Clinical Use of Home Spirometry in Children With Cystic Fibrosis

BACKGROUND: The use of home spirometry (HSPIR) has increased in pediatric cystic fibrosis (CF) care, but how it has been used clinically and its impact on clinical care have not been described. The purpose of this study was to address this knowledge gap through a secondary analysis of data from a HSPIR quality improvement project to characterize clinical use of HSPIR in children with CF (CwCF). METHODS: HSPIR devices were distributed to 161 CwCF (age ≥ 5 years) across three CF centers. Remote encounters were reviewed to identify HSPIR use from July 2023 to February 2025. Data collected included the clinical indication for testing and its impact on clinical decision making. Differences between HSPIR users and non-users were analyzed using Wilcoxon rank-sum, Pearson's chi-squared, and Fisher's exact tests as appropriate, and descriptive statistics were used to characterize clinical HSPIR use. RESULTS: Among 161 CwCF who were provided HSPIR devices, 50 (31%) used their HSPIR a total of 107 times and submitted tracking forms to their care teams over 20 months. There were no significant differences in demographics or clinical characteristics between HSPIR users and non-users. The most common reasons for HSPIR use were clinic follow-ups (44%) and sick calls (33%), with clinicians reporting that HSPIR data informed clinical decisions in 72% of encounters. In 41% of remote clinical encounters, we identified a missed opportunity for using HSPIR. CONCLUSION: In patients and families motivated to use HSPIR, its use avoided the need to return to the clinic for follow-up spirometry and influenced clinical decision making, suggesting that HSPIR can be a useful clinical tool. The overall low uptake of HSPIR highlights the need for further research to address patient and clinician barriers to its use. The impact of HSPIR on long-term CF outcomes also requires further study.