Feasibility of Home Spirometry for Early Identification of Pulmonary Dysfunction after HSCT in the Transpire Research Study

Introduction Bronchiolitis obliterans syndrome is a devastating complication following hematopoietic stem cell transplant (HSCT) which can be treated once detected. Spirometry offers the opportunity for earlier detection of lung function decline in at risk patients, but many patients do not live near their HSCT center and may not be able to return for frequent spirometry monitoring. As part of the TRANSPIRE research study, we are evaluating the feasibility of home spirometry as a remote monitoring strategy in pediatric and young adult HSCT recipients. Methods TRANSPIRE is an ongoing multicenter prospective cohort study of pulmonary complications in pediatric and young adult HSCT recipients. Home spirometry is being studied at three sites in eligible participants, defined as those with the ability to do acceptable and repeatable, or at least consistently usable, spirometry by American Thoracic Society standards in the clinical pulmonary function laboratory. Subjects were provided with a home spirometer (GoSpiro, Monitored Therapeutics, Dublin, OH) that connects to their blue tooth capable device via a free proprietary app and are trained in its use. Data is transmitted electronically directly to a HIPAA compliant server and then downloaded by study staff. If a subject was noted to not be performing home spirometry consistently, study staff reached out and provided reminders. Home spirometry was initiated at Day 100 post-HSCT and actively monitored for 6 months. Data collected for this interim feasibility analysis included patient demographics and the frequency of home spirometry use. Results Forty-seven subjects were eligible for home spirometry across all 3 sites, and 37 subjects were successfully initiated with a mean age of 14.9 years, 26 (70%) are male. Of those, one subject died, 2 electively withdrew, and 12 are still actively being monitored. Of the 22 (59%) subjects who have completed the study monitoring period, 21 (95%) had at least one use during month 1, 11 (50%) during month 3, and 10 (45%) during month 6. In subjects with at least one use during the month, they used it on average 4.1 days during month 1, 3.5 days during month 3, and 3.1 days during month 6. Conclusions Home spirometry monitoring of pulmonary function is feasible in pediatric post-HSCT patients with adherence rates similar to other home interventions in medically complex children. However, further efforts directed towards increasing longitudinal adherence rates are necessary.