COMPAIR: a comparison of directly supervised clinic versus virtually supervised home spirometry

Ashish Pradhan; Jacqui Pollington; Dinesh Saralaya; Matthew J Martin; Rod Hughes; Niki Arya; Nick Sanders; Hoda Sharifian; Katharine Locke; Matt Bonam; Tim W Harrison

doi:10.1183/23120541.01130-2024

COMPAIR: a comparison of directly supervised clinic versus virtually supervised home spirometry

ERJ Open Res. 2025 Oct 27;11(5):01130-2024. doi: 10.1183/23120541.01130-2024. eCollection 2025 Sep.

Authors

Affiliations

¹ The Nottingham Asthma Centre, Nottingham City Hospital NHS Foundation Trust, Nottingham, UK.
² BreathingSpace, Rotherham NHS Foundation Trust, Rotherham, UK.
³ Bradford Institute for Health Research, Bradford Teaching Hospitals, Bradford, UK.
⁴ Early Respiratory and Immunology Clinical Development, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK.
⁵ Late Stage Development, Respiratory and Immunology, Biometrics, BioPharmaceuticals R&D, AstraZeneca, Durham, NC, USA.
⁶ Late Stage Development, Respiratory and Immunology, Biometrics, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK.
⁷ Digital Health, Gothenburg, Sweden.
⁸ Evinova, Macclesfield, UK.
⁹ Respiratory and Immunology, Global Medical Affairs, AstraZeneca, Cambridge, UK.

Abstract

Background: Our objectives were to compare directly supervised in clinic spirometry (DSCS) with virtually supervised at home spirometry (VSHS), assess the utility of artificial intelligence (AI) over-reading and evaluate patients' views of VSHS.

Methods: A multicentre, prospective, 8-day study was conducted in adult patients with physician-diagnosed asthma or COPD from UK primary/secondary care. Spirometry (forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC)) was performed using the NuvoAir Air Next Bluetooth portable spirometer supported by trained healthcare providers (HCPs) in clinic (Days 1 and 8) and virtually supervised at home (Days 2 and 7). Over-reading was done manually and by ArtiQ.QC (cloud-based AI). Inter-method concordance and agreement were assessed by correlation analyses and Bland-Altman plots, respectively. Participants completed a questionnaire (Day 8) to assess their views on VSHS.

Results: 68 participants were included (asthma: n=47; COPD: n=21). There was excellent concordance between HCP-over-read DSCS (Day 1) and VSHS (Day 2) as indicated by intraclass correlation coefficients for FEV₁ (0.95 (95% CI 0.92-0.97)) and FVC (0.95 (95% CI 0.92-0.97)), which were slightly higher when over-read by ArtiQ.QC (FEV₁: 0.98 (95% CI 0.97-0.99); FVC: 0.96 (95% CI 0.93-0.97)). Bland-Altman plots showed good agreement between DSCS and VSHS, for both manual and ArtiQ.QC over-read assessments, with evidence of better agreement when over-read by ArtiQ.QC. More than 95% of patients considered the NuvoAir spirometer and mobile app easy to use and would be happy to use it in the future.

Conclusions: VSHS with the NuvoAir spirometer and ArtiQ.QC over-reading offers reliable and consistent measures of lung function for research purposes and potential clinical application in a population of patients with asthma or COPD. VSHS coupled with AI over-read allows spirometry to be performed at a more convenient location for patients while maintaining high-quality results, comparable to clinic-based spirometry.