A43-01 Unrecognized Desaturation Preceding Infectious Exacerbation in Idiopathic Pulmonary Fibrosis: Insight From Retrospective Bora Care® Monitoring

Introduction Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease with unpredictable exacerbations that can rapidly become life-threatening. Patients often underestimate their symptoms because of gradual adaptation to chronic dyspnea, which complicates early recognition of exacerbations. Bora band® (Biosency, France) is a CE-marked wearable device that continuously records oxygen saturation (SpO2), respiratory rate (RR), heart rate (HR) and physical activity, and allows automatic data transmission to Bora connect® a secured remote monitoring platform. In this case, the data were reviewed retrospectively, after the patient’s clinical decline. Description A 55-year-old man, former smoker, had biopsy-proven IPF diagnosed three years earlier with chronic hypoxemic respiratory failure treated with ambulatory oxygen and pulmonary rehabilitation. His medical history included well-controlled hypertension. In May 2025, Horton disease was diagnosed and treated with corticosteroids. On 23 June 2025, he reported increased dyspnea and fatigue.Despite his pulmonologist’s advice on 30 June, he initially refused hospitalization. Angio-CT-scan excluded pulmonary embolism but revealed new bilateral ground-glass opacites. Levofloxacin and cotrimoxazole were initiated.Continuous Bora band® data revealed a progressive decline in SpO2 (nadir of 86% despite oxygen supplementation), increased in RR, stable HR and a reduced activity, consistent with physiologic deterioration which was actually going on since the 14th of June, so 9 days before the disclosed symptoms. Based on these objective data, the patient was convinced to go to the hospital. He was admitted on 10 July for probable Pneumocystis jirovecii pneumonia, confirmed during hospitalization and died on 18 July from respiratory failure despite humidified high-flow oxygen. Discussion This case illustrates how retrospective review of continuous physiologic data can uncover early deterioration invisible to clinical observation. The triad of sustained desaturation, tachypnea, and reduced activity represented a reproducible physiologic signature of a subacute infectious exacerbation.In this case, the good adherence to Bora band® (>90% wear time) ensured data reliability until the last days before hospitalization. The retrospective interpretation of these trends, though not real-time, provided objective confirmation of the patient’s decline and supported the decision to insist on hospitalization after initial refusal.While the outcome was fatal, the temporal alignment between physiologic data and clinical events demonstrates the accuracy and relevance of continuous monitoring. Even when analyzed retrospectively, such data provide valuable insight into the dynamics of respiratory failure. Telemonitoring should complement clinical care, and future real-time integration may enable earlier intervention, more personalized follow-up, and potentially help to treat earlier exacerbations of IPF which are often fatal.