Feasibility study abstract evaluates home spirometry and FeNO for asthma diagnosis in adults
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Key Takeaway
Consider home spirometry and FeNO monitoring as early evidence requiring further evaluation via adequately powered diagnostic studies.
This publication is an abstract describing a feasibility study conducted in home and clinic settings. The population consisted of symptomatic, untreated adults with general practitioner-suspected asthma. The intervention involved home spirometry and fractional exhaled nitric oxide (FeNO) monitoring compared against in-clinic diagnostic tests and an expert panel reference standard. The primary outcome assessed clinical feasibility and potential utility in asthma diagnosis.
Regarding adherence to home measurements, the median adherence was 66.7(58.6-97.6)% for spirometry and 78.5(51.8-103.6)% for FeNO. Absolute numbers indicated 37 participants completed spirometry and 39 participants completed FeNO. Diagnostic accuracy results demonstrated high sensitivities at >=90% specificity. Specific counts included FeNO: n=32 and spirometry: n=28. Additionally, the pathway efficiency analysis suggested a potential to reduce reliance on bronchial challenge testing by 57%.
The authors note limitations, stating the need to support further evaluation through an adequately powered diagnostic accuracy study. Safety data regarding adverse events, serious adverse events, discontinuations, and tolerability were not reported. Practice relevance indicates the home-based testing strategy showed early potential to improve asthma diagnosis and pathway efficiency. However, the certainty note emphasizes early potential requiring further evaluation. This is not a definitive efficacy trial.
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View Original Abstract ↓
Introduction: Although temporal variation is the hallmark of asthma, recommended diagnostic approaches largely rely on single clinic-based measurements. Ambulatory monitoring captures diurnal and day-to-day variability and may therefore enhance diagnostic accuracy. We evaluated the clinical feasibility and potential utility of home spirometry and fractional exhaled nitric oxide (FeNO) monitoring in asthma diagnosis. Methods: Symptomatic, untreated adults with GP-suspected asthma underwent diagnostic tests including bronchodilator reversibility, in-clinic FeNO, blood eosinophil counts and bronchial challenge. Participants measured spirometry and FeNO four times daily over one week; during the second week spirometry were measured twice daily. The reference standard was provided (asthma/not-asthma) by an expert panel of at least two asthma specialists based on clinical history and the results of all in-clinic testing; home spirometry (except for peak expiratory flow) and FeNO measurements were blinded to the panel. Results: Of 67 eligible participants, 51(76%) were recruited, and 38 had asthma confirmed or excluded by the panel. 1058 home spirometry measurements were obtained from 37(73%) participants; 848 home FeNO readings were obtained from 39(76%) participants. Among those completing at least one home measurement, median (IQR) adherence was 66.7(58.6-97.6)% for spirometry and 78.5(51.8-103.6)% for FeNO. Collection of health impact data for economic evaluation was feasible. In participants with a confirmed diagnostic outcome who completed home measurements (FeNO: n=32; spirometry: n=28), the putative home-testing metrics demonstrated high sensitivities at [≥]90% specificity, and outperformed peak expiratory flow diurnal variability. Incorporating home testing into the BTS/NICE/SIGN 2024 diagnostic pathway had the potential to reduce reliance on bronchial challenge testing by 57%. Conclusions: Home spirometry and FeNO testing and the prospective collection of health-economic data in the diagnostic setting were feasible. Home-based testing strategy showed early potential to improve asthma diagnosis and pathway efficiency. These findings support further evaluation through an adequately powered diagnostic accuracy study and health-economic assessment.
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