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Reix P. The day after. Rethinking the Cystic Fibrosis model of care and structure of the CF team in the era of triple combination therapy. J Cyst Fibros 2024:S1569-1993(24)01784-3. [PMID: 39327196 DOI: 10.1016/j.jcf.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 09/18/2024] [Indexed: 09/28/2024]
Affiliation(s)
- Philippe Reix
- Centre de ressources et de compétences pour la mucoviscidose. Hôpital Femme Mère Enfants. Hospices Civils de Lyon. Bron. France et UMR5558. Equipe EMET. Villeurbanne. France.
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2
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Oppelaar MC, Emond Y, Bannier MAGE, Reijers MHE, van der Vaart H, van der Meer R, Altenburg J, Conemans L, Rottier BL, Nuijsink M, van den Wijngaart LS, Merkus PJFM, Heinen M, Roukema J. Potential, Pitfalls, and Future Directions for Remote Monitoring of Chronic Respiratory Diseases: Multicenter Mixed Methods Study in Routine Cystic Fibrosis Care. J Med Internet Res 2024; 26:e54942. [PMID: 39106098 PMCID: PMC11336494 DOI: 10.2196/54942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/09/2024] [Accepted: 05/27/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs). OBJECTIVE This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs. METHODS This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed. RESULTS Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65% (24/37) of HCPs and 89% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61%; HCPs: 21/24, 88%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92%) and HCPs (22/24, 92%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82%) and HCPs (22/24, 92%) wanted to keep using the RMP in future, with 79% (19/24) of HCPs and 75% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden. CONCLUSIONS Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs.
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Affiliation(s)
- Martinus C Oppelaar
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yvette Emond
- IQ Health Science Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michiel A G E Bannier
- Department of Paediatric Pulmonology, MosaKids Children's Hospital, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Monique H E Reijers
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hester van der Vaart
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Josje Altenburg
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Lennart Conemans
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
- Division of Respiratory & Age-related Health, Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht, Netherlands
| | - Bart L Rottier
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marianne Nuijsink
- Haga Teaching Hospital, Juliana Children's Hospital, The Hague, Netherlands
| | - Lara S van den Wijngaart
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maud Heinen
- IQ Health Science Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jolt Roukema
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
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Swetland DV, Savant AP. Cystic fibrosis year in review 2023. Pediatr Pulmonol 2024. [PMID: 39056532 DOI: 10.1002/ppul.27190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/23/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
This past year, there were many important advances for patients with cystic fibrosis (CF). Of the many publications related to CF in 2023, there was further evaluation of highly effective modulator therapy, new assessments and guidelines for clinical manifestations and therapies for CF, advances in newborn screening and diagnosis, and evaluation of outcomes for people with CF transmembrane conductance regulator-related metabolic syndrome/CF screen positive, inconclusive diagnosis. The aim of this review article is not to provide a full assessment of the wide range of articles published in 2023, but to provide a brief review of publication that may lead to changes in clinical care.
