FRESH AIR - Lung function testing in FRESH AIR countries

03 May 2017

"We train providers to perform and interpret spirometry, to find and treat common chronic lung disease”

Spirometry testing, one of the most comprehensive pulmonary function tests, is an important tool in the diagnosis and ongoing management of asthma and chronic obstructive pulmonary disease (COPD). As valuable as the clinical information from this test can be, its accuracy is dependent on the technique used by the tester and the person being tested, and is often performed incorrectly if the tester has not been properly trained. Interpretation of spirometry results also requires a foundation of knowledge, reinforced by case-based practice.

In a lung specialist setting, colleagues knowledgeable in spirometry are generally available to consult with and advise. However, this support is typically missing from the primary care setting where the majority of people with asthma or COPD in low and middle income countries are treated. As a result, most people with asthma or COPD have never undergone a spirometry test. As an analogy, imagine the challenge of treating hypertension without blood pressure monitoring?

To address this gap in primary respiratory care, Professor James Stout and his team at University of Washington (UW), have developed Spirometry 360. Spirometry 360 offers remote spirometry training and feedback on technique for spirometry tests performed at a practise site over several months. Self-paced, case-based tutorials are provided for those doing the test and for those interpreting. Since 2009, this online programme has been continuously delivered to over 300 primary care practices in the USA, and to 10 other countries via the International Primary Care Respiratory Group (IPCRG) network.

FRESH AIR provides an opportunity to deliver Spirometry 360 to the project countries.  Local FRESH AIR teams in Kyrgyzstan and Vietnam are translating the training materials into Russian and Vietnamese to increase the potential reach. This spring, local FRESH AIR teams in Kyrgyzstan and Vietnam will also create a studio recording of the training materials, and the UW team will then assemble them into language-specific online modules.

Professor Stout is also part of a team developing a smartphone-based spirometer known as SpiroSmart. A patient blows into the phone’s microphone, and the data is sent to a cloud-based server, where a software programme translates the tracheal sounds into a flow/volume curve, to show whether a person’s lungs are normal or obstructed, and by how much. As a result of relationships made through the IPCRG network, Dr Monsur Habib in Bangladesh and the Chest Research Foundation in India have contributed validation data for this project. This new technology is also part of the FRESH AIR project, and a usability test of SpiroSmart will be conducted in each of the four participating countries. Initially, SpiroSmart will be used to measure trends in the FEV1 (forced expiratory volume in one second), the main measure of lung obstruction. Professor Stout will be training the FRESH AIR country teams how to use SpiroSmart, and also how to collect usability data, at the 1st IPCRG South Asian Scientific Conference in August 2017 in Colombo, Sri Lanka.