Closer to the patient means better decisions: wearable remote monitoring of patients with COVID‐19 lung disease

Transitioning of clinic measurements to remote settings has been in a spotlight during the pandemic; however, many assessments are still under development and require validation studies. 9 A recent review of studies assessing lung function in acutely ill patients with COVID-19 indicated that the most pronounced change is the diminished diffusion capacity of the lungs for carbon monoxide (DLCO), followed by changes in mechanical parameters, such as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). The data from the studies included in the review did not reach a firm conclusion about obstructive versus restrictive patterns in lung tissue changes, due to variability in study design and relatively small numbers of patients included. 3 These preliminary data highlight the need for close longitudinal follow-up of these patients to understand natural history, disease progression/resolution, and subsequent appropriate intervention and treatment. [...]DLCO is an informative parameter, but it requires sophisticated equipment and can be done only during clinic visits, whereas other pulmonary function test (PFT) parameters, like FVC and FEV1, can be performed remotely by means of mobile spirometry, which were demonstrated to be equivalent to clinic measures in a pilot study. 10 Recent guidance from the American Thoracic Society indicates that at-home spirometry collection (FEV1 and FVC) can be a viable alternative to in-clinic spirometry tests, although caution remains about remote test accuracy as data continues to accumulate about its measurement properties, of which initial reports appear to be favorable. 11 Consistent with the DLCO data, impaired arterial oxygenation, as measured by pulse oximetry, has been shown to be an important prognostic factor for worse outcomes during the acute phase of COVID-19 illness. 12 Based on these observations, the use of oximetry is suggested for follow-ups during the recovery period. TABLE 1 A comparison of clinic and remote measurements to assess COVID-19 long-term impact on lung function Assessment type Clinic measurements Remote measurements Considerations Lung X-ray or CT scan Standard assessment for detecting lung tissue abnormalities Not applicable Spirometry DLCO, FVC, FEV1 FVC, FEV1 Comparability between FEV1 clinic and remote measures has been demonstrated 10; data may be more variable due to an unsupervised test procedure Pulse oximetry Heart rate, SpO2 Heart rate, SpO2 Pulse oximeters with r