Is Home-Based Spirometry Ready for Prime Time?

Two lung disease experts had a "lively" debate at the annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI), where they each took a position on the pro and con side of whether at-home spirometry tests and devices, which are now available from multiple companies, should be elevated to prime-time use.

In this exclusive MedPage Today video, Praveen Akuthota, MD, of UC San Diego School of Medicine, the expert who took the pro side of the debate, discusses both his argument and the rebuttal, as well as reactions from the audience.

Following is a transcript of his remarks:

I had this debate with Dr. [Loren] Denlinger from University of Wisconsin at the AAAAI meeting, and Loren and I both worked together on a network called the PrecISE [Precision Interventions for Severe and/or Exacerbation-Prone Asthma] Network for severe asthma. It's a clinical trial looking at multiple interventions in severe asthma. And as part of that trial, we really had some issues that we're trying to navigate with COVID. How do we do this complex trial with COVID?

So for us, that was our impetus to look into the possibility of home spirometry in the clinical trial setting to get the critical data that we needed for this clinical trial. But delving into home spirometry for our clinical trial, it really made us versed in home spirometry in general, and starting to think about how we could potentially utilize it in clinical practice as well, kind of in the quote unquote real-world setting, as well.

So based on that, we each took a position for how we wanted to do this debate. You know, sometimes these debates are a little bit artificial -- we have to take a strong stance on one side or another. But we thought it'd be a good framework to talk about an issue that's still got some pros and cons. So we did the proposal to put in this debate and went ahead and had our lively discussion at the AAAAI meeting.

On the pro side of the argument, I think a lot of it kind of writes itself given where we are at the moment with COVID. There's a whole push toward telemedicine engagement with healthcare providers, engagement with healthcare that can be done remotely from a safety perspective.

But I think just like work-at-home type things, people are starting to realize there's convenience to this that may stretch beyond COVID. So, home spirometry, remote monitoring solutions are, I think, something that's going to stay on people's minds going forward. So I think that was really the first point that I made, that this is convenient for patients.

The second point that I made is that this technology may not be perfect, but it's good enough. We're comparing these spirometers that you use at home to office-based spirometry or laboratory-based spirometry, and that's very sophisticated equipment and they are great equipment, and they meet very rigorous standards.

But the question is, to make clinical decisions do you really always need that kind of rigor? There is, of course, a place for that kind of rigor, but do you need that all the time and routinely?

So, I think if there's a con argument to be made, I think that's where the easiest con argument is, that these devices are maybe not quite completely up to snuff.

I also presented some data that we got from the PrecISE Network trial. We did some preliminary data looking at comparing remote spirometry to in-person spirometry. It's not published yet, but I showed a preview of it at the meeting. And, it actually does perform pretty well. Again, maybe not perfectly, but I think has enough fidelity to do what we needed to do in a clinical setting.

So I thought the arguments were strong. I think Dr. Denlinger's arguments really focused around things like the accuracy and also practical things for physicians like reimbursement, and how does this fit into some of those practical operational issues.

There were a few questions. One that stuck out in particular that I would point to is, somebody came up to the microphone and asked a question about why is this any better than just getting peak flows. And are you getting anything additional compared to peak flow?

And I think that's valid. I think there might even be an easier way to monitor with peak flow. But I think you get a little bit more data, and I think there's some utility to that, to get the numbers that tell you the degree of obstruction. You have the ability to potentially do a bronchodilator challenge remotely in the field, which I think also has some value as well.

So, I think overall the pro argument was a decent one that this technology maybe needs a little bit of a shakedown cruise, but is getting close to ready for prime time.

Comment