TABLE 3.
Characteristics of included studies on home monitoring in interstitial lung disease (ILD) patients
| Study | Setting/design | Sample size and characteristics | Disease group | Clinic measures/frequency | Home measures/frequency | Study length | Outcome | Quality | Results |
| Moor et al. (2020) [30] | NL/RCT | n=90 Age (mean±sd): 71±6.9 years Intervention (n=46) Male: 39 (85%) Age (mean): 70 years Control (n=44) Male: 43 (98%) Age (mean): 72 years |
IPF | Spirometry, K-BILD, PESaM, EQ-5D-5L, HADS, VAS, GRC, EQ-VAS (baseline, and at 12 and 24 weeks) | FVC (Once daily) K-BILD, PESaM, EQ-5D-5L, HADS, VAS, GRC, EQ-VAS (weekly) |
24 weeks | Investigate whether a home monitoring programme improves HRQOL and medication use for patients with IPF | Moderate | (1) Improved psychological well-being compared to standard care alone (mean difference 1.04 points; 95% CI 0.09–2.00; p=0.032) (2) Mean change in FVC was not significantly different between hospital-based group (−87.9 mL; range −209 to 33.2 mL) and home monitoring group (−7.9 mL; range −96 to 69.4 mL; p=0.25) (3) Correlation between home and hospital spirometry was high at all time-points (r=0.97, p<0.001 at baseline and 12 weeks; r=0.96, p<0.001 at 24 weeks) (4) Correlation between slopes was moderately strong (r=0.58; p<0.001) |
| Maher et al. (2020) [38] | RCT | n=253 Intervention (n=127) Age (mean): 70 years (range 61.0–76.0) Male: 70 (55%) Placebo (n=126) Age (mean): 69 years (range 63.0–74.0) Male: 69 (55%) |
Unclassifiable ILD | Spirometry 6MWD, UCSD-SOBQ, Leicester Cough Questionnaire, SGRQ (baseline and at 24 weeks) |
FVC (once daily) | 24 weeks | The mean change in FVC measured by daily home-based spirometry, change in FVC measured by site spirometry, change in 6MWD, change in UCSD-SOBQ | Good | (1) The primary end-point was not adequately analysed due to technical issues resulting in variability in home-based spirometry measurements (2) Mean FVC decline measured by clinic spirometry was less in pirfenidone than placebo group (treatment difference 95.3 mL; 95% CI 35.9–154.6, p=0.002) |
| Russell et al. (2016) [31] | UK/PCS | n=50 Male: 45 (90%) Age (mean±sd): 66.7±7.9 years |
IPF | Spirometry baseline, and at 3, 6 and 12 months | FEV1, FVC (once daily) | Median: 279 days, range 13–490 days | Feasibility and reliability of measuring daily FVC | Good | (1) Daily FVC measurement was most predictive for disease progression and mortality when measured at 3 months (hazard ratio 1.04; 95% CI 1.02–1.06; p≤0.001), 6 months (HR 1.02; 95% CI 1.01–1.03; p<0.001), and 12 months (HR 1.012; 95% CI 1.007–1.01; p=0.001); 28 days did not yield a positive correlation (2) Regular home measurement of FVC is feasible and reliable (3) Home spirometry showed high correlation with hospital-based spirometry |
| Johannson et al. (2017) [20] | USA/PCS | n=25 Male: 21 (84%) Age (mean±sd): 73.6±7.5 years |
IPF | Spirometry baseline and at 24 weeks | FEV1, FVC (three times per week) UCSD-SOBQ (weekly), dyspnoea-VAS (weekly) | 24 weeks | Feasibility and reliability of measuring FVC and dyspnoea | Good | (1) Weekly home measurement of FVC and dyspnoea in patients with IPF is reliable and feasible over 24 weeks (2) Mean adherence to weekly home spirometry >90% |
| Veit et al. (2020) [32] | DE/PCS | n=47 Male: 28 (59.6%) Age (mean±sd): 62.7 ±11.5 years |
ILD | Spirometry, 6MWD, DLCO, FVC, K-BILD, SGRQ, VAS Cough (baseline, at 3 and 6 months) | FVC (three times per day) | 6 months | Determine feasibility in different types of fibrotic non-IPF ILD and investigate the clinical impact of daily home spirometry in patients with progressive ILD with respect to disease progression | Good | (1) Adherence was higher within the first 3 months compared to the second 3 months (83.5±19.6% versus 78.4±22.3% of the days; p=0.0086) (2) Correlation between hospital FVC values and the mean of the home FVC measurements was similarly strong at 3-month (r=0.95; p<0.0001) and 6-month visits (r=0.93; p<0.0001) |
| Edwards et al. (2020) [39] | IE/USA/PCS | n=36 USA: Age (mean): 62 years Ireland: Age (mean): 66 years |
PF | FVC (once daily) mMRC (once daily) IPF-PROM (weekly) |
1 year | Acceptability and utility of patientMpower | Fair | (1) 93% of respondents reported a positive impact on their well-being (2) Good correlation between hospital-based and home-based spirometry |
|
| Moor et al. (2019) [45] | NL/PCS | n=10 Male: 6 (60%) Age (mean): 53 years |
Sarcoidosis | Spirometry, activity, PROM (baseline and at 1 month), patients’ KSQ, EQ-5D-5L, HADS, FAS Satisfaction (interview) |
PEF, FEV1, FVC (daily) VAS fatigue, dyspnoea, cough, well-being (weekly) |
4 weeks | Evaluate feasibility of home monitoring programme and patient satisfaction programme | Fair | (1) Home spirometry measurements highly correlated with in-hospital measurements of FVC (r=0.97, p<0.001) and FEV1 (r=0.96, p<0.001) (2) Mean adherence to daily spirometry was 94.6%; it was measured by dividing the total number of measurements by the total numbers of days |
