A Portable Self‐Powered Turbine Spirometer for Rehabilitation Monitoring on COVID‐19

Coronavirus disease 2019 (COVID‐19) patients may experience persistent impairment of the lungs after recovery and discharge, which can cause a decline in pulmonary function. Therefore, regular pulmonary function tests are essential for COVID‐19 recovered patients, and portable, home‐based pulmonary function test devices are of great significance during the pandemic. Herein, a portable self‐powered turbine spirometer (PSTS) is designed for respiratory flow measurement and assessment of pulmonary function with high accuracy, humidity resistance, good durability, and low cost. The respiratory airflow can directly drive PSTS to produce a sinusoidal signal with a signal‐to‐noise of 40.64 dB. By utilizing the long short‐term memory (LSTM) model, the flow is successfully predicted, and the "lag‐before‐start” and "spin‐after‐stop” defects of the turbine spirometer are eliminated effectively. For pulmonary function tests, the flow‐volume loop curve can be obtained from PSTS, and pulmonary function parameters such as inspiratory capacity (IC), forced vital capacity (FVC) and forced expiratory volume in the first 1 s (FEV1) can be calculated. The accuracy of IC is over 95%, and others can reach over 97%. A portable smart pulmonary function assessment system is further developed and used to test the pulmonary function of COVID‐19 patients one month after symptom onset, demonstrating potential for assessing rehabilitation trends and long‐term follow‐up of COVID‐19 recovered patients. [ FROM AUTHOR] Copyright of Advanced Materials Technologies is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Attitudes amidst the pandemic: Virtual delivery of care in an adult cystic fibrosis population

Background: The COVID-19 pandemic has altered how we deliver care to people with cystic fibrosis (CF) across the spectrum of disease severity. Because of lockdowns and avoiding exposure to COVID-19 by limiting inperson clinic visits, clinical care has pivoted from standard practices to virtual care in combination with in-person traditional visits. This approach has allowed patients to be monitored and treated in a timely manner. Such virtual visits have the advantage of reducing the time commitment for clinic visits because the patient does not have to travel to and from the hospital, but virtual care lacks the ability to conduct a physical examination and to obtain objective and standardized testing of key measurements known to be associated with health outcomes in CF. The objective of this study was to evaluate the attitude of patients to virtual delivery of care and their comfort level with such care. Method(s): This is a prospective, cross-sectional survey of adults with CF who are followed at St. Michael's Adult CF Center in Toronto, Canada. An online survey was created using SurveyMonkey to assess attitudes toward and satisfaction with virtual care. The survey was emailed to participants and included the Canadian CF Registry ID;a reminder email sent a week later. Baseline demographic and clinical data were obtained from the Canadian CF Registry and presented as median (range) or proportions as appropriate. Questions using a 3-point Likert scale will be categorized into agree, neutral, and disagree. Result(s): A total of 210 participants (53.0% female) completed the survey (median age 37.8, range 19.2-78.9). Median age of diagnosis was 2.2, 95.7% were Caucasian, 76.0% had completed post-secondary education, 63.0% were employed and 11.0% were students, 75% were pancreatic insufficient, 39.0% had CF-related diabetes, and 12.4% were post lung-transplant. Median percentage predicted forced expiratory volume in 1 second was 65.8% (range 17.9-126.9%), and median body mass index was 23.6 kg/m2 (range 15.5-45.7 kg/m2). Eighty-one percent of respondents had had a virtual visit before completing the survey. Sixty percent of respondents felt that in-person visits were the preferred way of completing a medical assessment, and 27.0% preferred virtual visits. Seventy-three percent felt it was important for the virtual visit to occur at the booked time, 59.0% had concerns that their lung function was not assessed during virtual visits, 46.0% felt they were losing the benefits of allied health team assessments with virtual visits, and 40.0% worried that their health would decline if primarily seen virtually. Just over half of respondents wanted to continue with virtual visits in some capacity after the pandemic. The optimal proportion of in-person visits was felt to be 50.0%. More than 85% of respondents were comfortable with technology (phone or computer) and had reliable access to the Internet to conduct virtual visits. Seventy percent of people would like to have access to a home spirometer, but cost was a barrier. Conclusion(s): From the patient's perspective, in-person visits were still the preferred way to complete a medical assessment, which seemed to be driven by concerns over lack of methods for assessment, particularly lung function, and access to the multidisciplinary team. Home spirometers, if freely available, might increase comfort with virtual appointments.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Feasibility of telehealth spirometry for people with cystic fibrosis

