Abstract
Introduction: Idiopathic pulmonary fibrosis (IPF) is an invariably fatal condition characterised by a variable course; prolonged periods of apparent disease stability are often interspersed by dramatic and often cryptogenic acute deteriorations. These acute exacerbation are a significant cause of morbidity and mortality in IPF. For lung transplant recipients, daily hand held spirometery has been shown to be an effective means of detecting acute rejection episodes. This exploratory study aims to determine the utility of daily hand held spirometry in IPF.
Methods: Patients with IPF were recruited from amongst new referrals to our unit. Baseline severity was assessed by FVC, DLco and 6 minute walk. Patients were given a hand held spirometer (Carefusion, UK) and provided with instruction on how to self-administer spirometry. Patients were asked to record daily FEV1 and FVC values.
Results: To date, 19 subjects have been recruited; 17 male, age 66.5±7.6 years (mean ± SD). Overall the subjects have moderate to severe disease with FVC 74.2±21.8% predicted, DLco 40.6±13.5% predicted and 6 minute walk distance 325±120m. For subjects thus far completing over 4 weeks of diary monitoring (n=9), mean hand held FVC correlates well with formal clinic spirometry (r2 0.902). Reproducibility of daily FVC has been good with mean variance 6.9% (range 3.0-12.1%).
Discussion: This pilot study suggests that daily spirometery can be reliably and reproducibly performed by patients with IPF. By recording daily FVC it is to be hoped that it will be possible to gain a clearer insight in to the true natural history of IPF and detect, and thus treat, acute exacerbations at an early stage in their evolution.
- © 2011 ERS