Spirometry: Men Who Breathe Into Phones

9. August 2016

Pulmonary function measurement via mobile phone – startups are working on this concept worldwide. They have developed several apps and tools. Even a classic pay phone, thanks to modern algorithms, can be made suitable for diagnosis.

There are worldwide an estimated 300 million people suffering from bronchial asthma and 210 million from chronic obstructive pulmonary disease (COPD). For all intents and purposes, they are supposed to have regularly checks of their lung function. This is easier said than done: in poorly developed regions, there are hardly any hospitals with the appropriate equipment. But even in our society patients ignore and forego these types of examinations if they feel subjectively good. Nonetheless Shwetak Patel, IT and electrical engineering professor at the University of Washington, had an idea. He is putting his faith in smartphones as mobile spirometers.

Taking APP paths for lung function

Together with doctors and programmers, he developed the app Spiro Smart. In order to investigate lung function, no additional hardware is required. Patients take a deep breath in and then breathe out as strongly as possible. The switched-on microphone on the smartphone records breathing sounds and transmits them online via app to a server for analysis. It sounds good in theory, has but one major drawback.

When conducting specific local tests, the researchers found that many people simply do not have a smartphone. In many parts of India and Pakistan classic handsets of older design are widespread. Out of necessity, there originated an idea to analyse breathing sounds through a phone call. Even in poorly served areas, mobile networks are now available and reasonably stable.

Test on the phone

To use “Spiro Call”, a regular phone does the job. Even the old payphone left behind from the earlier times becomes a valuable aid. Patients dial the free 1-800 number and blow firmly into the phone. “We had to reflect on the fact that the sound quality obtained via telephone line is bad”, says electrical engineering developer Elliot Saba. Breath sounds are analysed by the Spiro Call server using intelligent algorithms – with surprising accuracy.

At the Association for Computing Machinery’s conference CHI 2016 in San Jose, California, a few weeks ago, the developers presented current data. It shows that average deviation amounts to only 6.2 percent. This lies within the American Thoracic Society’s range with respect to criteria for clinical spirometer use, explains Patel. When comparing end devices there occurred small but not significant differences. More challenges followed for the developers.

Shwetak Patel noted that the breathing sounds of patients with advanced lung disease were not able to be reasonably evaluated. His team was not at a loss for an idea. Using 3D printing, engineers produced a standardised, easily-used whistle. They produced, without great burden on patients, characteristic sounds for analysis via server.

Competition not left breathlessly behind

Other startups after a longer lead up time picked up on the advantage of the situation. International Medical Research’s (MIR) SmartOne measures the lung function and transmits all values to an app. Besides measurements, patients have the option to keep their own diary and write comments: Which medication should they apply? How was the weather? And how did they feel?

CoHeroHealth delivers a tool that combines several features. It measures not only accurate data on respiratory function – an integrated sensor detects the use of inhalation medications. Have patients perhaps made a mistake? How does the situation look with respect to therapy adherence? Or were there certain key events that made patients reach more frequently for rescue medication? Via Bluetooth the relevant data makes its way to the smartphone or the tablet-computer. If the patients give consent, their doctor can draw valuable conclusions and possibly readjust their therapy. The first pilot studies at New York’s Mount Sinai Medical Center were certainly successful, and the US Food and Drug Administration (FDA) gave their stamp of approval.

Respi, a Greek start-up, hooks hardware and software up with a cloud solution that meets European standards. Patients can authorise their pulmonologists to directly evaluate measured data. And MySpiroo wants to even put professional equipment at the disposal of patients. After completion of ongoing developments, their tool will measure FVC (FEV1), forced vital capacity (FVC), vital capacity (VC), expiratory peak flow (PEF) and other ranges.

Developers are not however planning on replacing pulmonologists with technology. Their goal is to support physicians by way of better, closely monitored measurement readings.

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