Home Spirometry
DESCRIPTION
Home spirometry devices allow for the monitoring of pulmonary function in the home. The primary proposed use is for lung transplant recipients in an attempt to aid in the early diagnosis of infection and rejection. These devices have been suggested for potential use in monitoring pulmonary function in other situations and for other diseases or conditions including for asthmatic children.
Battery-operated spirometers permit regular daily measurement of pulmonary function in the home, typically forced expiratory volume in 1 second (FEV-1) and forced vital capacity (FVC). Home spirometry may also be referred to as ambulatory spirometry.
POLICY
Home monitoring of pulmonary function is considered investigational.
IMPORTANT REMINDER
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ADDITIONAL INFORMATION
Lung transplant recipients must be carefully monitored for the development of either rejection episodes or infectious complications. Home spirometry has been investigated as a technique to provide daily monitoring to promptly identify presymptomatic individuals who may benefit from a diagnostic transbronchial biopsy. However, published data are minimal. This paucity of published clinical data does not permit scientific conclusions regarding clinical use of home monitoring of FEV-1 and FVC. The current literature does not validate any improved health outcomes with using home spirometry for monitoring pulmonary function in lung transplant recipients, other situations, diseases or conditions including for asthmatic children.
SOURCES
American Association of Respiratory Care (AARC). (1996, July). AARC Clinical Practice Guidelines: Spirometry, 1996 Update. Retrieved June 16, 2010 from: http://www.rcjournal.com/cpgs/spirupdatecpg.html.
American Thoracic Society. (2005 April). Series ‘‘American Thoracic Society / European Respiratory Society Task Force: Standardization of Lung Function Testing’’ Standardization of spirometry. Retrieved June 16, 2010 from: http://www.thoracic.org/statements/resources/pfet/PFT2.pdf.
BlueCross BlueShield Association. Medical Policy Manual. (3:2010). Home Spirometry (2.01.33). Retrieved June 12, 2010 from BlueWeb. (6 articles and/or guidelines reviewed)
Brouwer, A., Roorda, R., & Brand, P. (2006). Home spirometry and asthma severity in children. European Respiratory Journal, 28 :(6),1131-1137. (Level 4 Evidence)
Ferreira, G., Haeffner, M., Barreto, S., & Dall’Ago, P. (2010). Incentive spirometry with expiratory positive airway pressure brings benefits after myocardial revascularization. Arquivos brasileiros de cardiologia, 94 (2), 230 - 235, 246 - 251, 233 - 238. (Level 4 Evidence)
Kugler, C., Fuehner, T., Dierich, M., DeWall, C., Haverich, A., Simon, A., et al. (2009). Effect of adherence to home spirometry on bronchiolitis obliterans and graft survival after lung transplantation. Transplantation, 88 (1), 129 - 134. (Level 4 Evidence)
National Guideline Clearinghouse. Institute for Clinical Systems Improvement (ICIS). (2008 January). Diagnosis and management of asthma. Retrieved November 21, 2008 from: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=12293&string=ambulatory+AND+spirometry.
National Guideline Clearinghouse. Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2009 September). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Retrieved June 15, 2010 from: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=15555&string=home+AND+spirometry.
U.S. Food and Drug Administration (2010, June). Center for Devices and Radiological Health. Product Classification. Retrieved June 15, 2010 from: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPCD/classification.cfm?ID=71.
U. S. Food and Drug Administration. (2005. May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K050853. Retrieved June 16, 2010 from: http://www.accessdata.fda.gov/cdrh_docs/pdf5/K050853.pdf.
U. S. Food and Drug Administration. (2008. February). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K080091. Retrieved June 16, 2010 from: http://www.accessdata.fda.gov/cdrh_docs/pdf8/K080091.pdf.
Wensley, D. and Silverman, M. (2004). Peak Flow Monitoring for Guided Self-management in Childhood Asthma: A Randomized Controlled Trial. American Journal of Respiratory and Critical Care Medicine, 170, 606-612. (Level 2 Evidence)
ORIGINAL EFFECTIVE DATE: 12/13/2008
MOST RECENT REVIEW DATE: 7/22/2010
ID_BT
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