Comments
From the Authors:
We are grateful to Wuyts and colleagues for their supportive comments and interest in our article (1). In developing our study, we set out to explore whether it was feasible and clinically informative for individuals with idiopathic pulmonary fibrosis (IPF) to undertake monitoring of their disease with domiciliary spirometry. We agree with the clearly articulated thoughts of Wuyts and colleagues that in achieving these aims our study raises a series of important questions, especially concerning choice of best device, working with patients to optimize performance of unsupervised spirometry, integration of home-based readings into clinical practice and clinical trials, and exploration of the relationship between change in FVC and quality of life.
At the time of initiating our study, the concept of home disease monitoring was in its infancy. Since then, the idea that home monitoring of physiological parameters might improve the care of patients with chronic disease has gained increasing traction (2). In the last few years, a number of new portable spirometry devices, many offering direct Internet connection, have become available. The potential for real-time hospital-based oversight of home-performed spirometry provides an exciting opportunity to build on the observations presented in our manuscript. At the same time, we strongly advocate patient involvement in research to define choice of best device and to define how to better educate and support individuals undertaking home monitoring of IPF. We also agree with Wuyts and colleagues that the psychological impact for patients of seeing decline in their lung function should not be underestimated. This can be offset by building the use of home monitoring into clinical algorithms. The availability of antifibrotic therapy now affords the potential for spirometry data to be integrated into decision making regarding initiation and continuation of specific antifibrotic medications. Furthermore, daily readings provide a mechanism for early detection of acute exacerbations and may make studies seeking to identify the etiology and best treatment of this life-shortening complication of IPF feasible (3). We are keen to see future research performed that addresses these specific challenges.
As Wuyts and colleagues highlight, another possible role for home spirometry is as an efficacy end point in clinical trials. We believe that daily spirometry has the potential to shorten IPF clinical trials and maintain study power in an era of effective antifibrotic therapy (4). The validation studies necessary to show that this is the case overlap with those required to bring domiciliary spirometry to the clinic. Like Wuyts and colleagues, we hope that our data will provide the impetus for larger multisite studies of home spirometry, with the ultimate goal of improving care and outcomes for those afflicted with the dreadful disease that is IPF.
| 1. | Russell AM, Adamali H, Molyneaux PL, Lukey PT, Marshall RP, Renzoni EA, Wells AU, Maher TM. Daily home spirometry; an effective tool for detecting progression in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2016;194:989–997. |
| 2. | Kahn JM. Virtual visits: confronting the challenges of telemedicine. N Engl J Med 2015;372:1684–1685. |
| 3. | Collard HR, Ryerson CJ, Corte TJ, Jenkins G, Kondoh Y, Lederer DJ, Lee JS, Maher TM, Wells AU, Antoniou KM, et al. Acute exacerbation of idiopathic pulmonary fibrosis: an international working group report. Am J Respir Crit Care Med 2016;194:265–275. |
| 4. | Wuyts WA, Antoniou KM, Borensztajn K, Costabel U, Cottin V, Crestani B, Grutters JC, Maher TM, Poletti V, Richeldi L, et al. Combination therapy: the future of management for idiopathic pulmonary fibrosis? Lancet Respir Med 2014;2:933–942. |
On behalf of all authors
Author disclosures are available with the text of this letter at www.atsjournals.org.
