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Home monitoring is an effective tool that can be used to promote the health of lung transplant recipients, but only if the recipients transmit data to the healthcare team. This study examines the relationship of the Multidimensional Health Locus of Control scale to adherence with home spirometry use. Form C of this scale was mailed to 139 eligible lung and heart-lung transplant recipients. Eighty-three respondents returned the questionnaire. The respondents were on average 4 years older and had greater adherence than nonrespondents. Men tended to score higher than women on all the subscales. These scales were not related to type of transplant or underlying disease. Adherence was also unrelated to the Multidimensional Health Locus of Control scale, with little difference in adherence across persons with various levels of the health locus of control subscales.

Adherence with prescribed therapies is a key factor in maintaining health in persons with chronic illnesses. The purpose of this descriptive study (which is one segment of a larger study being conducted to develop decision rules for early detection of infection or rejection in posttransplant patients) is to explore facilitators and barriers to adherence with home monitoring. Use of latent analysis revealed that the facilitators to adherence were health promotion, commitment to research, and following advice. Barriers to adherence were poor health status, laziness, and time conflict. Health professionals can use this information to plan strategies to promote adherence to home monitoring.

Objectives: To compare the detection of bronchiolitis obliterans syndrome (BOS) in lung transplant recipients by clinic pulmonary function laboratory measurement and home spirometry., Design: The subjects served as their own control group., Setting: A university-based thoracic transplant center., Subjects: Forty-five lung transplant recipients (26 women and 19 men; average +/- SD age, 47.7+/-11.4 years old at the time of transplantation). Lung function declined to at least BOS stage 1 in 17 of the 45 subjects., Measurements: All subjects were participants in a home monitoring program utilizing home spirometry measurements. Clinic spirometry and home spirometry measurements were collected concurrently. The determinations of BOS staging were based on home and clinic FEV1 values using retrospective analysis and development of the home-based BOS staging algorithm., Results: BOS stage 1 was detected an average of 341 to 276 days earlier with home spirometry than with clinic pulmonary function testing in the 17 subjects who had a pulmonary decline to BOS stage 1, depending on the persistence of the decline (1 day or 3 days, respectively). The difference in BOS detection time was statistically significant for both persistence requirements (p < 0.001)., Conclusions: Home spirometry detects pulmonary decline earlier than clinic spirometry; home spirometry can be a reliable and safe alternative to frequent pulmonary function testing in lung recipients.