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Affiliation(s)
- David V Swetland
- Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, Louisiana, USA
- Department of Pediatrics, Tulane University, New Orleans, Louisiana, USA
| | - Adrienne P Savant
- Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, Louisiana, USA
- Department of Pediatrics, Tulane University, New Orleans, Louisiana, USA
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4
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Medbo J, Imberg H, Hansen C, Krantz C, de Monestrol I, Svedberg M. Telemedicine and home spirometry in cystic fibrosis: A prospective multicenter study. Pediatr Pulmonol 2024. [PMID: 38963304 DOI: 10.1002/ppul.27166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 06/11/2024] [Accepted: 06/25/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES Telehealth and home spirometry feasibility for children has been established, but their impact on cystic fibrosis (CF) disease progression remains unassessed. We aimed to evaluate the effects of telehealth and home spirometry on CF disease progression and care. METHODS Children with CF aged 5-17 years from all Swedish CF centers were provided with home spirometers. A minimum of two in-person visits were replaced with telemedicine visits and participants were instructed to conduct home spirometry before visits. Linear mixed-effects models were used to compare annual CF disease trajectories during the intervention period and prepandemic period (1 January 2019 to 28 February 2020). Participants and caregivers completed study questionnaires. RESULTS A total of 59 individuals completed the study over a mean (SD) period of 6.8 (1.4) months, made 3.1 (1.0) physical visits and 2.2 (0.6) telehealth visits per patient year during the study period. The mean difference (95% CI) between the intervention and prepandemic period progression rate for FEV1%, lung clearance index and BMI were -0.4 (-1.3 to 0.5, p = 0.39), 0.11 (-0.07 to 0.28, p = 0.25) and -0.02 (-0.13 to 0.08, p = 0.70), respectively. There were no major shifts in the incidence of airway pathogens, sputum cultures, or antibiotics use between the periods (p > 0.05). The intervention did not increase stress. Almost all participants and caregivers expressed a desire to continue with home spirometry and telemedicine. CONCLUSION Combining telehealth and physical visits with access to home spirometry demonstrated comparable effectiveness as exclusively in-person care with enhanced flexibility and personalization of CF care.
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Affiliation(s)
- Jakob Medbo
- Department of Pediatrics, Institute of Clinical Science at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Queen Silvia's Children Hospital, Gothenburg, Sweden
| | | | - Christine Hansen
- Department of Pediatrics, Lund CF Centre, Skåne University Hospital, Lund, Sweden
| | - Christina Krantz
- Department of Pediatrics, Uppsala CF Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Isabelle de Monestrol
- Stockholm CF Centre, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institute, Stockholm, Sweden
| | - Marcus Svedberg
- Department of Pediatrics, Institute of Clinical Science at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Queen Silvia's Children Hospital, Gothenburg, Sweden
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Hoppe JE, Sjoberg J, Hong G, Poch K, Zemanick ET, Thee S, Edmondson C, Patel D, Sathe M, Borowitz D, Putman MS, Lechtzin N, Riekert KA, Basile M, Goss CH, Jarosz ME, Rosenfeld M. Remote endpoints for clinical trials in cystic fibrosis: Report from the U.S. CF foundation remote endpoints task force. J Cyst Fibros 2024; 23:725-733. [PMID: 38429150 DOI: 10.1016/j.jcf.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
The COVID-19 pandemic necessitated a rapid shift in clinical research to perform virtual visits and remote endpoint assessments, providing a key opportunity to optimize the use of remote endpoints for clinical trials in cystic fibrosis. The use of remote endpoints could allow more diverse participation in clinical trials while minimizing participant burden but must be robustly evaluated to ensure adequate performance and feasibility. In response, the Cystic Fibrosis Foundation convened the Remote Endpoint Task Force (Supplemental Table 1), a multidisciplinary group of CF researchers with remote endpoint expertise and community members tasked to better understand the current and future use of remote endpoints for clinical research. Here, we describe the current use of remote endpoints in CF clinical research, address key unanswered questions regarding their use and feasibility, and discuss the next steps to determine clinical trial readiness.
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Affiliation(s)
- Jordana E Hoppe
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora CO, USA.