Background: Telemedicine has flourished during the COVID-19 pandemic. There is increasing interest in performing spirometry at home as part of a telehealth program, especially in cystic fibrosis (CF), to follow the course of the disease, but it is unclear whether the quality and accuracy of home spirometry are comparable with those of in-clinic spirometry [1-3]. This study aimed to evaluate the feasibility and measurement quality of telehealth spirometry assessments for people with CF. Method(s): Patientswith acceptable hardware at homewere provided with a flow sensor portable spirometer (Spirobank Smart) compatible with ATS/ ERS 2019 standards for volume accuracy. They performed spirometry during "home admissions" or ongoing home monitoring for 1 year during the COVID-19 pandemic (January 2021 to January 2022). At the end of each session, the family forwarded the data to the CF center. Result(s): Twenty-nine people were evaluated (median age 17.4, range 6.7- 34;58% female;mean baseline percentage predicted forced expiratory volume in 1 second 79.8 +/- 21.4%). According to American Thoracic Society/ European Respiratory Society criteria, spirometry was performed successfully in 320 of 430 (74.5%) attempted sessions. The median distance between the subject's home and the hospital was 124 km (range 49- 418 km)-a median travel time saving of 1.5 hours per hospital visit. Conclusion(s): Home-based telehealth spirometry is feasible in people with CF and can support the CF team in ongoing outpatient monitoring.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Telehealth use in Australian cystic fibrosis centres: The clinician experience

Introduction/Aim: Telehealth has been rapidly adopted by cystic fibrosis (CF) centres in response to the COVID-19 pandemic, and ongoing use in routine CF care is endorsed by CF consumers. Data describing CF clinician perceptions and experiences with telehealth are scarce. These data are crucial to inform the future use of telehealth in CF care. We aimed to describe clinician experiences and attitudes towards telehealth in CF care among multidisciplinary health professionals across Australian paediatric and adult CF centres. Method(s): An anonymous electronic survey was sent to CF multidisciplinary health professionals from all CF clinics in Australia on a single occasion. The survey consisted of 48 questions designed by a multidisciplinary team. Result(s): Eighty-five responses were received representing 15/23 (65%) centres. Respondents worked in a mixture of paediatric (57.6%), adult (36.5%) and combined (5.9%) settings. Most clinicians reported using telehealth for routine clinic visits and a range of other clinical encounters (69.9%). Telehealth was widely perceived as acceptable (91.8%), and clinicians were comfortable/very comfortable (81.2%) integrating telehealth into future CF care. Despite this, 64.1% of respondents considered telehealth clinics to be much worse than face-to-face clinics and 57.5% reported quality of care was somewhat/much worse using telehealth. Home spirometry was available in 73.7% of centres, however, only 26.7% of clinics could provide spirometers for >75% eligible patients. Growth and microbiology assessments were often missed in telehealth clinics and 75.7% reported a technical issue had prevented a telehealth consultation from occurring. Conclusion(s): Telehealth for CF in Australia is considered feasible and acceptable by CF health professionals, although use of telehealth varies widely between centres. Concerns exist around the impact of telehealth on health outcomes;especially given core assessments are frequently omitted. National guidelines may help ensure the benefits of telehealth are realised for people with CF without compromising the standard of care.

Ultrasonic personal spirometer appears accurate and feasible for remote monitoring

Introduction/Aim: Home spirometry may improve respiratory disease monitoring and management and mitigate the decline in testing exacerbated by COVID-19. Smartphone-connected spirometers could allow patients to conduct spirometry independently without the need to travel to lung function clinics. This study assessed the accuracy of a personal spirometer and the feasibility of unsupervised home spirometry. Method(s): Subjects (19-88 years) with (n = 44) and without (n = 20) respiratory disease, were recruited and supervised to perform spirometry on a standard desktop spirometer (MGC Diagnostics) and a personal ultrasonic spirometer (SpiroHome) in the clinical laboratory. Unsupervised testing was subsequently conducted using the SpiroHome at the subjects' home (2 tests/week for 3 weeks). Subjects returned to the clinic to conduct an exit survey which assessed their willingness to adopt a personal spirometer into their long-term care plan. Comparisons between desktop and personal spirometry, as well as supervised and unsupervised spirometry, were compared by Bland-Altman analysis (%Bias +/- CI) and Pearson's correlation. Result(s): The proportion of tests meeting American Thoracic Society/European Respiratory Society criteria (80%) remained constant across clinic and home spirometry sessions for subjects who completed 3 weeks of home testing (p = 0.73, Fisher's exact test, n = 61). Supervised spirometry on the SpiroHome (n = 56) reliably measured FEV 1 (-3.12+/-27.01%;r=0.98, p < 0.0001) and FVC (-0.38+/-22.91%;r=0.99, p < 0.0001) producing a small underestimation compared to desktop spirometry. Unsupervised home spirometry (when performed <24 hrs from the clinic appointment) on the SpiroHome (n = 51) produced a small underestimation of FEV 1 (-2.41+/-35.57%;r=0.96, p < 0.0001) and a slight overestimation of FVC (0.08+/-24.70%;r=0.98, p < 0.0001) compared with supervised manoeuvres in the clinical laboratory. Conclusion(s): Findings indicate that lung function assessed by SpiroHome compares well with in-clinic standard desktop spirometry across a range of diseases and severities in both the clinic and home settings. A larger cohort of subjects are being recruited to confirm the accuracy and the overall utility of personal spirometry.