| Moor et al. (2018) [40] | NL/PCS | n=10 Male: 9 (90%) Age (mean): 71 years |
IPF | Spirometry, patient-reported outcome (baseline and at 1 month), patients’ K-BILD, HADS, EuroQoL 5D-5 L | Home spirometry (daily) Patient-reported outcome (weekly) |
4 weeks | Feasibility of a pre-developed home monitoring programme in IPF (home spirometry) | Fair | (1) Home-based spirometry showed similar results to hospital-based spirometry; measurements of home and hospital FVC were correlated (r=0.94; p<0.001) and FEV1 (r=0.97; p<0.001) were highly correlated (2) Feasibility and potential barriers of home spirometry: 80% of patients reported easy to use and 90% said it was not burdensome; mean adherence was 98.8% to home monitoring programme |
| Moor et al. (2020) [46] | NL/PCS | n=50 (n=44 acceptable data) Age range: 43–79 years Male: 68% |
IPF | Questionnaire (baseline and at 6 weeks) | FVC (twice daily) Patient-reported K-BILD online |
6 weeks | Measure diurnal variation in FVC in patients with f-ILD using home spirometry, evaluate the relationship between FVC and activity, home-based FVC, home and hospital-based correlation | Fair | (1) Morning FVC was significantly higher than afternoon FVC (mean difference 36 mL, p<0.001); the mean difference between morning and afternoon FVC was similar for patients with IPF compared with all f-ILDs (2) Daily step correlated with FVC (r=0.32, p=0.028, K-BILD total score (r=0.5, p<0.001)) (3) Home and hospital-based spirometry were correlated (r=0.98, p<0.0001) |
| Broos et al. (2017) [41] | NL/PCS | n=21 Male: 13 Female: 8 Age (mean±sd): 43±11 years 76% diagnosed with Scadding stage II sarcoidosis |
Sarcoidosis | Clinic spirometry, SGRQ, SF-36, KSQ, MRC, FAS at baseline, 1 and 3 months | FVC (daily) MRC, FAS (weekly) |
3 months | Detect early steroid treatment effects in newly treated pulmonary sarcoidosis |
Good | (1) Home spirometry in sarcoidosis is reliable (2) Home and hospital spirometry were correlated (r=0.98; p<0.001) |
| Marcoux et al. (2019) [28] | NL/PCS | n=20 Male: 16 (80%) Age (mean±sd): 73±6.9 years |
IPF | Clinic spirometry at baseline, 4 and 23 weeks 6MWD (baseline and at 12 weeks) |
FVC (3 manoeuvres daily) | 12 weeks | Test the 12-week feasibility of blinded daily handheld spirometry and physical activity monitoring in patients with IPF | Good | (1) The correlation for office-based and handheld FVC measurements was 0.99 (95% CI 0.97–0.99) and 0.95 (95% CI 0.91–0.98), respectively (2) Mean adherence to home spirometry was 84% |
| Noth et al. (2021) [43] | NL/PCS | n=346 diagnosed with IPF in the previous 3 years and had an FVC ≥80% predicted; 116 randomised to nintedanib, 230 randomised to placebo for 12 weeks, followed by an open-label period in which all subjects received nintedanib 150 mg twice daily for 40 weeks |
IPF | Clinic spirometry at baseline and weeks 4, 8, 12, 16, 20, 24, 36 and 52 | FVC (weekly) | 1 year | Investigate the feasibility and validity of home spirometry as a measure of lung function decline in patients with IPF | Good | (1) Over 52 weeks, mean adherence was 86% (2) Strong correlations were observed between home- and clinic-measured FVC at all time-points (r=0.72 to 0.84), but correlations between home- and clinic-measured rates of change in FVC were weak (r=0.26 for rate of decline in FVC over 52 weeks); the correlations were weaker in subjects who provided more FVC readings per week, due to variability in change in FVC measured at home (greater number of outliers) and errors in measurements |
| Moor et al. (2020) [42] | NE/PCS | n=10 Female: 60% Age (mean±sd): 60.3±9.9 years |
Systemic sclerosis-associated ILD | Spirometry at baseline and 3 months K-BILD, HADS, EQ-5D-5L (baseline and at 6 weeks) |
FVC (once daily) | 3 months | Investigate the feasibility of an online home monitoring application, and spirometry | Good | (1) Mean±sd adherence was 98.8±1.5% (2) Strong adherence and acceptability; 90% found home monitoring pleasant and wanted to continue to use home monitoring application daily |
IPF: idiopathic pulmonary fibrosis; CAT: COPD Assessment Test; EQ-5D-5L: EuroQoL Five-Dimensions Questionnaire; FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; GRC: Global Rating Change; HRQOL: health-related quality of life; ILD: interstitial lung disease; 6MWD: 6-min walk distance; HADS: Hospital Anxiety and Depression Scale; IE: Ireland; K-BILD: The King's Brief Interstitial Lung Disease; NL: Netherlands; PESaM: Patient Experiences and Satisfaction with Medication questionnaire; PCS: prospective cohort study; RCT: randomised controlled trial; SGRQ: St George's Respiratory Questionnaire; UK: United Kingdom; US: United States; VAS: visual analogue scale; mMRC: Modified Medical Research Council; EQ-VAS: EuroQol-visual analogue scales; IPF-PROM: Idiopathic Pulmonary Fibrosis (IPF) Patient Reported Outcome Measure; KSQ: King's Sarcoidosis Questionnaire; PEF: peak expiratory flow; f-ILD: fibrosing interstitial lung disease; SF36: 36-Item Short Form; UCSD-SOBQ: The University of California, San Diego, Shortness of Breath Questionnaire.