Unsupervised home spirometry vs supervised clinic spirometry for respiratory disease: a systematic methodology review and meta-analysis.

Rohan Anand, Rebecca McLeese, John Busby, Jonathan Stewart, Mike Clarke, William Mann, Judy Bradley*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The number of patients completing unsupervised home spirometry has recently increased due to more widely available portable technology and the COVID-19 pandemic, despite a lack of solid evidence to support it. This methodological systematic review and meta-analysis explores quantitative differences in unsupervised spirometry compared to spirometry completed under professional supervision.

Methods: We searched four databases to find studies that directly compared unsupervised home spirometry to supervised clinic spirometry using a quantitative comparison (e.g. Bland-Altman). There were no restrictions on clinical condition. The primary outcome was measurement differences in common lung function parameters (FEV1, FVC) which were ooled to calculate overall mean differences (MD) with associated limits of agreement (LoA) and confidence intervals (CI). We used the I2 statistic to assess heterogeneity, QUADAS-2 to assess risk of bias and GRADE to assess evidence certainty for the meta-analyses. PROSPERO registration: CRD42021272816.

Results: 3607 records were identified and screened, with 155 full texts assessed for eligibility after which we included 28 studies that quantitatively compared spirometry measurements. 17 studies reported a Bland-Altman analysis for FEV1 and FVC. Overall, unsupervised spirometry was lower than supervised spirometry for both FEV1 with wide variability (MD= -107ml; LoA= -509, 296; I2= 95.8%; p=
Conclusions: Analysis under the conditions of the included studies, indicate unsupervised spirometry is not interchangeable with supervised spirometry for individual patients due to variability and underestimation.
Original languageEnglish
JournalEuropean Respiratory Review
Publication statusAccepted - 31 May 2023


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