Home Testing of Lung Function with a Smartphone

Home Testing System Approved by FDA

Background: It would be helpful to those with asthma or COPD to monitor their lung function by doing breathing tests in their home. Then, the results could be sent electronically to a health coach or to the office of their health care provider. This information could be used along with the person’s symptoms, such as shortness of breath, to evaluate any changes.

New Home Testing System: The US Food and Drug Administration recently approved Wing, an app-connected spirometer from St. Louis, Missouri-based Sparo Labs (see image below). Wing is a “pocket-sized device that will help individuals know how well their lungs are functioning” at home. It connects to a smartphone and is smaller, easier to use, and less expensive than other testing systems typically used in a medical office or hospital.

Sparo testing system using iPhone

Sparo testing system using iPhone

 

The FDA has cleared the device so it can purchased over-the-counter without a prescription. This means that the company can market it directly to consumers. The press release did not state how much the Wing system will cost.

Woman performing breathing test.

Woman performing breathing test.

My Comments: This device will measure how much air that you can exhale [called forced vital capacity (FVC)] and how much air you can exhale in one second [called forced expiratory volume in one second (FEV1)].  These results provide more useful information than simply measuring peak expiratory flow. Peak flow meters for use at home have been available for decades.

I have no financial interest in Sparo Labs.

 

My Sister died from Complications of Alpha-1

Good Afternoon Dr. Mahler:

I hope you can help me with some information about Alpha-1. My sister recently died from complications of Alpha-1, this was diagnosed through an autopsy. We have no idea how long she was suffering with the disease, but was admitted to the hospital and passed 5 days later from cirrhosis, spontaneous peritonitis, and sepsis. Such a shock. I had my blood test and found that I am a carrier and unlikely? to have problems. I do have asthma and nodules in my lung so I am very concerned.

Would you suggest I have further tests to assure my lung issues

Would you suggest I have further tests to assure my lung issues are not related to Alpha 1? Thank you in advance for your assistance.

Cordially,
Judy from Kalamazoo, MI

Dear Judy,

I am sorry to hear about your sister.

It is important to remember that alpha-1 antitrypsin deficiency (abbreviated Alpha-1) is a liver disease that can affect the lungs, especially if someone smokes.  The Alpha-1 protein is made in the liver and is called a protease inhibitor – this means that it protects the lung from damage. The condition is most common among Europeans and North Americans of European descent.

Cirrhosis affects about 30-40% of those with Alpha-1 over the age of 50 years.  Unless your mother had another reason to have cirrhosis (like hepatitis or excess alcohol intake), her cirrhosis was likely due to Alpha-1 disease. Your health care provider should be able to tell you this from the autopsy results.

You stated that you are a carrier.  You should ask you health care provider for the exact results.  This includes the alleles (two letters) and the level of Alpha-1 in the blood.  Being a carrier means that you probably have a Z or S allele (inherited from one parent); the other allele is probably M, which is normal.  You should share this information with any siblings and children, who can then tell their health care provider.

You are correct that it is very unlikely that you will have any liver or lung problem as a carrier for Alpha-1.  Certainly, it is quite important that you do not smoke cigarettes or inhale irritants in the air.

The figure shows possible conditions associated with Alpha-1 deficiency.

Conditions associated with Alpha-1

 

In response to your question about additional tests:

Has your health care provider told you what is the cause of the lung nodules? There are many causes for lung nodules, and the key issue is to determine that they are benign (not cancer).  Usually, follow-up CT scans of the chest are done to make sure that the nodules are stable in size over a 2 year period.  If so, then it is assumed that the nodules are benign.

Asthma is diagnosed by a medical history AND breathing tests. If you have not had pulmonary function tests (breathing tests), you should request these.  The information can help in making the correct diagnosis and in determining how your lungs are working.  As the above figure indicates, sometimes Alpha-1 can be misdiagnosed as asthma.