| | | | - Gina Hong
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia Pennsylvania, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver CO, USA
| | - Edith T Zemanick
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora CO, USA
| | - Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claire Edmondson
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital, London WC1N3JH, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis MO, USA
| | - Meghana Sathe
- Pediatric Gastroenterology and Nutrition, University of Texas Southwestern/Children's Health, Dallas Texas, USA
| | - Drucy Borowitz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA
| | - Melissa S Putman
- Division of Pediatric Endocrinology, Boston Children's Hospital, Boston MA, USA
| | - Noah Lechtzin
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
| | - Melissa Basile
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY, USA
| | - Christopher H Goss
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington Medical Center, Seattle Washington, USA; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Research Institute, Seattle Washington, USA
| | | | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Research Institute, Seattle Washington, USA
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Hakizimana A, Devani P, Gaillard EA. Current technological advancement in asthma care. Expert Rev Respir Med 2024; 18:499-512. [PMID: 38992946 DOI: 10.1080/17476348.2024.2380067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/10/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Asthma is a common chronic respiratory disease affecting 262 million people globally, causing half a million deaths each year. Poor asthma outcomes are frequently due to non-adherence to medication, poor engagement with asthma services, and a lack of objective diagnostic tests. In recent years, technologies have been developed to improve diagnosis, monitoring, and care. AREAS COVERED Technology has impacted asthma care with the potential to improve patient outcomes, reduce healthcare costs, and provide personalized management. We focus on current evidence on home diagnostics and monitoring, remote asthma reviews, and digital smart inhalers. PubMed, Ovid/Embase, Cochrane Library, Scopus and Google Scholar were searched in November 2023 with no limit by year of publication. EXPERT OPINION Advanced diagnostic technologies have enabled early asthma detection and personalized treatment plans. Mobile applications and digital therapeutics empower patients to manage their condition and improve adherence to treatments. Telemedicine platforms and remote monitoring devices have the potential to streamline asthma care. AI algorithms can analyze patient data and predict exacerbations in proof-of-concept studies. Technology can potentially provide precision medicine to a wider patient group in the future, but further development is essential for implementation into routine care which in itself will be a major challenge.
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Affiliation(s)
- Ali Hakizimana
- Department of Paediatric Respiratory Medicine. Leicester Children's Hospital, University Hospitals Leicester, Leicester, UK
| | - Pooja Devani
- Department of Paediatric Respiratory Medicine. Leicester Children's Hospital, University Hospitals Leicester, Leicester, UK
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
| | - Erol A Gaillard
- Department of Paediatric Respiratory Medicine. Leicester Children's Hospital, University Hospitals Leicester, Leicester, UK
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
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M R, A B, G S, E NK, B F, B ZC, Al H. Incorporating the perspectives of participants and research coordinators on home spirometry into clinical trial design: The example of the OUTREACH study. J Cyst Fibros 2024; 23:739-743. [PMID: 39079878 DOI: 10.1016/j.jcf.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/31/2024] [Accepted: 06/25/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND We undertook a human-centered design approach to design the OUTREACH study of home spirometry as a CF clinical trial endpoint. We conducted a qualitative needs assessment to elicit the perspectives of people with CF (PwCF) and research coordinators (RCs) about home spirometry in the research setting and co-produced written and video home spirometry instructions in partnership with representatives from these stakeholder groups. METHODS We conducted 7 focus groups of PwCF (N = 27), caregivers of children with CF (N = 6), or RCs (N = 24) to elicit current experiences, barriers and facilitators of home spirometry across 6 target areas, followed by discussion and prioritization. The co-production team, composed of 3 PwCF, 3 RCs and study team members created written and video training materials. RESULTS While most PwCF and caregivers found home spirometry convenient, many experienced technical barriers, reported a "learning curve", and expressed uncertainty about the quality and reliability of measurements. Major barriers identified by RCs included tailoring participant training to individual needs, scheduling remote coaching, and performing effective coaching remotely. Participants offered age-specific recommendations in key domains: training materials and procedures, remote coaching, monitoring progress and maintaining engagement. Co-produced training materials included handouts and videos on how to perform spirometry, and troubleshooting, cleaning, and maintaining home spirometers. CONCLUSIONS The OUTREACH design was improved by incorporating results of the needs assessment. The home spirometry training materials are freely available for public use. We hope our results and materials can help to inform the design and success of remote clinical trials of the future.
