Spirometry States the Obvious: Recognizing Bronchiolitis Obliterans Syndrome Early after Hematopoietic Cell Transplantation

Association between six-minute walk tests with lung diffusion capacity for carbon monoxide in chronic respiratory disease: A cross-sectional study

Introduction and Aim: Interstitial lung disease (ILD) is a heterogeneous disorder that share common clinical, radiographic, and physiological features. Most patients with ILD usually experience an exertion – induced dyspnea as first symptom. A noticeable change in oxygen saturation was noticed in ILD patients while exercise. The study objective was to ascertain the functional parameter that correlates best with ILD by comparing age, sex, and smoking history with different ILD pattern. Materials and Methods: A proforma (including Six Minute Walk Test and Pulmonary Function Test with lung diffusion capacity) for one-year period (September 2014 - November 2015) was taken for the 40 included participants. The study includes patients with Interstitial Lung diseases diagnosed by clinical, radiological and spirometric parameters. The study tests the sensitivity and the specificity of six-minute walk test versus lung carbon monoxide diffusing ability.  Results: A total of 40 participants were included (19 were males and 21 were females). 12 were smokers and 28 were non-smokers. 20 patients belonged to Usual Interstitial Pneumonia (UIP) pattern, 14 were Non-Specific Interstitial Pneumonia (NSIP) and 6 were others. The mean±SD spirometric parameters were FEV1/FVC=101.71±16.752, FVC=55.29±17.322, FEV1=57.66 ± 20.246.  Conclusion: There was no statistical significance between age, gender, smoking and ILD patterns. Spirometer and diffusion capacity indices co-relate best with NSIP pattern of ILD in our study. In a resource limited setting, clinical and radiological assessment of ILD with six-minute walking distance and spirometry should or need not be supplemented by DLCO for severity assessment.

Home Spirometry Telemonitoring for Early Detection of Bronchiolitis Obliterans Syndrome in Patients with Chronic Graft-versus-Host Disease

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.

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IIa. The 2020 Clinical Implementation and Early Diagnosis Working Group Report

Recognition of the earliest signs and symptoms of chronic graft-versus-host disease (GVHD) that lead to severe manifestations remains a challenge. The standardization provided by the National Institutes of Health (NIH) 2005 and 2014 consensus projects has helped improve diagnostic accuracy and severity scoring for clinical trials, but utilization of these tools in routine clinical practice is variable. Additionally, when patients meet the NIH diagnostic criteria, many already have significant morbidity and possibly irreversible organ damage. The goals of this early diagnosis project are 2-fold. First, we provide consensus recommendations regarding implementation of the current NIH diagnostic guidelines into routine transplant care, outside of clinical trials, aiming to enhance early clinical recognition of chronic GVHD. Second, we propose directions for future research efforts to enable discovery of new, early laboratory as well as clinical indicators of chronic GVHD, both globally and for highly morbid organ-specific manifestations. Identification of early features of chronic GVHD that have high positive predictive value for progression to more severe manifestations of the disease could potentially allow for future pre-emptive clinical trials.