Using digital technology for home monitoring in children and adolescents with cystic fibrosis

Introduction: Cystic Fibrosis (CF) centers globally increased the number of telehealth clinics during the Covid-19 pandemic and developed processes utilizing telemedicine to replace a standard clinic visit. Whether these new approaches provide an opportunity to improve patients' clinical condition need further investigations. Aims and objectives: To assess the short-term clinical impact of using the NuvoAir Home platform to monitor children and adolescents with CF at home for six months as part of a virtual model of care. Method(s): The NuvoAir Home platform consists of a smartphone application, Bluetooth spirometer and clinician portal. Patients and/or parents were trained to use the platform and asked to do home spirometry monthly. Cystic Fibrosis Questionnaire-Revised (CFQ-R) was collected at the time of study entry and after six months. We calculated the percentage of change between "pre" and "post" conditions of the variables. Result(s): Sixteen children and adolescent CF patients from Federico II Hospital, Naples, Italy (9 females;mean age 16.3+/-0.9;5 homozygous for delta F508;FEV1 79.5+/-26.2 % predicted;FVC 91.6+/-23.6 % predicted;BMI 21.5+/-3.8) were recruited from June 2021. All patients had completed six months follow-up. CFQ-R revealed higher scores indicating a higher patient-reported quality of life with regard to "health perception" + 3%, "social limitations" + 11%, "digestive symptoms" + 6%. We observed a 2 % improvement from baseline in FEV1 % predicted. There was no difference in pulmonary exacerbation versus the previous year. No changes of medical treatment were reported during that time. Conclusion(s): Digital technology for home monitoring in children and adolescents with cystic fibrosis led to improved quality of life and lung function.

Post-recovery pulmonary function test and thorax CT correlations in COVID-19 survivors

Aim: Long-COVID has been described as persistent symptoms involving multiorgan systems in COVID-19 survivors. This single-centred study investigated the correlation between pulmonary function test (PFT) and thorax computed tomography (CT) results in COVID-19 survivors after six months of follow-up period. Material(s) and Method(s): Patients recovered from COVID-19 aged between 18 and 50 years were included in this study and divided into two groups according to PFT results as patients with normal PFT results (PFT normal;n = 74) and with PFT results with restrictive pattern (PFT restrictive;n = 12). The primary aim of this study was to try to predict the prognosis of long-term chronic pulmonary system diseases using pulmonary function test, thorax CT and laboratory findings in the sixth month after recovery. Result(s): There were no significant differences between the patients in PFT normal and PFT restrictive groups in terms of symptoms and CT findings at admission. On the other hand, the rate of dyspnoea and exertional dyspnoea was significantly more pronounced in patients in PFT restrictive group, while there were no significant differences between CT findings. Both univariate and multivariate regression analyses showed that percent forced expiratory volume in one second (%FEV1) and percent forced vital capacity (%FVC) results are associated factors in discriminating normal and PFT results with restrictive pattern in COVID-19 survivors. Discussion(s): PFTs should be included in follow-up evaluations of COVID-19 patients in order to elucidate the post-COVID-19 pulmonary abnormalities.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Feasibility of telehealth spirometry for patients with cystic fibrosis in a regional setting

Introduction: Telemedicine has flourished during the covid-19 pandemic. There is an increasing interest in performing spirometry at home, as part of a telehealth program, especially in cystic fibrosis (CF), to follow the course of the disease. However, it is unclear whether the results of home spirometry are comparable with the in-clinic performed spirometry in terms of quality and accuracy. Aim(s): To evaluate the feasibility and measurement quality of telehealth spirometry assessments for patients with CF living in a regional setting. Method(s): Patients with acceptable hardware at home were provided with a flow sensor portable spirometer (Spirobank Smart) compatible with ATS/ERS 2019 standards for volume accuracy. They performed spirometry during 'home admissions' or ongoing home monitoring for one year over the COVID-19 pandemic (January 2021 to January 2022). At the end of each session, the family forwarded the data to the CF Centre. Result(s): Twenty-nine patients with median age 17.4 years (6.7 to 34 years), 58% females were evaluated (mean baseline FEV1pp 79.8 (21.4). According to the American Thoracic Society/European Respiratory Society criteria, they performed successful spirometry in 320 of 430 (74.5%) attempted sessions. The median distance between the subject's home and the hospital was 124 km (range 49-418 km), equating to a median travel time saving of 1.5 hours per hospital visit. Conclusion(s): Home-based telehealth spirometry is feasible among patients with CF and can support the CF team for ongoing outpatient monitoring.

