Browsing by Author "Boente, Ryan D."

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    Assessing the acceptability and feasibility of remote spirometric monitoring for rural patients with interstitial lung disease: a multimethod approach
    (Springer Nature, 2024-02-20) Boente, Ryan D.; Schacht, Sydney; Borton, Rebecca; Vincent, Joseph; Golzarri‑Arroyo, Lilian; Rattray, Nicholas; Medicine, School of Medicine
    Introduction: Interstitial lung disease encompasses a group of rare lung conditions causing inflammation and scarring of lung tissue. The typical method of monitoring disease activity is through pulmonary function tests performed in a hospital setting. However, accessing care can be difficult for rural patients due to numerous barriers. This study assesses the feasibility and acceptability of home spirometry telemonitoring using MIR-Spirometers and the patientMpower home-monitoring platform for rural patients with interstitial lung disease. Methods: Unblinded, uncontrolled, prospective, multiple-methods study of the feasibility and utility of remote monitoring of 20 rural subjects with interstitial lung disease. Study assessments include adherence to twice weekly spirometry for 3 months in addition to mMRC dyspnea and EQ-5D-5L health-related quality of life questionnaires with each spirometry maneuver. Upon completion, subjects were encouraged to complete an 11-question satisfaction survey and participate in semi-structured qualitative interviews to further explore expectations and perceptions of rural patients to telehealth and remote patient monitoring. Results: 19 subjects completed the 3-month study period. Adherence to twice weekly spirometry was mean 53% ± 38%, with participants on average performing 2.26 ± 1.69 maneuvers per week. The median (Range) number of maneuvers per week was 2.0 (0.0, 7.0). The majority of participants responded favorably to the patient satisfaction survey questions. Themes regarding barriers to access included: lack of local specialty care, distance to center with expertise, and time, distance, and high cost associated with travel. Remote monitoring was well perceived amongst subjects as a way to improve access and overcome barriers. Conclusions: Remote spirometry monitoring through web-based telehealth is acceptable and feasible for rural patients. Perceived benefits include overcoming access barriers like time, distance, and travel costs. However, cost, reimbursement, and internet access must be addressed before implementing it widely. Future studies are needed to ensure long-term feasibility and to compare outcomes with usual care.
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    Treatment outcomes for rheumatoid arthritis associated interstitial lung disease; a real-world, multisite study of the impact of immunosuppression on pulmonary function trajectory
    (Elsevier, 2023-04) Matson, Scott M.; Baqir, Misbah; Moua, Teng; Marll, Michael; Kent, Jessica; Iannazzo, Nicholas S.; Boente, Ryan D.; Donatelli, John M.; Dai, Junqiang; Diaz, Francisco J.; Demoruelle, M. Kristen; Hamblin, Mark B.; Mathai, Susan K.; Ryu, Jay H.; Pope, Kristen; Walker, Christopher M.; Lee, Joyce S.; Medicine, School of Medicine
    Background Rheumatoid arthritis (RA) associated interstitial lung disease (ILD) is common in patients with RA and leads to significant morbidity and mortality. There are no randomized, placebo-controlled data to support the role of immunosuppression to treat RA-ILD despite being widely used in clinical practice. Research Question How does immunosuppression impact pulmonary function trajectory in a multi-site retrospective cohort of RA-ILD patients? Study Design and Methods Patients with RA who started treatment for ILD with mycophenolate, azathioprine, or rituximab were retrospectively identified from five ILD centers. Change in lung function before and after treatment was analyzed using a linear spline mixed effect model with random intercept. Prespecified secondary analyses examined the impact of radiologic pattern of ILD (i.e., usual interstitial pneumonia [UIP] vs non-UIP) on treatment trajectory. Results 212 patients were included in the analysis: 92 (43.4%) were treated with azathioprine, 77 (36.3%) with mycophenolate mofetil and 43 (20.3%) with rituximab. In the combined analysis of all three agents, there was an improvement in forced vital capacity (FVC) % predicted after 12 months of treatment compared to the potential 12-month response without treatment [+3.90%, p=< 0.001; 95% CI, (1.95, 5.84)]. Diffusing capacity for carbon monoxide (DLCO) % predicted also improved at 12 months [+4.53%, p=<0.001; (2.12, 6.94)]. Neither the UIP pattern of ILD or choice of immunosuppressive agent significantly impacted the pulmonary function trajectory on immunosuppression. Interpretation Immunosuppression was associated with an improved trajectory in FVC and DLCO compared to the pre-treatment pulmonary function trajectory. Prospective, randomized trials are required to validate these findings.