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Introduction Remote monitoring of lung function has been proposed as an adjunct to support clinical care in patients with interstitial lung diseases (ILD). Previous studies have shown that home spirometry correlates well with hospital measurements and that patients are willing to do these measurements at home.Objectives To investigate the impact of introducing remote monitoring for the provision of contemporaneous lung function at clinical appointments for patients with ILD.Methods REMOTE-ILD was a randomised controlled multi-centre study in England ( NCT05662124). Patients with fibrotic ILD were recruited and randomised (1:1) to remote monitoring (RM) or usual care (UC). Participants in the RM arm were asked to record home spirometry and oximetry three times weekly for fortnightly clinical review of their data. The primary endpoint was contemporaneous spirometry within two weeks at scheduled clinical appointments during a 12-month observation period. Chi-squared was used to test independence of endpoint.Results 139 participants were recruited and randomised, 67 RM participants and 66 UC participants completed 12-month observation. A total of 113 patients had a scheduled clinical appointment, 63 participants in RM and 50 participants in UC arms. The primary endpoint was met in 58 RM participants (92%) and 14 (28%) UC participants (p<0.001).In the RM arm, median adherence to weekly home spirometry was 80.8% (IQR 46.2–96.2). The mean percentage of spirometry readings per person which were acceptable according to ATS/ERS criteria was 74.46% (SD 21.35). There was high correlation between home and hospital FVC readings (rho 0.891, p<0.001), home spirometry FVC had a mean difference of 347 mL (SD 331) compared with hospital FVC.Five RM participants were contacted by clinical teams for an additional outpatient appointment in response to abnormal home measurements, of whom two were subsequently started on new ILD medications. Three RM participants had domiciliary oxygen assessments arranged in response to home oximetry without need for additional clinical appointments.Discussion Home spirometry led to a greater number of scheduled clinical appointments with contemporaneous lung function when compared with usual care. Availability supported clinical decision making, whilst remote monitoring supported responsive clinical management.Funding This study is funded by the NIHR (NIHR203424).