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Affiliation(s)
- Rosenfeld M
- Center for Respiratory Biology and Therapeutics, Seattle Children's Research Institute, United States; Department of Pediatrics, University of Washington School of Medicine, United States.
| | - Berlinski A
- University of Arkansas for Medical Sciences, United States
| | - Sawicki G
- Boston Children's Hospital, United States
| | | | - Fogarty B
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, United States
| | - Zappone-Case B
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, United States
| | - Hartzler Al
- Biomedical Informatics and Medical Education, University of Washington School of Medicine, United States
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Yanaz M, Yilmaz Yegit C, Gulieva A, Kalyoncu M, Selcuk M, Uzunoglu B, Tastan G, Ergenekon AP, Gokdemir Y, Erdem Eralp E, Karakoc F, Karadag B. Electronic home monitoring of children with cystic fibrosis to detect and treat acute pulmonary exacerbations and its effect on 1-year FEV 1. J Cyst Fibros 2024; 23:329-333. [PMID: 37748990 DOI: 10.1016/j.jcf.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND We aimed to investigate the effect of the use of electronic home spirometry in children with cystic fibrosis (CF) on 1-year FEV1 (% predicted, pp) change. METHODS This is a randomised, one-year prospective study including children with CF between 6 and 18 years of age. Subjects were randomised into home spirometry group (HSG) and usual care group (UCG). Children in HSG performed two pulmonary function tests (PFT) per week. Data regarding acute pulmonary exacerbations (PEx) was obtained from patients' records. At baseline and 12th month, health related quality of life questionnaire for CF patients (CFQ-R) and lung clearance index (LCI) were performed. RESULTS Sixty children were recruited with a median (IQR) age of 13.3 (11.4-15.4) years. Absolute change in FEV1pp from baseline to 12th month as median (IQR) was +1% (-6.75-9.75) in HSG and -2.50% (-7.50-3.25) in UCG (p = 0.10). Sensitivity analysis including only adherent children in HSG (n = 22), yielded an increase of 5% (-3.50-12) in HSG and a decrease of 2.50% (-7.50-3.25) in UCG (p = 0.009). A total of 29 (96.7%) subjects in HSG and 23 (76.7%) in UCG had PEx (p = 0.05). Absolute change in median (IQR) LCI2.5 from baseline to the 12th month was -1.6 [-2.9-0] (p<0.001) in HSG and -1.5 [-2.8-(-0.6)] (p<0.001) in UCG (p = 0.94). There was a significant increase in the social domain of the CFQ-R in HSG (from 59.1 to 76.2, p = 0.01). CONCLUSIONS Electronic home monitoring of children with CF by spirometry may result in improvement in lung function.
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Affiliation(s)
- Muruvvet Yanaz
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey.
| | - Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Mine Kalyoncu
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Merve Selcuk
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Burcu Uzunoglu
- Selim Coremen Cystic Fibrosis Center, Marmara University School of Medicine, Istanbul, Turkey
| | - Gamze Tastan
- Selim Coremen Cystic Fibrosis Center, Marmara University School of Medicine, Istanbul, Turkey
| | - Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
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Bouteleux B, Beaufils F, Fayon M, Bui S. Home-spirometry exacerbation profiles in children with cystic fibrosis. Pediatr Pulmonol 2024; 59:552-561. [PMID: 38014613 DOI: 10.1002/ppul.26781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Pulmonary exacerbations (PEx) are strong predictors of respiratory disease progression in children with cystic fibrosis (CwCF) and may be associated with persistent decreased lung function after acute management. Telemonitoring devices can be used for early detection and monitoring of PEx, but its utility is debated. RESEARCH QUESTION Which symptoms and telemonitoring spirometry characterics are related to outcome dynamics following initial PEx management? METHODS This retrospective study included CwCF followed at Bordeaux University Hospital, France. All severe PEx episodes treated with intravenous (IV) antibiotics (ATB) between 1 January 2017 and 31 December 2021 in CwCF using home telemonitoring were analyzed. Symptoms and home spirometry data were collected 45 days before and up to 60 days after each IV ATB course. We defined three response profiles based on terciles of baseline forced expiratory volume in 1 s (FEV1 ) recovery. RESULTS A total of 346 IV ATB courses for PEx were administered to 65 CwCF during the study period. The drop in FEV1 became significant 8 days before IV ATB initiation. Forty-one percent of IV ATB courses failed to restore baseline FEV1 . The magnitude of FEV1 drop and a greater delay in the initiation of treatment correlated with a low response level. On the 14th day of the IV treatment, a FEV1 recovery less than 94% of baseline was associated with a nonresponder profile. INTERPRETATION Home spirometry may facilitate the early recognition of PEx to implement earlier interventions. This study also provides an outcome lung function threshold which identifies low responders to IV ATB.
