Speaker- Marium Naqvi

A real-world observational study investigates the potential of home monitoring for patients with interstitial lung disease (ILD), which presents significant challenges in diagnosis and management. In the UK, patients are often referred to specialized ILD centers for accurate diagnosis and timely access to treatment. However, rising demand for these services requires many patients to travel long distances, often resulting in round trips of four to five hours. This travel burden adds to the challenges faced by ILD patients, who frequently suffer from exertional breathlessness, rely on supplemental oxygen, and are at increased risk of infection from travel. Additionally, younger patients with progressive pulmonary fibrosis (PPF) often struggle with work commitments, further limiting their ability to attend regular in-person clinic visits. Standard face-to-face appointments, scheduled every three to six months, may not be sufficient to meet their needs. Home monitoring, therefore, offers a promising solution for managing ILD over the long term without frequent hospital visits. To explore this approach, a collaboration was formed with a rural ILD specialist center in the South West of the UK, alongside technology partner Patient Empower and the patient advocacy charity Action for Pulmonary Fibrosis. A funding award of just under £200,000 was secured from National Health Service (NHS) Digital to implement home monitoring for ILD patients. An expert steering committee comprising specialists in-home monitoring technology, ILD study, and patient care guided the design and implementation of the program. Two patient representatives participated in the committee, ensuring patient perspectives were integral to the process. Regular biweekly meetings were held to provide continuous input and refinement of the program to reduce the frequency of in-person visits while enhancing the management of ILD.

The home monitoring technology for patients with ILD leverages a digital portal to longitudinally track key respiratory parameters, such as spirometry and oximetry. Clinicians can monitor spirometry trends, assess the quality of spirometric efforts, and customize alerts tailored to individual baseline investigations. Oxygen saturation is continuously tracked through oximetry, with alerts set to detect deviations from baseline values according to national guidelines. The project included the active involvement of ILD specialists, who screened and evaluated patients for eligibility. After obtaining informed consent, patients underwent comprehensive baseline assessments, including laboratory-based pulmonary function tests, high-resolution computed tomography (HRCT) to confirm fibrotic ILD and a six-minute walk test. Patients received extensive training on the technical aspects of home monitoring and proper spirometry techniques. All data were accessible to clinicians in real-time, with secondary care providers accessing the shared data. The study's primary goal was to evaluate the safety of home monitoring and its efficacy in detecting disease progression or treatment response, intending to enhance timely clinical interventions. Additionally, the project sought to reduce the need for in-clinic spirometry and face-to-face appointments by 50% while tracking patient adherence to the monitoring program over 12 months.

The study enrolled 186 patients and generated over 1,800 alerts across 52 weeks, most of which were forced vital capacity (FVC) alerts. Approximately one-third of the alerts were related to oxygen levels. Most alerts prompted clinical interventions, with 422 indicating clinical changes and 241 identifying technical issues, while the majority led to follow-up actions. The most significant interventions were related to oxygen management. Among 118 oxygen-related events, 107 changed patients' oxygen prescriptions. Additionally, alerts prompted adjustments in treatment regimens, such as increasing immunosuppressive or anti-fibrotic therapies. In 81 instances, the program detected changes in clinical status, leading to recommendations for patients to start antibiotic therapy. The study also analyzed outpatient consultation patterns, comparing pre-pandemic years 2019–2020 to 2023–2024. Face-to-face consultations decreased by one-third, while telephone and total consultations increased significantly. The findings underscore that healthcare utilization rises as patients' conditions advance despite the increased feasibility of remote consultations. The study did not observe a significant reduction in laboratory-based pulmonary function tests, as the home monitoring program supplemented routine care. However, it is anticipated that confidence in home monitoring could eventually reduce the need for laboratory-based tests over time. Further analysis is required to assess the long-term impact of this program on clinical workflow and patient outcomes.

The heat maps illustrate participants' adherence to weekly spirometry and pulse oximetry. Gold stars denote consistent weekly readings submitted by patients throughout the program, while irregular readings are flagged to identify reasons for non-compliance. Several clinical interventions highlight the program's impact. For instance, one patient, initially reluctant to attend outpatient appointments, engaged successfully through home monitoring. Another case involved a patient with PPF who was identified via remote monitoring. Additionally, a patient with a chest infection who had been prescribed antibiotics and steroids experienced a drop in oxygen saturation to 86%. This prompted a hospital referral, where they received seven days of intravenous antibiotics. The patient expressed gratitude for the Patient Power app's role in early detection. In another case, remote monitoring of a patient receiving immunosuppression revealed an increase in FVC over time, guiding future clinical management. Another patient, managed collaboratively with a secondary care center, experienced an infective exacerbation of ILD based on home readings. Upon referral, the patient underwent echocardiography and chest Magnetic Resonance Imaging (MRI) and was newly diagnosed with pulmonary hypertension. Additionally, oxygen levels were reassessed, and the patient was referred for pulmonary rehabilitation. These examples underscore the program's ability to enable timely, critical interventions. Overall, the data reflects significant improvements in patient outcomes, including better adherence to spirometry and pulse oximetry and enhanced monitoring of disease progression.

The environmental impact of home monitoring is substantial. By reducing just one clinic appointment per patient for 186 patients, the program could save approximately 1.75 metric tons of carbon emissions, equivalent to the carbon footprint of a round-trip flight from Paris to New York. This reduction represents a savings of about 30 pounds of carbon per patient per visit. However, several challenges remain, including scalability, funding, and equitable access to care. As patient numbers increase significantly, it is essential to integrate home monitoring into routine care without over-reliance on grants. Developing a nationally deliverable framework is crucial to maintaining equity in care provision. Moreover, the potential role of artificial intelligence in enhancing the effectiveness and delivery of home monitoring is under exploration. Artificial Intelligence technology could offer advanced solutions to optimize monitoring processes and improve patient outcomes.

European Respiratory Society Congress 2024,  7–11 September, Vienna, Austria