High-Quality Pediatric Spirometry Via Telemedicine

RATIONALE: Spirometry is an important component of pediatric asthma care. Rural areas are challenged with lack of skilled pediatric pulmonary function test laboratories and often patients need to travel long distances to tertiary care centers. We developed a telemedicine model to address this healthcare need.

METHODS: Rural pediatric patients attended a subspecialty asthma clinic via telemedicine with remote spirometry testing between February-June 2017. An experienced respiratory therapist (RT) based at Arkansas Children’s Hospital was connected to a rural originating site using telemedicine endpoints. Through remote desktop access (TeamViewer^®), the RT accessed and controlled the spirometry software (CompPAS,^® Morgan Scientific) at the originating site. A telepresenter prepared and positioned the patient and assisted the patient with the pneumotachograph. Real-time audio-visual technology allowed for direct communication and coaching between the patient and the RT throughout the spirometry procedure. The telepresenter provided technical assistance as needed while the patient was coached by the RT. Prior to testing, the spirometer was calibrated by the telepresenter under the RT’s supervision through real-time audiovisual communication.

RESULTS: 32 of 33 patients attending a pediatric asthma clinic via telemedicine successfully completed remote spirometry. The mean age was 10.2 years (range 9-11.4) and 76% were Caucasian. The mean [95%CI] FVC was 116% [111-121%] predicted, FEV1 108% [104-113%] predicted, FEF_25-75% 92% [83-102%] predicted, and exhalation time 7.3s [6.3-8.3s].

CONCLUSIONS: Rural pediatric patients successfully completed spirometry via telemedicine. Our model demonstrates feasibility of utilizing telemedicine to expand subspecialty asthma services to children living in rural and medically underserved regions.