Evaluation of Telemedicine Spirometry Testing for Veterans with ALS (E-TEST VA)
Abstract
Amyotrophic lateral sclerosis (ALS) is a universally fatal, progressive loss of coordination and control over muscles controlling movement, breathing, eating, swallowing, and speaking. Weakness of muscles that control breathing places people with ALS at risk of developing pneumonia and from build-up of toxic levels of carbon dioxide in the blood. Most patients with ALS will die from a breathing complication. Even before causing these fatal consequences, the weakness of breathing muscles leads to significant sense of shortness of breath, sleepiness, and confusion. For this reason, doctors and nurses routinely monitor the breathing of patients with ALS using a test called spirometry. When the spirometry shows the patient s respiratory muscles are abnormally weak, doctors and nurses can start therapy with a breathing support machine worn at night and occasionally in the daytime as needed. Studies have shown that these machines, referred to as non-invasive ventilation (NIV) improve quality of life for all patients with ALS and can prolong life for some patients. Spirometry involves a mouthpiece and a machine that measures speed and quantity of airflow. It is commonly used in pulmonary medicine to help determine type and severity of a variety of respiratory diseases. In ALS, it is used to determine the initial breathing strength and quantity of air moved with each breath so that doctors and nurses can track these values over time. Once these values begin dropping rapidly or drop below a normal threshold, NIV is recommended. During the COVID-19 pandemic, breathing tests including spirometry were routinely cancelled across the VA and other healthcare systems because they posed a danger to patients and staff. As a result, the multidisciplinary ALS clinics at the Rocky Mountain Regional and Puget Sound VA Medical Centers began issuing portable spirometers to perform this necessary testing in patients homes. Although these devices have been tested with real-time coaching from respiratory therapists over video connections, showing that this produces high-quality results, this coaching is not available for all patients and all tests in most care settings. Additionally, it is not clear if patients like these devices or become frustrated with them. Our initial observations suggest that patients have a strong preference for home spirometry testing because it is one of the few portions of their multidisciplinary clinic visit that must occur in person. Once this requirement is eliminated patients can conduct visits from their own homes if they wish, eliminating challenges arranging transportation and caretaker time. However, without further evaluation of test quality, patient satisfaction, and cost we cannot say for certain whether this program warrants expansion and continuation. In this study we will evaluate a program of home spirometry for ALS patients to determine the role that home spirometry should play in ALS care going forward after pulmonary function labs return to normal. Our evaluation will be guided by other studies of telehealth technologies and include the quality of results produced with these home spirometry devices compared to gold-standard pulmonary testing, patient satisfaction with these devices compared with other gold-standard care, and the costs of a home spirometry program compared with usual care practices. This evaluation will provide information for VA and non-VA decision-makers to determine how portable home spirometry may fit in the spectrum of ALS care. As these devices are approved for use and become available from multiple retailers, this program could be expanded rapidly as soon as our evaluation is completed. Elimination of in-person spirometry testing could rapidly improve patient experience with their ALS care by eliminating the need for routine in-person visits if otherwise clinically stable.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210077
Entities
People
- Matthew Griffith
Organizations
- Denver VA Medical Center
- United States Army