Monitoring pulmonary function in asthma and COPD: point-of-care testing.

OBJECTIVE: To provide pharmacists and other healthcare providers with a better understanding of new monitoring technologies for asthma and chronic obstructive pulmonary disease (COPD) available to clinics and pharmacies. DATA SOURCES: Forty scientific articles were identified through a MEDLINE search (1990-June 2003), additional references listed in articles, and abstracts from scientific meetings. STUDY SELECTION AND DATA EXTRACTION: English-language literature of controlled human clinical studies was reviewed to evaluate the accuracy, reliability, validity, and response of the new monitoring technologies. DATA SYNTHESIS: The In-Check DIAL is a pulmonary airflow meter that identifies the most appropriate inhaler for a patient and is useful in determining how efficiently patients use their inhalers. Electronic peak flow meters such as the AirWatch, VMX Wright Mini-Log, PiKo-1, and electronic asthma monitor store and download multiple pulmonary function test (PFT) readings to a personal computer, allowing easy identification of patients who are fabricating results. The AirWatch also has the ability to measure forced expiratory volume in 1 second. The Spirophone AG-SP, VM Plus, and Micro DiaryCard spirometer are portable spirometers that can be used at home without the need for supervision. Bronchial challenge tests have been recently standardized and may prove to be beneficial in modifying drug therapy in patients with asthma and COPD.
CONCLUSIONS: Despite recent advances in medical technology, monitoring of asthma and COPD has not changed significantly. PFTs continue to be the gold standard for evaluating airway obstruction and/or restriction. Clinical trials that will evaluate outcomes such as decreased number of hospitalizations, emergency department visits, unscheduled visits to physicians, and days absent from school or work are needed to determine the utility of new monitoring technologies.