Opportunities and challenges of adopting a wearable device for sweat chloride monitoring: A qualitative study with experts in cystic fibrosis
Cristiano Bortolotti, Stefano Canali, Andrea Gramegna, Andrea Aliverti, Francesco Blasi, Viola SchiaffonatiBackground
Cystic fibrosis (CF) care has been transformed by CF transmembrane conductance regulator (CFTR) modulators. This has expanded sweat chloride testing from a primarily diagnostic procedure to a tool for longitudinal treatment monitoring. However, current protocols remain clinic-based, resource-intensive and limited to spot measurements. Wearable sweat sensors may enable non-invasive, frequent and potentially automated monitoring, but their clinical, practical and ethical implications remain unexplored.
Objectives
This study investigates the clinical, ethical and social considerations associated with integrating a wearable sweat chloride sensor into CF care practices.
Methods
Semi-structured interviews were conducted with ten healthcare professionals from the pneumology unit of the Policlinico di Milano hospital. Participants had multiple roles in CF care and sweat testing. Interviews explored opportunities and concerns related to wearable chloride monitoring, with attention to data privacy, quality and fairness, patient autonomy, self-monitoring and over-surveillance. Data were analyzed using thematic analysis.
Results
The analysis identified recurring themes related to patient burden, monitoring frequency, therapy adherence, multimodal sensing, automation, telemedicine, self-monitoring and ideal device characteristics. Participants recognized the limitations of current sweat testing and identified potential benefits of wearable monitoring, including improved data reliability, reduced clinic visits, greater treatment personalization and opportunities for longitudinal research. They raised concerns about the limited clinical validation of sweat chloride dynamics, over-medicalization, threats to patient autonomy and misinterpretation of patient-generated data. Automation and telemedicine were viewed as promising, but dependent on careful design, clinical validation and safeguards.
Conclusion
This study highlights opportunities and challenges in developing wearable technologies for sweat chloride monitoring in CF care. While such devices may support more accessible, personalized and research-oriented monitoring, responsible implementation requires attention to clinical utility, usability, data governance, patient autonomy and equitable access. These findings support the future adoption of ethics-by-design for clinically meaningful, ethically sound and effectively integrated wearable technologies.