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‘You’re on mute!’ Does paediatric CF home spirometry require physiologist supervision?
  • +4
  • Emma Fettes,
  • Mollie Riley,
  • Stephanie Brotherston,
  • Claire Doughty,
  • Benjamin Griffiths,
  • Aidan Laverty,
  • Paul Aurora
Emma Fettes
Great Ormond Street Hospital for Children
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Mollie Riley
Great Ormond Street Hospital for Children
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Stephanie Brotherston
Great Ormond Street Hospital for Children
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Claire Doughty
Great Ormond Street Hospital for Children
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Benjamin Griffiths
Great Ormond Street Hospital for Children
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Aidan Laverty
Great Ormond Street Hospital for Children
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Paul Aurora
Great Ormond Street Hospital for Children
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Abstract

Introduction: The COVID-19 pandemic has accelerated the move towards home spirometry monitoring, including in children. Our aim was to determine whether the remote supervision of spirometry by a physiologist improves the technical quality and failure rate of the manoeuvres. Method: Children with cystic fibrosis who had been provided with NuvoAir home spirometers were randomly allocated to either supervised or unsupervised home spirometry following a detailed training session. Home spirometry was performed every 2 weeks for 12 weeks. Tests were assigned a quality factor (QF) using our laboratory grading system as per ATS/ERS standards, with tests marked from A to D, or Fail. In our laboratory we aim for QF A in all spirometry tests, but report results of QF B or C with a cautionary note. QF A was therefore the primary outcome, and QF A-C the secondary outcome. Results: 61 patients were enrolled; 166 measurements were obtained in the supervised group, and 153 in the unsupervised group. Significantly more measurements achieved QF A in the supervised compared to unsupervised group (89% vs 74%; p= <0.001) whilst proportions reaching grade A-C were similar (99% vs 95%; p=0.1). All significant declines in spirometry results had a clinical rather than technical reason. Family/patient feedback for both arms was very positive. Conclusion: These results suggest that home spirometry in children should ideally be remotely supervised by a physiologist, but acceptable results can be obtained if resources do not allow this, provided that training is delivered and results monitored according to our protocol.

Peer review status:ACCEPTED

16 Jul 2021Submitted to Pediatric Pulmonology
20 Jul 2021Submission Checks Completed
20 Jul 2021Assigned to Editor
20 Jul 2021Reviewer(s) Assigned
11 Aug 2021Review(s) Completed, Editorial Evaluation Pending
11 Aug 2021Editorial Decision: Revise Minor
03 Sep 20211st Revision Received
06 Sep 2021Submission Checks Completed
06 Sep 2021Assigned to Editor
06 Sep 2021Reviewer(s) Assigned
19 Sep 2021Review(s) Completed, Editorial Evaluation Pending
19 Sep 2021Editorial Decision: Accept