Assessing the utility of home spirometry for managing children with cystic fibrosis during COVID-19 pandemic

Background: The coronavirus pandemic has accelerated the change to e-health services. Home spirometry has been rolled out to facilitate remote monitoring, but accurate measurements are essential. Aim(s): This study compares the technology for home spirometry (using Nuvoair) with that used for standard spirometry in hospital (using EasyOne). Method(s): Spirometry data of 81 children with CF (Cystic Fibrosis) were collected prospectively over a period of 9 months. All patients had paired spirometer measurements taken on the same day and time in clinic, prior to Nuvoair spirometers being given out for home use. A survey was sent to all participants included in the study. Result(s): Of 81 children, 54 provided interpretable measurements, 27 were excluded due to poor quality results. Mean age was 13.2 years (range 7.3 - 17.2). The mean difference between paired measurements in FEV1 (L) was 55 ml, 95% CI (29ml, 80 ml), FEV1% was 2.4%, 95% CI (1.5%, 3.4%) and FEV1 Z score was 0.22, 95% CI (0.14, 0.3). The Bland-Altman of FEV1 Z-score shows a degree of agreement between the methods with a bias of 0.22, limits of agreement (-0.3, 0.8). All the survey respondents (n=11) found home spirometer easy to use. 81% of the respondents preferred a combination of home and hospital testing. Conclusion(s): The study shows comparable results between the two methods of spirometry with no significant statistical or clinical difference. Feedback from families was positive. Home spirometers (Nuvoair) provide acceptable results when used with professional supervision and can be used as a resource in managing children with CF. Separate evaluation is needed for unsupervised home spirometry.

Effect of compression of fourth ventricle on the respiratory capacity in the post COVID patients

Introduction and Aim: Post-covid syndrome is the group of nonspecific symptoms which are seen among the patients who have been recovered from COVID-19 and that persist over 4 weeks. Symptoms involve fatigue, breathlessness, cough, cognitive disturbances, depression and anxiety, many organs related symptoms, and the prominent features involve shortness of breath and inability to return to baseline activity level. Studies show that Pneumonia which is associated with the COVID-19 infections can lead to long-standing damage to the alveoli in the lungs and as a result scar tissues may develop which in the future can lead to long-term breathing problems. The aim of this study is to assess the effectiveness of osteopathic CV4 technique in post covid patients. Material(s) and Method(s): This is a pre-test and post-test experimental study conducted at Sri Sri University. In this study, 20 subjects both male and female, having mean age of 23.3 +/- 2.81 years were taken. After assessment of all inclusion and exclusion criteria, a brief history regarding COVID-19 and if present other respiratory disorders was taken. Following this, a 5 minutes window period was given to all participants before the collection of pre-test data. Result(s): When CV4 osteopathic technique was given to post-covid patients, there was a significant change in FVC, FEV1, PEF and pulse rate when compared to the pretest intervention data. However, the changes in oxygen saturation levels were not statistically significant. Conclusion(s): The results show that osteopathic CV4 technique alters the respiratory capacity in post covid patients.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.

Successful creation of a home spirometry program within an adult cystic fibrosis clinic

Background: Highly effective modulator therapy and the COVID-19 pandemic have transformed cystic fibrosis (CF) care. Increased use of telehealth has resulted in fewer in-person visits, although close monitoring continues to be crucial in preventing complications. Home spirometry is a useful, accessible tool that people with CF can use to monitor their lung function. In spring 2020, the University of North Carolina (UNC) Adult CF Clinic began to distribute home spirometers to their patients through the Cystic Fibrosis Foundation (CFF). At the time, we lacked a standardized home spirometry program and found it challenging to engage patients in regular use of the device. As a result, the UNC adult CF advanced practice provider (APP) and respiratory therapist (RT) collaborated to lead a quality improvement (QI) project aimed at improving home spirometry at their center. Method(s): Goals of the QI effort were to provide individual education for all patients with a home spirometer, incorporate home spirometry assessments into the RT workflow, and provide monthly interpretation of home spirometry results. The CF RT used Epic MyChart messages to engage patients who needed education and to remind patients to use their device before all visits (virtual or face-to-face). The RT and APP also provided inperson teaching and troubleshooting in clinic, and an educational handout was created. Lastly, one-on-one educationwas provided over the phone on nonclinic days. Between November 2021 and January 2022, people with CF who had received a device and adult CF clinicians were surveyed for anonymous feedback on the program. Survey questions used a 5-point Likert scale to indicate agreement with the survey statement and were adapted from a previous home spirometry survey in lung transplant patients [1]. Result(s): Two hundred sixty-five patients (of 327 total adults with CF at UNC) have received a home spirometer through the CFF or another source;250 of these (94%) have received one-on-one education. All six adult CF clinicians completed the feedback survey. The results indicated a high level of satisfaction and a sense that spirometer use was clinically useful (Figure 1). Seventy-eight patients completed the feedback survey. Regarding the program's utility, respondents agreed or strongly agreed with the following statements: spirometer is easy to use (81%), received adequate training (88%), spirometer is accurate (78%), team is interested in my results (96%), makes me feel secure in detecting problems with my lungs (60%), helpful to share results on the provider dashboard (68%), and am overall satisfied with the home spirometry program (78%). When patients were asked about barriers to use of their home spirometer, 48 (62%) selected "none." The most commonly identified barriers (number of responses)were anxiety (5), too difficult to use (4), too time consuming (3), forgetfulness (3), and accuracy (2).(Figure Presented) Figure 1. Adult cystic fibrosis clinician survey results on home spirometry Conclusion(s):Wewere able to leverage thewidespread availability of home spirometers to create a successful home spirometry program within the UNC adult CF clinic. Our survey results indicate that clinicians and patients felt that home spirometry was useful and were highly satisfied with the program Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Design and implementation of a spirometric measurement system that can measure COPD parameters

