Objectives: To compare the detection of bronchiolitis
obliterans syndrome (BOS) in lung transplant recipients by clinic
pulmonary function laboratory measurement and home spirometry.
Design: The subjects served as their own control
Setting: A university-based thoracic
Subjects: Forty-five lung
transplant recipients (26 women and 19 men; average ± SD age,
47.7 ± 11.4 years old at the time of transplantation). Lung
function declined to at least BOS stage 1 in 17 of the 45
Measurements: All subjects were participants
in a home monitoring program utilizing home spirometry measurements.
Clinic spirometry and home spirometry measurements were collected
concurrently. The determinations of BOS staging were based on home and
clinic FEV1 values using retrospective analysis and
development of the home-based BOS staging algorithm.
Results: BOS stage 1 was detected an average of 341 to 276
days earlier with home spirometry than with clinic pulmonary function
testing in the 17 subjects who had a pulmonary decline to BOS stage 1,
depending on the persistence of the decline (1 day or 3 days,
respectively). The difference in BOS detection time was statistically
significant for both persistence requirements (p < 0.001).
Conclusions: Home spirometry detects pulmonary decline
earlier than clinic spirometry; home spirometry can be a reliable and
safe alternative to frequent pulmonary function testing in lung