An essential step in home monitoring of pulmonary diseases: reliability of measurements with portable spirometry

Öz

Purpose: Measurement of pulmonary function test (PFT) parameters is an essential component in diagnosing and monitoring pulmonary diseases. While traditional spirometers used in laboratories by trained technicians are the standard, they may face challenges including technical and accessibility issues. Portable spirometry might be a promising tool for remote monitoring. This study aims to evaluate the compatibility of data obtained by using a portable spirometer (MIR Spirobank®) versus traditional spirometry. Materials and methods: Consecutive adult patients referred to the PFT laboratory from the outpatient clinic were included in this cross-sectional study. Each underwent PFT to obtain FVC, FEV1, FEV1/FVC, PEF, and FEF25-75 parameters. The intraclass correlation coefficient (ICC) was calculated, and Bland-Altman plots were created to evaluate the agreement of the measurements from the two devices. Results: The mean age was 51.97±9.37 (33-72) years, and 56.7% of the 30 participants were male. Spirometry results indicated 56.7% normal, 33.3% obstructive, and 10% restrictive disorders using traditional methods, with compatible distributions observed for the portable spirometer (Kappa coefficient=0.656, p=0.0001). High agreement and correlation were found (p<0.0001), and the Bland-Altman plots showed good consistency between the devices. Conclusion: Acceptable reliability may suggest the use of portable spirometry in telemedicine for assessing pulmonary diseases remotely and enhancing patient care.

Anahtar Kelimeler

• Portable spirometer
• Spirobank
• pulmonary diseases
• remote monitoring
• telemedicine

Akciğer hastalıklarının evde izleminde önemli bir adım: taşınabilir spirometre ile yapılan ölçümlerin güvenilirliği

Öz

Amaç: Solunum fonksiyon testi (SFT) parametrelerinin ölçümü, akciğer hastalıklarının tanı ve takibinde temel bir bileşendir. Eğitimli teknisyenler tarafından laboratuvarlarda kullanılan geleneksel spirometreler standart olmasına rağmen teknik ve erişimle ilgili zorluklarla karşılaşılabilmektedir. Taşınabilir spirometreler, uzaktan izlem için umut verici bir araç olabilir. Bu çalışma, taşınabilir bir spirometre (MIR Spirobank®) ile geleneksel spirometre kullanılarak elde edilen verilerin uyumluluğunu değerlendirmeyi amaçlamaktadır. Gereç ve yöntem: Kesitsel çalışmaya, göğüs hastalıkları polikliniğinden solunum fonksiyon testi laboratuvarına yönlendirilen ardışık erişkin hastalar dâhil edilmiştir. Her katılımcıya FVC, FEV1, FEV1/FVC, PEF ve FEF25-75 parametrelerini elde etmek için SFT uygulanmıştır. İki cihazdan elde edilen ölçümlerin uyumunu değerlendirmek için sınıf içi korelasyon katsayısı (ICC) hesaplanmış ve Bland-Altman grafikleri oluşturulmuştur. Bulgular: Katılımcıların medyan yaşı 51,97±9,37 (33-72) yıl olup, 30 katılımcının %56,7’si erkekti. Geleneksel yöntemlerle yapılan spirometri sonuçları %56,7 normal, %33,3 obstrüktif ve %10 restriktif bozukluk göstermiş olup, taşınabilir spirometre ile uyumlu dağılımlar gözlenmiştir (Kappa katsayısı=0,656, p=0,0001). İki spirometre cihazı ile yapılan ölçümler arasında yüksek düzeyde uyum ve korelasyon tespit edilmiştir (p<0,0001), Bland-Altman grafikleri cihazlar arasında iyi bir tutarlılık göstermiştir. Sonuç: Kabul edilebilir güvenilirlik ve geleneksel spirometri ile yüksek uyum, taşınabilir spirometrinin akciğer hastalıklarının uzaktan değerlendirilmesi ve hasta bakımını iyileştirmek için teletıpta kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler

• Taşınabilir spirometre
• Spirobank
• göğüs hastalıkları
• uzaktan izlem
• teletıp

Kaynakça

1. Levine SM, Marciniuk DD. Global Impact of Respiratory Disease: What Can We Do, Together, to Make a Difference? Chest. 2022;161(5):1153-1154. doi:10.1016/j.chest.2022.01.014
2. Bindler R, Haverkamp HC, O'Flanagan H, et al. Feasibility and acceptability of home monitoring with portable spirometry in young adults with asthma. J Asthma. 2023;60(7):1474-1479. doi:10.1080/02770903.2022.2160345
3. Park HJ, Rhee CK, Yoo KH, Park YB. Reliability of Portable Spirometry Performed in the Korea National Health and Nutrition Examination Survey Compared to Conventional Spirometry. Tuberc Respir Dis (Seoul). 2021;84:274-281. doi:10.4046/trd.2021.0016
4. Kupczyk M, Hofman A, Kołtowski Ł, et al. Home self-monitoring in patients with asthma using a mobile spirometry system. J Asthma. 2021;58(4):505-511. doi:10.1080/02770903.2019.1709864
5. Zhou J, Li X, Wang X, Yu N, Wang W. Accuracy of portable spirometers in the diagnosis of chronic obstructive pulmonary disease A meta-analysis. NPJ Prim Care Respir Med. 2022;32(1):15. doi:10.1038/s41533-022-00275-x
6. Lin CH, Cheng SL, Wang HC, et al. Novel App-Based Portable Spirometer for the Early Detection of COPD. Diagnostics (Basel). 2021;11(5):785. doi:10.3390/diagnostics11050785
7. Saryal SB, Ulubay G, editors. Solunum Fonksiyon Testleri. Toraks Kitapları, Sayı 16. İstanbul: AVES Yayıncılık; 2012.
8. Heffler E, Crimi C, Mancuso S, et al. Misdiagnosis of asthma and COPD and underuse of spirometry in primary care unselected patients. Respir Med. 2018;142:48-52. doi:10.1016/j.rmed.2018.07.015