The importance and need for respirators has once again shown itself due to the coronavirus (Covid-19) epidemic, which has recently spread around the world and has been declared as a Pandemic (epidemic worldwide) by the world health organization. Monitoring respiratory activity plays a vital role in detecting respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD). In this study, a working group of 6 participants was formed to measure respiratory parameters. Each individual was provided to perform FVC, VC, MVV, RR and TV performance. The measurements were carried out simultaneously with the medical spirometer device. A total of 1860 data (1500 data for VC, 360 data for MVV) were sampled and all data were analyzed in Matlab program. It was observed that the results obtained were quite similar to each other (RMVV=0.998 for MVV;RVC=0.997 for VC). One of the most important contributions of this study is that the measured data can be sent to the computer and saved to the SD card. Thus, with the thermal printers in standard spirometers, paper wastage was prevented and the data was stored in digital environment. The developed system offers a practical and low cost solution. The developed device is expected to take an important place in biomedical device technology with its ability to measure COPD parameters.

CLINICALLY MEANINGFUL DATA FROM REMOTE SPIROMETRY MONITORING IN ASTHMA MANAGEMENT IN A US-BASED OBSERVATIONAL STUDY

SESSION TITLE: Unique Uses of Pulmonary Function Tests SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Prevention of asthma exacerbations can be done through adequate self management at home. This study aimed to evaluate the feasibility and safety of a portable spirometer for unsupervised home spirometry measurements among patients with asthma. METHODS: A single center, prospective, single-arm, open study recruited 25 patients with moderate or severe asthma. After a 45 min video training session by a respiratory therapist, patients performed daily spirometry at home with the Spirobank Smart MIR mobile spirometry system that was bluetooth connected to the KevaTalk app. Each spirometry examination was recorded and evaluated according to the ATS/ERS acceptability and repeatability criteria. Patients had to perform at least three technically acceptable maneuvers with the KevaTalk app guiding them if they had a good or bad blow. The best value of the three maneuvers were used for subsequent analyses. Patients also entered their daily check ins and symptoms via the KevaTalk Asthma app, tracked their controller and rescue medication use, filled up ATAQ questionnaires as well as were reminded of their action plans. Data obtained from spirometry was reviewed by nurses and pulmonologist and the Keva365 remote monitoring platform prompted alerts based on patient checkins, use of medication and PEF values in the red or yellow zone. Any escalations based on nurse review were reported to the office. RESULTS: Mean age of the patients was 57 years. 1155 spirometry sessions were completed over the duration of 9 months of the study. Data for FEV1, FEV6, PEF FEV1/FVC, as well as the Best Predicted and LLN values was reviewed daily for patients. Flow volume loops during the sessions were reviewed to identify if the home spirometry was done correctly and retraining was provided if needed. The reported values were tracked over the duration the patient was enrolled in the Keva program. 60.9% of patients were found to have peak flows in their respective red zones at least once and 87% were found to have peak flows in their yellow zone at least once, during the course of the study. If 3 consecutive values were in the yellow or red zone along with worsening of symptoms, the physician's office was informed for further course of action. CONCLUSIONS: The COVID-19 pandemic led to paucity of in office spirometry and face-to-face visits for asthmatic patients. Increasing the availability of spirometry with handheld devices along with a remote monitoring platform is useful for improving asthma control and reducing the risk of asthma-related hospital admissions and deaths. CLINICAL IMPLICATIONS: Remote objective spirometry yields clinically meaningful information that helps with asthma patient management and prevent an exacerbation from becoming worse. DISCLOSURES: No relevant relationships by Karim Anis No relevant relationships by Varada Divgi No relevant relationships by Jyotsna Mehta No relevant relationships by Shail Mehta No relevant relationships by Denzil Reid