Finally, the Alpha-1 Foundation is a great resource for more information.

Best wishes,

Donald A. Mahler, M.D.

 

 

 

Asthma-COPD Overlap Examined in New Study

15% of Those with COPD also have Asthma (called Asthma-COPD Overlap)

The asthma-COPD overlap (ACO) is one of the “hot” topics at respiratory meetings.  These individuals have some features of both asthma and COPD.

ACOS = asthma COPD Overlap Syndrome

ACOS = asthma COPD Overlap Syndrome

In the January 2016 issue of the journal CHEST (volume 149; pages 45-52), Dr. Cosio and colleagues studied 831 individuals seen for COPD in Spain. Based on specific characteristics, the authors considered that 15% of those with COPD also had asthma.  Of the group with the asthma-COPD overlap, 82% were male and 67% had mild ot moderate disease based on results of breathing tests. Interestingly, they found that those with asthma-COPD Overlap had a better survival over one year compared with those who only had COPD.

Professor Peter J. Barnes of the Imperial College in London

Professor Peter J. Barnes of the Imperial College in London

Editorial about the study: Dr. Peter Barnes reviewed the differences in types of inflammatory cells in asthma and in COPD.  He commented that the reason to identify ACO is to select the most appropriate therapy. Studies suggest that those with COPD who have a specific type of white blood cell called an eosinophil in sputum or blood will benefit from adding an inhaled corticosteroid medication to the two different types of bronchodilator called beta2-agonists and muscarinic antagonists.  The use of all three types of medications is commonly called “triple therapy.”

 

My Comments: The following diagram shows the overlap between COPD (chronic bronchitis and emphysema) and asthma.  I was taught about these overlapping conditions during medical school and fellowship training.

Overlapping circles show that some individuals have features of asthma and COPD.

Overlapping circles show that some individuals have features of asthma and COPD.

Most individuals in my practice who have severe or very severe COPD or severe asthma are on “triple therapy” because this is considered optimal for relief of symptoms (breathing difficulty) and for reducing the risk for an exacerbation (worsening of shortness of breath, cough, and yellow or green mucus).

From my perspective, the diagnosis of asthma-COPD overlap will be important when new unique and specific treatments become available.

Asthma and COPD Overlap Syndrome

Hot Topic at Respiratory Meetings – Asthma and COPD Overlap

Discussions about those individuals who have features of both asthma and COPD is a “hot topic” at medical meetings. It is important to understand this overlap, or combination, because different medications are used to treat asthma and to treat COPD (see below My Comment).

In a medical article published on-line on August 20, 2015, in the journal CHEST, Dr. Cosio and colleagues from Spain identified individuals who were considered to have both asthma and COPD. This is called asthma-COPD overlap syndrome and abbreviated ACOS.

The authors studied 831 patients diagnosed as having COPD. To identify those who also had asthma, they measured improvements in breathing tests after someone inhaled albuterol (a quick acting bronchodilator) and  examined blood tests that are usually positive in those with asthma,

Main Findings: 15% of the group were considered to have both asthma and COPD (ACOS). They were predominantly male (82%) and 63% were taking an inhaled corticosteroid medicine.

Circles show overlap between asthma and COPD. COPD includes chronic bronchitis and emphysema.

Circles show overlap between asthma and COPD. COPD includes chronic bronchitis and emphysema.

My Comment: Why is this important to you? The main reason is that inhaled corticosteroid medications are used to reduce inflammation (redness and swelling) in the breathing tubes in those with asthma. Rather, different types of inhaled bronchodilators are used to treat  those with COPD. Inhaled corticosteroids should be used to treat COPD mainly for those who have experienced frequent episodes of worsening of COPD usually due to a chest infection (called an exacerbation). One concern about use of inhaled corticosteroids in the treatment of COPD is an increased risk of pneumonia.

With any medication, there needs to be consideration of expected benefit and possible risk. You may wish to discuss this topic with your healthcare provider.