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Affiliation(s)
| | - Fabien Beaufils
- CHU Bordeaux, Département de Physiologie, Département de Pédiatrie, Service de Pneumologie Pédiatrique, Centre de Ressources et de Compétences pour la Mucoviscidose, Centre d'Investigation Clinique, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Université de Bordeaux, Pessac, France
- INSERM, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France
| | - Michael Fayon
- CHU Bordeaux, Département de Physiologie, Département de Pédiatrie, Service de Pneumologie Pédiatrique, Centre de Ressources et de Compétences pour la Mucoviscidose, Centre d'Investigation Clinique, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Université de Bordeaux, Pessac, France
- INSERM, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France
| | - Stéphanie Bui
- CHU Bordeaux, Département de Physiologie, Département de Pédiatrie, Service de Pneumologie Pédiatrique, Centre de Ressources et de Compétences pour la Mucoviscidose, Centre d'Investigation Clinique, Bordeaux, France
- INSERM, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France
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Boente RD, Schacht S, Borton R, Vincent J, Golzarri-Arroyo L, Rattray N. Assessing the acceptability and feasibility of remote spirometric monitoring for rural patients with interstitial lung disease: a multimethod approach. Respir Res 2024; 25:92. [PMID: 38378645 PMCID: PMC10877761 DOI: 10.1186/s12931-024-02735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Interstitial lung disease encompasses a group of rare lung conditions causing inflammation and scarring of lung tissue. The typical method of monitoring disease activity is through pulmonary function tests performed in a hospital setting. However, accessing care can be difficult for rural patients due to numerous barriers. This study assesses the feasibility and acceptability of home spirometry telemonitoring using MIR-Spirometers and the patientMpower home-monitoring platform for rural patients with interstitial lung disease. METHODS Unblinded, uncontrolled, prospective, multiple-methods study of the feasibility and utility of remote monitoring of 20 rural subjects with interstitial lung disease. Study assessments include adherence to twice weekly spirometry for 3 months in addition to mMRC dyspnea and EQ-5D-5L health-related quality of life questionnaires with each spirometry maneuver. Upon completion, subjects were encouraged to complete an 11-question satisfaction survey and participate in semi-structured qualitative interviews to further explore expectations and perceptions of rural patients to telehealth and remote patient monitoring. RESULTS 19 subjects completed the 3-month study period. Adherence to twice weekly spirometry was mean 53% ± 38%, with participants on average performing 2.26 ± 1.69 maneuvers per week. The median (Range) number of maneuvers per week was 2.0 (0.0, 7.0). The majority of participants responded favorably to the patient satisfaction survey questions. Themes regarding barriers to access included: lack of local specialty care, distance to center with expertise, and time, distance, and high cost associated with travel. Remote monitoring was well perceived amongst subjects as a way to improve access and overcome barriers. CONCLUSIONS Remote spirometry monitoring through web-based telehealth is acceptable and feasible for rural patients. Perceived benefits include overcoming access barriers like time, distance, and travel costs. However, cost, reimbursement, and internet access must be addressed before implementing it widely. Future studies are needed to ensure long-term feasibility and to compare outcomes with usual care.
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Affiliation(s)
- Ryan D Boente
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy, Sleep and Occupational Medicine, Indiana University School of Medicine, 1120 W. Michigan St, Gatch Hall, CL 290B, Indianapolis, IN, 46202, USA.
- Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA.
| | - Sydney Schacht
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy, Sleep and Occupational Medicine, Indiana University School of Medicine, 1120 W. Michigan St, Gatch Hall, CL 290B, Indianapolis, IN, 46202, USA
| | | | | | - Lilian Golzarri-Arroyo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Nicholas Rattray
- Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana School of Medicine, Indianapolis, IN, USA
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