REMOTE PATIENT MONITORING STUDY AMONG PATIENTS WITH ASTHMA: A SINGLE CENTER EXPERIENCE

SESSION TITLE: Unique Uses of Pulmonary Function Tests SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Asthma is one of the most common chronic respiratory illnesses affecting quality of life of patients, mortality as well as a high impact on health care utilization. In the era of the COVID19 pandemic, telemedicine and remote patient monitoring (RPM) have been heavily utilized by healthcare systems and providers for patient care. In our pilot program at a large US healthcare center, we enrolled patients known to have asthma to evaluate how RPM could be of value to both the patients and providers. METHODS: Patients included in the study had a confirmed diagnosis of moderate/severe asthma, were at least 18 years of age, and had access to an Android/iOS mobile device with internet access. The patients were excluded from the study for any conditions that would prevent them from using an app such as visual, cognitive, or other impairments that may prevent the patient from being able to participate. Patients were provided with a connected mobile spirometer, the KevaTalk app on their phones and educational introductory sessions during 9 months of the study. Each patient had their action plan and list of medications entered into the Keva365 platform by the nurse or the patient themselves. We provided a baseline patient questionnaire to assess usefulness and evaluate the app features, an ATAQ questionnaire for asthma control and a Smoking cessation questionnaire. Patients were asked to check in daily into the app as green (no symptoms), yellow (some symptoms) or red (bad symptoms). Patients were asked to perform spirometry using a connected spirometer. Remote monitoring protocols were set up for patients which included specific requirements for alerts being escalated to the pulmonologists. We monitored check-ins, alerts, and escalations during the study time window. RESULTS: A total of 25 patients were included in this pilot. Mean age was 57 and majority (23) were female. A baseline questionnaire rating the app, indicated that ease of check-in and ease of modification to the patient's asthma plan were the two highest rated features. 2066 total check ins (1550 green, 506 yellow and 10 red checkins) and 1155 spirometry sessions were recorded during this period. 484 alerts were recorded and evaluated by the monitoring team, of which 37% required an escalation to the physician requiring an intervention which included transfer to a medical facility, change in respiratory medication or further education. CONCLUSIONS: Patient driven engagement along with a well executed RPM program leads to increased compliance and improved outcomes among patients with respiratory illnesses. CLINICAL IMPLICATIONS: Our findings demonstrate preliminary evidence of the clinical impact of respiratory focused remote monitoring combined with a process for triaging our pulmonary patients. Adoption by pulmonolgists and allergists of these digital remote programs can pave the way for reduced physican burden, improved outcomes and reduced costs. DISCLOSURES: No relevant relationships by Karim Anis No relevant relationships by Jyotsna Mehta No relevant relationships by Shail Mehta No relevant relationships by Denzil Reid

The characterisation of a patient cohort that had home spirometry devices and opted into sharing their data with the US Cystic Fibrosis Foundation

Objectives: To analyse characteristics of people with cystic fibrosis (PwCF) who were using home spirometry devices (HS) during 2020–2021 Methods: During the COVID-19 pandemic, the CF Foundation (CFF) partnered with a technology vendor, ZephyRx, to distribute MIR HS devices to eligible PwCF. During 04/2020–12/2021, 20,157 spirometers were shipped to PwCF. PwCF enrolled in the CFF patient Registry (CFFPR) provided an additional consent to have their HS values linked to their CFFPR data. An application programming interface (API) was built to allow transfers of HS data (FEV1, FVC, FEF25–75, sex, date of birth, height) from each device. Each record contained a CFFPR ID to enable its linkage to the CFFPR. This analysis uses CFFPR data to describe the HS cohort and the data obtained through API to characterise HS utilisation trends. Demographic and clinical characteristics between the HS cohort and the 2019–2020 CFFPR population ages 7 and older were also compared. Results: 272 (94.4%) CF programs participated in the HS program. Records of 1,537 patients, who had activated their device by January 10, 2021, or earlier were linked to CFFPR. The cohort was 69.8% adult, 89.5% Caucasian, 57.8% female, and had a mean age of 27.8, and mean FEV1 of 79.9% predicted. When compared to the CFFPR population, the HS cohort was older, contained more Caucasians and females, and had lower lung function. The median number of acceptable FEV1 measurements supplied per PwCF was 4 (IQR 2–8). 1065 (69%) PwCF in the HS cohort continued to use their device 6 months from activation. Conclusions: HS data has the potential to augment care and research databases like the CFFPR. Little is known about PwCF’s long-term usage of HS devices in a real-world setting. While the HS cohort is small and may be biased compared to the CFFPR population, we have established a reliable channel for collecting HS data and that PwCF’s usage patterns suggests that most are using the devices on a regular basis.

