoring. To maintain continuity, we implemented a home spirometry service to complement our telemedicine clinic. Methods: We provided NuvoAir Air Next© home spirometers in clinic or by courier to those of our adult CF cohort with good service engagement and spirometry technique. Training and instruction was given by ARTP-registered physiologists, who are also available at telemedicine clinics to grade spirometry and offer support to service users. Results are uploaded by pwCF via a connected phone. We report our experiences, and the quality of independently-performed home spirometry as graded against ATS/ERS guidelines. Results: Over 4 months, we provided 302 of the 354 pwCF attending our centre with spirometers ([mean ± SD] age 32 ± 11 years (range 17–76), BMI 23.4 ± 4 kgm–2, % predicted FEV1 76.5 ± 23.6. Of the 300, 2 did not tolerate home spirometry, one due to an incompatible phone, and one due to poor compliance. 20 (6.8%) pwCF have yet to use their spirometer. 278 (93%) have performed a total of 5,344 manoeuvres across 1,636 sessions (mean sessions 5.8, mean interval 14.9 days, see Table). We report no adverse events. Quality of spirometry below grade D was often repeated after physiologist feedback. Grade E spirometry was often recorded when only a single acceptable spirometry was performed (20%) or when end-of-test criteria had not been met (46.4%). [Table Presented] Conclusion: Home spirometry can be implemented in a large cohort in a short time frame. Engagement and quality of independently performed spirometry in this group of expert performers was high, but falls below that of hospital quality spirometry. The availability of physiologists to support this service in real-time is an important factor in this and in the reinforcement of reproducible spirometry.