A study to explore how a Physiologist-led home spirometry service (PLHSS) can help identify different asthma phenotypes for an improved patient centred approach.

Abstract

Background Varying presentations and variability in asthmatics lead to treatment delays and quantitative measurements are to achieve an optimised and personalized management plan. Optimal care relies on an accurate diagnosis. Due to the variable physiology, single tests do not provide enough information about the patient’s condition as peak flows and spirometry can vary between days, seasons and in response to triggers. Asthma can be severe or difficult-to-treat, and many conditions coexist mimicking its symptoms which makes it difficult to determine which aspect is contributing most to the patient’s presentation. A physiology-led home spirometry service (PLHSS) obtaining quality assured spirometry (QAS) ensures spirometry including airflow obstruction is captured with the best patient effort which can help associate patients’ spirometry to their symptoms to objectively evaluate asthma control and determine the most appropriate management. This study will evaluate the value of PLHSS in the management of asthmatics in the outpatient clinic.

Methods 20 patients were monitored over 12 weeks in the asthma clinic and onboarded to NuvoAir-PLHSS. Patients were coached by a respiratory physiologist on performing QAS four-times-weekly and when symptomatic. Data are evaluated and reported on a digital platform.

Results High (>20%) variability of FEV1 was identified in 11 patients out of 20. 60% of patients had confirmation of a management plan after the first clinic appointment and within a month of initiating the PLHSS as they were referred for biologics or other therapies such as speech-and- language. All patients reported that PLHSS was easy to use and 88% reported it helped their understanding of doing tests with guidance and explanation of what spirometry measured and its importance.

Conclusion PLHSS can improve aspects of patient care in an outpatient pathway and clinic utilisation, ensuring treatment plans are formulated sooner, quicker discharges and referrals are made, and severe patients are seen earlier.