Title : Estimating the economic burden associated in the treatment of community acquired pneumonia (CAP) among adults with chronic obstructive pulmonary disease (COPD) in Ireland
Remote spirometry is a novel form of supervised lung function testing of the patients in their homes. It consists of the patient performing a spirometry examination at home, using a mobile spirometer, under the supervision of a specialist who communicates online with the patient in real time, during the test. In this pilot study, the quality of spirometry tests performed by the patients during remote spirometry was evaluated. The protocol of the remote spirometry test was as follows: a) mobile spirometer (AioCare, Healthup) with antibacterial filter is sent to the patient in a package, b) patient receives the spirometer, downloads the mobile application (AioCare Patient), and create a patient account, c) the patient communicates with the specialist by an online communicator (with video or audio connection) and after short instruction performs spirometry examination under its supervision with the dashboard-visible result of the examination in real time, d) the patient sends back the spirometer. 101 subjects (39 females) with a mean age of 39.4±14.4 years (range: 13-72 years) and an average BMI index of 25.5±4.6 kg/m^2 were included in the analysis. Spirometry assistance was provided by 2 trained operators. Among 101 spirometry examinations, 77 (76%) were correct based on ATS/ERS Standardization. There were no significant differences in the percent of correct examinations between the patients <=40 years vs. >40 years (80% vs. 71%, p=0.403), nor between females and males (79% vs. 74%, p=0.713). Among the correct examinations, 10 (13%) indicate bronchial obstruction (7 – mild, 2 – moderate, 1 – severe obstruction). In the incorrect examination the main cause of the not meeting correctness criteria was: lack of repeatability (75%), time to PEF > 300 ms (52%), BEV error (1%), lack of plateau (4%), cough occurred (2%). The process of service management and spirometry was monitored using an online dashboard, which allowed for optimal remote visits planning. The study showed a high level of the quality of remote spirometry examinations, comparable to the performance obtained in the clinical environment, even for the elderly patients who are generally less familiar with the mobile technologies. The advantage of this form of testing is to increase accessibility of spirometry tests, especially during Covid-19 pandemic (when the performance of spirometry in clinical settings has been significantly reduced), for immobilized patients or those who live in smaller urban centers.