Question

Spirometry is currently the only recognized method of definitively diagnosing and tracking the progression of chronic obstructive pulmonary disease (COPD). Recent efforts have been made towards developing systems for performing at-home measurements. One example is the NuvoAir Air Smart, which is CE-marked spirometer intended for the measurement of time forced expired volumes (ISO 26782) and peak expiratory flow (ISO 23747), but not yet approved by the FDA. It is the first device that allows users to visualize results on a smartphone and accurately determine FVC, FEV1, and their ratio. Based upon your experience in performing spirometry, respond to the following prompts * What is the role of proper training/coaching in performing breathing maneuvers, and how may improper breathing (e.g., incomplete exhale) lead to misdiagnosis? How is training implemented in at-home devices, such as the NuvoAir? Is it possible to detect improper breathing without oversight by a medical professional? (hint: search for the user manual or instructions for use) The NuvoAir spirometer relies on a mechanical turbine mechanism to measure flow rate The manufacturer claims that this device does not require calibration. Do you believe them? What are the potential source of error in pneumotachs (i.e., devices that measure pressure drop across a resistance) and why do they not play a role here?

Answer 1

*Spirometry testing is performed with the patient seated or standing. The patient should wear comfortable, non-restrictive clothing. It includes three phases: inhalation, the initial “blast” phase of exhalation, and completion of exhalation. The patient is instructed to inhale maximally and then to exhale immediately by “blasting” the breath out. The patient is coached to continue exhalation until airflow is no longer recorded and a minimum of six seconds has elapsed since initiation of the test.

Spirometry is associated with many potential sources of error and variability, that leads to misdiagnosis, so scrupulous care must be exercised in its performance.

Patient coaching through explanation, demonstration of the technique, and enthusiastic encouragement while the patient is performing the manoeuvre is essential to obtaining accurate results. Training workshops in coaching technique are especially important for staff that conduct testing in primary care practices, as such workshops.

* First enable the Bluetooth on the mobile device and allow the application to access and use Bluetooth and follow the instructions on the screen. The spirometer lights up when it is connected to the mobile device.

Perform a Lung Function Test:

Insert a new turbine by sliding it through the device. Turn the turbine clockwise until it locks into place. Create an account or sign in to an existing one and select your profile. Tap the plus button to perform a lung function test. Perform a lung function test. Perform a lung function test for 2s, and the exhalation should exceed 6 seconds in order to obtain a high-quality test. Take a slow deep breath as deep as you can. Close your lips around the opening of the turbine. Blow as hard and as fast as you can into the mouthpiece. You should rest 15 to 30 seconds before starting a new test. Perform a minimum of 3 test for high-quality results. The application displays the best result. Through the machine, it is possible to detect improper breathing without oversight by a medical professional

* If the manufacturer claims that the device does not require a calibration all the machines may show some errors. Routine measurements of vital capacity forced expired volume in one second, and forced expiratory flow are easy to make, and so are errors in these measurements. Even if the technologist observes all the rules in performing the tests, there is still a potential source of error in the machine.

Here any way the equipment is not approved by the FDA.