Early detection of pulmonary exacerbations in children with cystic fibrosis by electronic home monitoring of symptoms and lung function

Abstract

<b>Background</b> Prevention of pulmonary exacerbations is important in Cystic Fibrosis (CF). To prevent exacerbations it is necessary to detect them at an early stage. We investigated whether early detection of exacerbations in children with CF is possible by electronic home monitoring of respiratory symptoms and lung function. <b>Methods</b> During this one-year prospective multi-centre study, 49 children with CF were asked to use an electronic home monitor three times a week. Measurements consisted of a respiratory symptom questionnaire and three maximal forced expiratory manoeuvres with assessment of the forced expiratory volume in one second (FEV₁). Monitor data were sent online to the coordinating CF centre and all pulmonary exacerbations were recorded. Linear mixed-effects and multiple logistic regression analyses were used. <b>Results</b> Data of 37 children could be analysed: 28 had at least one exacerbation (exacerbation group), nine experienced none (control group). In the period of four weeks before the exacerbation, the FEV₁ as percentage of predicted (FEV₁%pred) and the Respiratory Symptom Score (RSS) were significantly lower in the exacerbation group compared to the control group. Moreover, the combination of FEV₁%pred and the RSS was predictive for pulmonary exacerbations with a sensitivity of 92.9% (CI 75.0 – 98.8%) and specificity of 88.9% (CI 50.7 – 99.4%). <b>Conclusion</b> The use of an electronic home monitor with assessments of FEV₁%pred and RSS in children with CF was helpful to predict pulmonary exacerbations.