Early detection of bronchiolitis obliterans syndrome in lung transplant recipients with chronic rejection using home spirometry

Declining pulmonary function, as measured by staging for bronchiolitis obliterans syndrome, is considered a primary indication of future chronic rejection in transplanted lungs. Staging has been evaluated in a group of transplant recipients using a paperless, electronic spirometer/diary instrument for home monitoring. Eleven of 104 lung recipients were diagnosed with chronic rejection. Seven of these subjects had performed home monitoring for a minimum of 8 months at the time of this study. Clinic and home spirometry variables were used in the staging algorithm to determine the onset and rate of clinical decline related to the rejection. Using home spirometry, the onset of decline began an average of 284 days before diagnosis or chronic rejection, which was significantly earlier (p<0.05) than the decline observed with clinic pulmonary function testing. Staging changes based on home spirometry preceded diagnosis of chronic rejection in all subjects, but only occurred in 4 of 7 subjects using clinic testing. Home spirometry can provide early and consistent indication of pulmonary decline prior to chronic rejection, and should be considered as a future component of post-transplant follow-up care.