9. Kichloo A, Albosta M, Dettloff K, et al. Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA. Fam Med Community Health. 2020;8(3):e000530. doi:10.1136/fmch-2020-000530
10. Wosik J, Fudim M, Cameron B, et al. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020;27(6):957-962. doi:10.1093/jamia/ocaa067
11. Koh JH, Chong LCY, Koh GCH, Tyagi S. Telemedical Interventions for Chronic Obstructive Pulmonary Disease Management: Umbrella Review. J Med Internet Res. 2023;25:e33185. doi:10.2196/33185
12. Ferguson GT, Enright PL, Buist AS, Higgins MW. Office spirometry for lung health assessment in adults: A consensus statement from the National Lung Health Education Program. Chest. 2000;117(4):1146-1161. doi:10.1378/chest.117.4.1146.
13. Pulmonary Function Assembly, Chinese Thoracic Society of Chinese Medical Association. Zhonghua Jie He He Hu Xi Za Zhi. 2022;45(10):970-979. doi:10.3760/cma.j.cn112147-20220302-00167
14. Xiao S, Wu F, Wang Z, et al. Validity of a portable spirometer in the communities of China. BMC Pulm Med. 2022;22(1):80. doi:10.1186/s12890-022-01872-9
15. Degryse J, Buffels J, Van Dijck Y, Decramer M, Nemery B. Accuracy of office spirometry performed by trained primary-care physicians using the MIR Spirobank hand-held spirometer. Respiration. 2012;83(6):543-552. doi:10.1159/000334907
16. Boros PW, Maciejewski A, Nowicki MM, Wesołowski S. Comparability of portable and desktop spirometry: a randomized, parallel assignment, open-label clinical trial. Adv Respir Med. 2022. doi:10.5603/ARM.a2022.0013
17. Exarchos KP, Gogali A, Sioutkou A, Chronis C, Peristeri S, Kostikas K. Validation of the portable Bluetooth® Air Next spirometer in patients with different respiratory diseases. Respir Res. 2020;21(1):79. doi:10.1186/s12931-020-01341-z
18. Çetin N, Bostan P, Altınışık G. A perspective on the scope of videoconferencing-based telemedicine in respiratory diseases outpatient clinic. Tuberk Toraks. 2023;71:335-346. doi:10.5578/tt.20239602
19. Bostan P, Çetin N, Altınışık G. A Retrospective Assessment of the Continuous Health Care Provided to COVID-19 Patients Consulted Via Videoconference. Thorac Res Pract. 2023;24(1):14-21. doi:10.5152/ThoracResPract.2023.22058
20. Metin M, Kaya Ş, Sözmen K, Altınışık G. Smoking Cessation Support via Video Counseling (e-Cessation): A Promising Field for Telemedicine Implementation. Thorac Res Pract. 2024;25(3):121-129. doi:10.5152/ThoracResPract.2024.23056
21. Tran D, Lim M, Vogrin S, Jayaram L. Point of care portable spirometry in the diagnosis and treatment of ınpatients with chronic obstructive pulmonary disease. Lung. 2020;198(1):143-150. doi:10.1007/s00408-019-00314-4
22. Stanojevic S, Kaminsky DA, Miller MR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60(1). Epub 20220713. doi:10.1183/13993003.01499-2021
23. Nishimura K, Nakayasu K, Kobayashi A, Mitsuma S. Case identification of subjects with airflow limitations using the handheld spirometer “Hi-Checker™”: comparison against an electronic desktop spirometer. COPD. 2011;8(6):450-455. doi:10.3109/15412555.2011.626817
24. Dirksen A, Madsen F, Pedersen OF, Vedel AM, Kok-Jensen A. Long-term performance of a hand held spirometer. Thorax. 1996;51(10):973-976. doi:10.1136/thx.51.10.973
25. Malmberg LP, Hedman J, Sovijärvi AR. Accuracy and repeatability of a pocket turbine spirometer: comparison with a rolling seal flow-volume spirometer. Clin Physiol. 1993;13(1):89-98. doi:10.1111/j.1475-097x.1993.tb00320.x
26. Brouwer AF, Roorda RJ, Brand PL. Comparison between peak expiratory flow and FEV(1) measurements on a home spirometer and on a pneumotachograph in children with asthma. Pediatr Pulmonol. 2007;42(9):813818. doi:10.1002/ppul.20660
27. Gaye Ulubay, Miraç Öz, editors. Türk Toraks Derneği Solunum Fonksiyon Testlerine Yönelik Tanısal Yaklaşım Uzlaşı Raporu. Ankara: Türk Toraks Derneği; 2024. ISBN: 978-625-6615-04-5.
28. Kumar A, Kaur R, Hadda V, et al. Spirometry-based prevalence of chronic obstructive pulmonary disease & associated factors among community-dwelling rural elderly. Indian J Med Res. 2021;154(5):707-715. doi:10.4103/ijmr.IJMR_358_19
29. Chen G, Jiang L, Wang L, Zhang W, Castillo C, Fang X. The accuracy of a handheld “disposable pneumotachograph device” in the spirometric diagnosis of airway obstruction in a Chinese population. Int J Chron Obstruct Pulmon Dis. 2018;13:2351-2360. doi:10.2147/COPD.S168583