Letter to the Editor
Spirometry Outside the Hospital
La espirometría en el medio extrahospitalario
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Barbosa, Cláudia S. Sousa, Isabel Almeida, Lara Pimenta, Rita Aguiar" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Mário" "apellidos" => "Morais-Almeida" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] 1 => array:4 [ "nombre" => "Miguel T." "apellidos" => "Barbosa" "email" => array:1 [ 0 => "migueltrbarbosa@gmail.com" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Cláudia S." "apellidos" => "Sousa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Isabel" "apellidos" => "Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Lara" "apellidos" => "Pimenta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Rita" "apellidos" => "Aguiar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Allergy Centre, CUF Descobertas Hospital, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pulmonology Department, Hospital Centre of Barreiro-Montijo, Barreiro, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Pulmonology Department, Central Hospital of Funchal, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La espirometría en el medio extrahospitalario" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">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.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4–7</span></a> 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.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> 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.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">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.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial Support</span><p id="par0025" class="elsevierStylePara elsevierViewall">No funding was received for the publication of this article.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial Support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Both authors contributed equally.</p>" "identificador" => "fn0005" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Impact of the COVID-19 pandemic on lung function laboratories: considerations for “Today” and the “Day After” [published online ahead of print, 2020 July 7]" "tituloTraducido" => "Impacto de la pandemia COVID-19 en los laboratorios de función pulmonar: consideraciones sobre el «hoy» y el «día después» [published online ahead of print, 2020 Jul 7]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. 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