COMPAIR: a comparison of directly supervised clinic versus virtually supervised home spirometry

Background Our objectives were to compare directly supervised in clinic spirometry (DSCS) with virtually supervised at home spirometry (VSHS), assess the utility of artificial intelligence (AI) over-reading and evaluate patients’ views of VSHS. Methods A multicentre, prospective, 8-day study was conducted in adult patients with physician-diagnosed asthma or COPD from UK primary/secondary care. Spirometry (forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC)) was performed using the NuvoAir Air Next Bluetooth portable spirometer supported by trained healthcare providers (HCPs) in clinic (Days 1 and 8) and virtually supervised at home (Days 2 and 7). Over-reading was done manually and by ArtiQ.QC (cloud-based AI). Inter-method concordance and agreement were assessed by correlation analyses and Bland–Altman plots, respectively. Participants completed a questionnaire (Day 8) to assess their views on VSHS. Results 68 participants were included (asthma: n=47; COPD: n=21). There was excellent concordance between HCP-over-read DSCS (Day 1) and VSHS (Day 2) as indicated by intraclass correlation coefficients for FEV 1 (0.95 (95% CI 0.92–0.97)) and FVC (0.95 (95% CI 0.92–0.97)), which were slightly higher when over-read by ArtiQ.QC (FEV 1 : 0.98 (95% CI 0.97–0.99); FVC: 0.96 (95% CI 0.93–0.97)). Bland–Altman plots showed good agreement between DSCS and VSHS, for both manual and ArtiQ.QC over-read assessments, with evidence of better agreement when over-read by ArtiQ.QC. More than 95% of patients considered the NuvoAir spirometer and mobile app easy to use and would be happy to use it in the future. Conclusions VSHS with the NuvoAir spirometer and ArtiQ.QC over-reading offers reliable and consistent measures of lung function for research purposes and potential clinical application in a population of patients with asthma or COPD. VSHS coupled with AI over-read allows spirometry to be performed at a more convenient location for patients while maintaining high-quality results, comparable to clinic-based spirometry.