Comparison of FEV on a remote spirometry device with hospital software in an adult cystic fibrosis cohort

Objectives: The use of digital technology for remote monitoring has increased within CF care in recent years, including the use of remote spirometry. The challenges posed by the COVID-19 pandemic have also meant that delivery of CF care virtually has been required. The NuvoAir platform allows for remote lung function monitoring and is validated for spirometry, however there is no real-world data comparing results to hospital spirometry within an adult CF cohort. FEV1 is an established marker of disease progression within CF. Accurate spirometry results are therefore key in guiding appropriate decision-making. Repeatability of FEV1 and FVC is defined as results being within 150 mls of each other. Methods: FEV1 (L) completed by CF patients at St Bartholomew’s Hospital, on the same day on the NuvoAir Air Next spirometer and SentrySuite Vyaire Medical software, were recorded. Spirometry was completed at either an outpatient review, MDT clinic or during admission. Results were collected between August 2020 and December 2021. Results: A total of 46 sets of results were recorded. The mean difference between FEV1 (L) on the 2 devices was 0.035L (1.6%). The correlation between the FEV1 (L) on the NuvoAir Air Next and SentrySuite was statistically significant (p = 0, r = 0.97). The number of FEV1 results that varied by more than 150mls between devices was 22/46 (47.8%). Conclusion: FEV1 results from the 2 devices showed a statistically significant correlation and a small mean difference. However, as almost half of the sets of results varied by more than is acceptable for determining repeatability, the 2 devices cannot consistently be perceived to be comparable in clinic practice. Further data collection is needed to review the sensitivity to change on the NuvoAir Air Next device compared with hospital spirometry software within a CF cohort.

Telemedicine clinics for people with cystic fibrosis (CF): experiences 18 months on

Introduction: At the start of the 2020 COVID-19 pandemic, our adult CF unit established a telemedicine service to deliver clinical care for people with CF (pwCF). We previously assessed the impact of this change during the UK lockdown, with audio-visual quality and home spirometer connectivity issues identified as barriers to service delivery.1 Despite the cessation of lockdown and shielding advice for pwCF, this service continues at our centre. Physiologist-led home spirometer coaching, provision of postal sputum surveillance and face-to-face (FTF) consultations offered to selected individuals have attempted to address these issues. Methods: We designed a cross-sectional survey of 18 rating-scale questions to evaluate perceptions of our telemedicine service, which was sent to all pwCF registered to our centre, via the AccuRx service. Results: A total of 64/365 (18%) responded (see table). Respondents rated their overall telemedicine experience as positive and 88% preferred telemedicine over FTF consultations. 92% rated the service as efficient as compared to 86% people previously. 99% reported good audio-visual quality, up from 68% previously. Conclusion: Telemedicine services continue to be an efficient means of outpatient service delivery for pwCF. (Table Presented)

Home spirometry and virtual visits in children with cystic fibrosis – the child’s perspective

Objectives: Children with cystic fibrosis (CF) in Sweden are routinely monitored at the hospital more often than the recommended CF guidelines. The COVID-19 pandemic has challenged the healthcare system and the use of digital tools and virtual visits has rapidly increased. The aim of this study was to investigate how children experienced home spirometry (HS) and virtual visits. Methods: A prospective multicentre study including children aged 5–17 years from all 4 Swedish CF centres were conducted between May 2020 to November 2021. All participants received a home spirometer AirNext (NuvoAir,Stockholm, Sweden). Physical visits could be converted to virtual visits during the study and the children were instructed to perform HS prior to both virtual and a physical visits. An anonymous survey was conducted at the end of the study. Results: A total of 60 children with CF were included in the study. During the mean (range) study period of 6.8 (3.1–11.5) months, they completed on average 2.3 (1–4) virtual visits and 3.0 (2–4) physical visits. The survey was completed by 55 (92%) participating children with a mean age of 11.5 (5– 17) years. The virtual visitswere rated just as high as the physical meetings. No child felt more stressed with the opportunity to perform HS;on the contrary, some children (22%) felt less stressed with this possibility. After the introduction of HS, almost all children (98%) responded that they felt calmer or as before the introduction of HS. Half of the children responded that they nowunderstand their CF-disease better than before. Virtual visits reduced the burden of travel time to the hospital and shortened the mean time away from school up to 3.0 (1.3–4.0) days over a year. Conclusion: Home spirometry increased the understanding of the CF lung disease and did not cause more stress in children with CF. Virtual visits were very appreciated and provide a possibility to decrease school absenteeism due to fewer physical visits at the hospital.

