Evaluating Asthma Exacerbation-induced Changes in Lung Function With a Home-based Spirometer
Condition: Asthma; Asthma Attack; Asthma, Allergic
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The investigators will study the use of a home-based spirometer (Spirobank Smart spirometer)
      that connects to a smartphone app (VitalFlo) in teenagers with persistent asthma to determine
      if clinically significant changes in lung function detected by the spirometer are associated
      with patient-reported asthma symptoms.
    

Detailed description: 
      Asthma is a common chronic illness and significant expense to our healthcare system. Asthma
      affects nearly 25 million Americans, including 10% of U.S. adolescents. Teenagers are one of
      the most difficult groups to engage in self-management of chronic health problems like asthma
      and are at greater risk of poorly controlled asthma compared to younger children. Up to 80%
      of children with asthma are non-adherent to their controller medications, often due to lack
      of parent or child-perceived need or beneficial effects of these medications. Adolescents may
      have a higher threshold for initiating rescue treatment due to the perceived normalcy of
      asthma symptoms and frequently under-report symptoms to parents and healthcare providers.

      Poor perception of asthma symptoms leads to overestimation of asthma control. Defining well
      controlled versus poorly controlled asthma is highly dependent on self-reported asthma
      symptoms. Up to half of patients with severe asthma symptoms report well controlled asthma.
      Many have low expectations of asthma control and have adapted to the disease so much so that
      they no longer perceive their limitations. Inaccurate self-reported data can be problematic
      in studies evaluating the impact of environmental factors or the efficacy of asthma
      treatments. An objective measure of asthma impairment is pulmonary function testing performed
      by spirometry. Ready access to a conventional spirometer is not always realistic in clinical
      care or research settings. The investigators propose integrating technology-based tools that
      leverage on the high rates of smartphone use among youth to identify early signs of
      deteriorating asthma control.

      The Spirobank smart spirometer is a compact, portable, home-based spirometer approximately
      the size of an inhaler that pairs with a smartphone app called VitalFlo. The device uses an
      energy conserving turbine. Exhaled air flow causes the turbine to rotate, generating a
      voltage analogous to the rate of air flow across the turbine. The spirometer measures Forced
      expiratory volume in 1 second (FEV1), or the volume of air that is exhaled in the first
      second. The device prompts the user to perform a minimum of three expiratory maneuvers in and
      records the best of the three maneuvers. The information generated is collected on a
      microprocessor and then transmitted by a low power Bluetooth radio to the VitalFlo App
      (password protected) on the user's iPhone. The user is alerted, by the App, if their
      expiratory effort is inadequate (such as early termination of exhalation) and is provided
      coaching for proper technique. The data is then transmitted to a HIPAA-compliant cloud
      database. Participants will receive a survey after each time they measure lung function to
      gather information about any asthma symptoms they are experiencing. Investigators will ask
      that they use the spirometer prior to using albuterol for symptoms if possible. VitalFlo will
      also track, via cloud databases, outdoor temperature, humidity, air quality, and pollen
      counts: all environmental factors that can influence asthma symptoms. Routine calibration is
      not needed. The eventual goal of home spirometer use is to identify drops in lung function
      preceding asthma symptoms to allow persons with asthma to intervene with rescue medications
      early in hopes of preventing progression to a more serious exacerbation of asthma ("red
      zone") requiring healthcare utilization, such as emergency care or hospitalization.

      This is a prospective single arm intervention study of 12-21 year olds with persistent
      asthma. Participants will be given the home spirometer after receiving instruction on proper
      use of the device. The participants will also receive an iPhone 5S (without SIM card) loaded
      with the VitalFlo app. Participants will be asked to use the spirometer at least twice daily
      (in the morning between 6am and 10am and in the evening between 6am and 10pm) and whenever
      rescue medication (albuterol) is administered or the participant feels symptoms of asthma
      (such as cough, wheezing, or shortness of breath) in order to document lung function.
      Pulmonary function testing is known to show diurnal variability. Investigators will use the
      morning and evening measurements to calculate the mean FEV1 for the day. After performing the
      spirometry maneuver, the user will be prompted to answer questions about their asthma
      symptoms. The lung function measurements and responses to the questions will be transmitted
      to a cloud-based HIPAA-compliant database and will be available for the investigators to
      download. Changes in lung function will be matched to subject-reported asthma symptoms and/or
      albuterol use.
    

Intervention name(s): Spirobank Smart spirometer
Intervention type(s): Device
Intervention description(s): The spirometer is a compact, portable, home-based spirometer that pairs with a smartphone app. Exhaled air flow causes the turbine to rotate, generating a voltage analogous to the rate of air flow across the turbine. The spirometer measures Forced expiratory volume in 1 second (FEV1), or the volume of air that is exhaled in the first second. The device prompts the user to perform a minimum of three expiratory maneuvers in and records the best of the three maneuvers. The information generated is then transmitted to the VitalFlo App (password protected) on the user's iPhone. The user is alerted, by the App, if their expiratory effort is inadequate (such as early termination of exhalation) and is provided coaching for proper technique.
Intervention model: Single Group Assignment
Intervention model description: This is a prospective single arm study of 12-21 year olds with persistent asthma. Participants will be given the home spirometer and an iPhone 5S (without SIM card) loaded with the VitalFlo app. Participants will be asked to use the spirometer at least twice daily (in the morning between 6am and 10am and in the evening between 6am and 10pm) and whenever rescue medication (albuterol) is administered or the participant feels symptoms of asthma (such as cough, wheezing, or shortness of breath) in order to document lung function. After performing the spirometry maneuver, the user will be prompted to answer questions about their asthma symptoms. Changes in lung function will be matched to subject-reported asthma symptoms and/or albuterol use.
Masking: None (Open Label)
Primary purpose: Other