Pulmonary function testing is an important diagnostic and treatment management tool for chronic lung diseases like COPD. This month’s Market Analysis Q&A asked executives from Vitalograph Inc and Futuremed, two of the leading manufacturers of spirometry and PFT equipment, to look ahead at the industry and technology trends for spirometers. Participating in the discussion were:
- Susan Lukenbill, national sales manager, Futuremed
- Rich Rosenthal, vice president, USA Sales and Marketing, Vitalograph Inc.
RT: A large percentage of spirometer usage is with pediatric populations. What challenges do clinicians face in using spirometry with pediatric patients, and how do your devices help them overcome these challenges?
Susan Lukenbill (Futuremed): Spirometers for kids need to address multiple concerns. One is the practical: the equipment needs to be easy for children, especially younger ones, to hold and work with. Since a spirometry maneuver is effort dependent, it is also helpful if the software includes a child-friendly incentive to encourage optional patient effort. The other factor to consider is whether the predicted normals on the spirometer fit the pediatric population. All Futuremed spirometers consist of a lightweight, ergonomically designed handset that are easy to hold. The handset is separated from the body of the spirometer, so that the operator can monitor test results on a screen while the patient is performing the maneuver.
Tests can be performed with a choice of adult or pediatric disposables to ensure proper and comfortable mouthpiece fit between the patient’s lips. And all Futuremed spirometers have some form of pediatric incentive display. We have used “Bubbles” for years and now have a flying fish incentive display as well, and both make a game out of the effort and encourage the patient to blow out as hard as they can and to continue to their predicted best. Last, not least, Futuremed spirometers are equipped with a choice of predicted norms, including the latest equations for pediatric patient populations.
Rich Rosenthal (Vitalograph): All the advanced spirometers from Vitalograph include incentive graphics, including our portable and desktop systems. Our PC-based model (Pneumotrac model 6800 with Spirotrac V software) includes eight different animated incentives including a motorcyclist that needs to jump across a canyon or otherwise crash. Our recent marketing alliance with Morgan Scientific extends this option to include incredible gaming line animations in the optional Morgan ComPAS software. Spectacular animation of a dragon burning down a castle is synchronized with the patient’s expiratory effort. Turning performance of a spirometry maneuver to a gaming experience really helps with today’s pediatric patients (and lots of adults too).
Other features of the ComPAS software allow pediatric caregivers to more accurately assess trending of any pulmonary parameter set based upon body mass during the patient’s growing years. It’s an amazing tool for more realistic interpretation of the PFT.
RT: What factors do you recommend hospitals consider when deciding to purchase or upgrade their spirometry equipment?
Lukenbill: The question they should answer is “What do we want from this spirometer?” Depending on the size of the hospital and how many patients they see, the answer may be different. Some may want a spirometer that prints report to paper immediately following the test. Others may not need a printout at all but would rather store results straight in an electronic chart. Futuremed offers a line of spirometers to meet different needs. We think all spirometers should have the following traits: they should be easy to use, both for the operator and for the patient. Measurements should be easy to check with a calibration syringe, and you should be comfortable that your results are accurate every time.
Quality control messages are helpful. More importantly, a spirometer should display flow/volume and time/volume graphs in real time so that the operator can know right away if a test is performed correctly. It is helpful too if a spirometer can be used with different types of disposables so that the operator can control their cost, quality and availability. And we feel that when a hospital buys a spirometer, they are also buying the ongoing support of the people behind the spirometer. Futuremed has been in the spirometry business for over 30 years now. Many of our older models are still in use and we are happy to be there to help those using them in any way we can.
Rosenthal: Of course there are many things to consider. Use of the new GLI equations by US hospitals will drive their use down to the doctors’ offices and improve the standardization of spirometry results against global populations. We encourage hospitals to make that change from the predicted equations they currently employ. Secondly, hospitals face more stringent infection control requirements. We like to remind hospital users that in addition to using bacterial/viral filters (Vitalograph BVF), the Pneumotrac can be completely disassembled and disinfected via both cold sterilization and autoclave methods. Although not needed in most situations, this can be a critical factor for immune compromised lung disease patients such as those with cystic fibrosis.
RT: If early detection and diagnosis of respiratory conditions like asthma and COPD benefits outcomes, how can the industry increase access to spirometry testing for these diseases? And what are the greatest obstacles to increasing spirometry access?
Lukenbill: Spirometers have become much more user friendly, and we continue to work on software that can help make testing easier for the patient and the operator. We also encourage customers to be in touch with us whenever they have questions about equipment or testing in general, and if we can’t answer those questions we give them references and put them in touch with people who can. I think many physicians look to respiratory professionals and to peers within their community to guide them and to affirm the value of performing spirometry in their clinics. Some can use a little handholding too.
The Asthma Toolkit in Colorado is an example that comes to mind. This is a program where National Jewish Health provided primary care offices in rural parts of Colorado with a spirometer and training in order to see if there would be a change in the way they treated asthma patients. The Asthma Toolkit educators spent hours coaching in the clinics to make sure the staff were comfortable performing spirometry. The result was a significant increase in use of spirometers for diagnosis. There are other educational initiatives around the country and are making a difference as well. But I think we would see major changes in use of spirometers if there were more one-of-one mentoring efforts like the Asthma Toolkit.
Rosenthal: Getting these measurements to the home in the form of inexpensive devices that can transmit their data to the disease management entity and ultimately the caregiver will surely improve outcomes by creating a more proactive and actionable care plan. The biggest barrier is still that most primary care practitioners either do not have a spirometer or only use them on known lung disease patients, rather than creating a standard of care where all patients are given a spirometry test during their (hopefully) annual healthy patient visits. Certainly in the adult population, ALL current smokers older than 30 years should have spirometry to potentially nip COPD in the bud by motivating such patients to quit smoking.
RT: How have products and technology changed in the last few years and what do you anticipate will be the future for spirometry?
Lukenbill: When I was growing up, people always asked if something was “bigger than a bread box.” Well, spirometers were indeed as big as a bread box, weighed as much, and were permanently plugged into a wall socket. Futuremed spirometers are now much smaller (we have one that fits in the pocket), with batteries that last hours, and can store hundreds of tests, print reports on standard printers, save them on a flash drive, or store them in the patient’s EMR. Measurements are also even more accurate.
What we at Futuremed are considering now are different ways of using the technology to measure more. For example, we offer Spiropalm6MWT, a compact spirometer that can be worn on a belt during a 6-minute walk test. The device comes with a mask and a pulse oximeter. The purpose of it is to continually measures breathing and SpO2 while a patient performs a standard 6-minute walk. The result is a complete one page report that goes beyond showing baseline and end of test values, with minute ventilation, breathing pattern, SpO2 and HR monitoring throughout the test. This allows for a full assessment of ventilation limitation due to dynamic hyperinflation and air trapping in patients with pulmonary disease.
Rosenthal: Although we can only talk generally about product plans, suffice it to say that Vitalograph has a large team of highly talented device and database engineers in our facility in Ennis, Ireland, dedicated to bringing forward some of the most innovative spirometry-related technology. We have released a few products in Europe which are awaiting FDA clearance, including the Compact Expert, a diagnostic workstation which is a standalone but networkable and communicative full-size touchscreen system with multiple test modalities, including spirometry, but adding on pulse oximetry, wireless ECG, wireless weight scale, wired and wireless blood pressure, and more. We are working on more devices to fit into this diagnostic platform, and increasing our capabilities in communicating medical data in a safe, secure, and efficient manner. RT
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