Spirometry Outside the Hospital.

Dear Editor,

We carefully read the editorial by Burgos Rincón et al., titled Impact of the COVID-19 Pandemic on Lung Function Laboratories: Considerations for “Today” and the “Day After”, recently published in Archivos de Bronconeumología. The study considered important aspects, including the need to reorganize the lung function laboratories to recover the healthcare activity with sufficient security guarantees for both patients and professionals. The study also stated that current COVID-19-related limitations warrant the need for respiratory teams to engage and explore innovative methods for lung function assessment.

Home-based spirometry, particularly, those with on-screen encouragement and/or remote guidance by a technician, could be an alternative to conventional spirometry for management and telemonitoring of chronic respiratory diseases. Home-based spirometry transmits the lung function data from patients’ home to a remote monitoring center (generally on a daily basis from previously trained patients) for a cautious evaluation by a respiratory function technician and interpretation by an expert physician, upholding the quality of the lung function assessment.2, 3 In 1997, Brudeman et al. described a home-based portable spirometry system to detect early signs of asthma deterioration, which improved asthma management, quality of life, and reduced emergency department visits and hospitalizations. For chronic obstructive pulmonary disease (COPD), Rodriguez-Roisin et al. compared the results of home-based spirometries performed by more than 2000 patients with severe COPD, after face-to-face training, and in clinical settings (using the same spirometry device); they found a good agreement between in-clinic and home-based measurements.

In contrast, telespirometry conducted by respiratory function technicians in outpatient clinics might be an acceptable alternative after the resolution of regional COVID-19 outbreaks. Telespirometry uses a portable spirometer and transmits the lung function data online from a primary care clinic to a specialized center for interpretation. Consequently, some national networks were implemented, with positive outcomes.4, 5, 6, 7 Results from the “RespiraNet Program” in Brazil and a Spanish study by Marina et al. showed that telespirometries performed by previously trained technicians, and analyzed and interpreted remotely by expert physicians, is a useful alternative to improve the diagnosis and management of chronic obstructive lung diseases.4, 5 Furthermore, another Spanish study by Masa et al. concluded that telespirometry performed by a remotely located technician controlling the spirometer computer online enhanced the quality and the reliability of the maneuver. The “Alliance” study results showed that Italian general practitioners accepted telespirometry as an useful exploratory modality to improve the early diagnosis, monitoring, and management of COPD and asthma.

Thus, home-based spirometry could decrease the burden on hospital services, avoid gathering of patients in high-risk facilities, and obviate the need for transportations of patients to central areas during the COVID-19 pandemic. In addition, after the pandemic, telespirometry could be a key add-on to improve the response to future demand related to currently postponed laboratory lung function tests.

Financial Support

No funding was received for the publication of this article.

Conflict of Interest

None declared.