Comparison of Video-Coached Remote Spirometry with In-Person Spirometry in Patients with Severe Asthma Participating in the NHLBI PrecISE Network

Introduction: PrecISE is an ongoing Phase II clinical trial sponsored by the National Heart, Lung, and Blood Institute to investigate the efficacy of several treatments for severe asthma. The threat of COVID-19 has raised interest in obtaining reliable spirometry data for asthma research and clinical care in a remote, “no-touch” fashion. Prior studies of the accuracy of remote spirometry have not included real-time coaching. The PrecISE investigators hypothesized that remote spirometry with real-time video coaching could provide an accurate FEV1 for use as a study endpoint in a clinical trial setting. Methods: PrecISE network participants had remote spirometry post-bronchodilator (4 puffs of albuterol) measured with video coaching from trained research coordinators using the ZEPHYRx platform connected to MIR Spirobank Smart handheld spirometers. Remote spirometry measurements occurred within a +/- 3-day window from scheduled in-person PrecISE visits during which in-person spirometry with bronchodilator challenge was measured with standard equipment (Vyaire Medical). All measurements occurred during the screening/run-in period of the PrecISE protocol. Both remote and in-person spirometry was overread by the PrecISE Spirometry Core and only included in analysis if sessions met ATS acceptability and reproducibility criteria. Correlations between remote and in-person FEV1 and FVC were analyzed, and Bland-Altman plots generated. As a comparison, within subject biological variability was measured using data from separate in-person visits during the screening/run-in period. Results: A total of 128 pairs of remote/in-person spirometry data were obtained. The mean FEV1 for remote spirometry was 2.50 L (SD 0.81) and for inperson spirometry was 2.42 L (SD 0.80), with an estimated correlation of 0.95 (95% CI: 0.93, 0.97). The mean difference in FEV1 (in-person - remote) was -0.07 L (95% CI: -0.11, -0.03, SD 0.25). The mean FVC for remote spirometry was 3.72 L (SD 1.01) and for in-person spirometry was 3.53 L (SD 0.93), with an estimated correlation of 0.91 (95% CI: 0.87, 0.93). The mean difference in FVC (in-person - remote) was -0.19 L (95% CI: -0.27, -0.12, SD 0.42). A total of 142 pairs of repeated in-person spirometry measurements were performed (median time between measurements: 43 days), with mean difference in FEV1 of -0.01 L (95% CI: -0.06, 0.03) and FVC of -0.02 L (95% CI: -0.07, 0.03). Bland-Altman plots for FEV1 differences are shown in Figure 1. Conclusions: Remote spirometry with real-time video coaching provides a reliable FEV1 measurement which correlates closely with in-person spirometry and is suitable for use in clinical trials. (Figure Presented).

New Possibilities for Home E-monitoring of Pulmonary Function in Patients with Duchenne Muscular Dystrophy - ePULMoDMD Project

RATIONALE. Duchenne muscular dystrophy (DMD) is the most common and severe muscular dystrophy recognized in childhood. Genetically determined progressive dystrophin dysfunction in skeletal and multiple organ muscles is fatal before the age of 20 years without multi-specialized care. The most common cause of death is respiratory muscle failure. The primary task in caring for patients with DMD is the early monitoring of pulmonary functions. This has become difficult during the pandemic SARS-CoV-2 as the procedures generate aerosols, i.e. high risk of SARS-CoV-2 virus transmission. The aim of the study was to evaluate the capacity of the patients with DMD to perform longitudinal daily spirometry examinations at home. METHODS. The patients with DMD were recruited from the Rare Disease Centre, Medical University of Gdask, Poland (a member of the TREAT NMD Alliance Neuromuscular Network). Physical examination with anthropometry measurement, Vignos scale (VS), Brooke scale (BS), and Pulmonary Function Tests were measured during 3 months of monitoring. Participants used home spirometry (AioCare System, Healthup), twice every day. The adherence and correctness (separately for FEV1 and FVC) of spirometry examinations were evaluated. RESULTS. We recruited 20 boys with mean age 11.7(3.0) years (range 7-16 years) and BMI 22.3(5.5) kg/m∧2 with a median VS of 2.5 (IQR 6.5) and BS of 2 (IQR 4.0). During 3 months of monitoring 1301 spirometry examinations were performed;32% of them meet ATS/ERS criteria for FEV1 and FVC, 35% for FEV1 and 33% for FVC, however 50% of patients performed examinations with at least one maneuver with correct FVC. The mean adherence considering performance spirometry examinations twice a day was 39(26)% (range: 6%-98%). We observed a significant increase of FVC values during the monitoring period in 4/20 of patients based on linear regression model estimation. The study is still ongoing. CONCLUSIONS. The systematic pulmonary function monitoring at home in patients with restrictive diseases is an innovative project. The results showed that patients with DMD are able to monitor the lung function using a mobile spirometry system. We observed that in some cases, based on patient feedback, systematic spirometry tests were a form of pulmonary exercises and could be one of the factors that increase FVC after 3 months of monitoring. Personal spirometers could be used as a part of the therapy of patients with muscular dystrophy.