Spirometer games to help with airway clearance in children with Cystic Fibrosis

http://www.ncbi.nlm.nih.gov/pubmed/22348602

Respir Care. 2012 Feb 17. [Epub ahead of print]
Pilot Trial of Spirometer Games for Airway Clearance Practice in Cystic Fibrosis.
Bingham PM, Lahiri T, Ashikaga T.

Abstract
BACKGROUND:
Many children with cystic fibrosis (CF) adhere poorly to airway clearance techniques (ACTs), and would rather play video games that challenge their dexterity and visual tracking skills. We developed gaming technology that encourages forced expiratory maneuvers.

OBJECTIVE:
Following interviews regarding recreational activities and subjects' practice of ACTs, we conducted a pilot trial of spirometer games in thirteen adolescents with CF to test the hypothesis that games could (1) increase subjects' engagement with forced expiratory breathing maneuvers, and (2) improve pulmonary function tests (PFTs).

METHODS:
After baseline PFTs, subjects were provided with digital spirometers and PCs set up as "game only" or "control" devices. After the first of 2 periods (each > 2 weeks), the PC was set-up for the alternate condition for period 2. T test and non-parametric correlation analyses examined use, number of expiratory high flow events (HFEs), and change in PFTs, identifying trends at p< .1, significance at p< .05.

RESULTS:
Interviews disclosed minimal awareness of ACTs among our pediatric CF patients. Subjects used games and control software a similar percentage of days during Game (26%) and Control periods (32%). There was a trend towards more minutes with the Game vs. Control setup (p=.07), though HFE count did not differ between the two conditions (p=.71). Game play showed no overall effect on FEV₁, though correlation analysis showed a modest relation between minutes of play and change in FEV₁ from Baseline (r = .50, p = .09). Game period showed a trend to increased VC (p=.05).

CONCLUSION:
Spirometer games elicit forced expiratory breath maneuvers in pediatric CF patients. Improvement in PFTs may be due to improved test performance technique, though improved obstructive/restrictive lung function due to game play cannot be excluded. A formal clinical trial of this approach is planned.