Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities.Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients' experiences.Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices.Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.

https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1590ST

Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement.

Objective Consumers are living longer, creating more pressure on the health system and increasing their requirement for self-care of chronic conditions. Despite rapidly-increasing numbers of mobile health applications (‘apps’) for consumers’ self-care, there is a paucity of research into consumer engagement with electronic self-monitoring. This paper presents a qualitative exploration of how health consumers use apps for health monitoring, their perceived benefits from use of health apps, and suggestions for improvement of health apps. Materials and Methods ‘Health app’ was defined as any commercially-available health or fitness app with capacity for self-monitoring. English-speaking consumers aged 18 years and older using any health app for self-monitoring were recruited for interview from the metropolitan area of Perth, Australia. The semi-structured interview guide comprised questions based on the Technology Acceptance Model, Health Information Technology Acceptance Model, and the Mobile Application Rating Scale, and is the only study to do so. These models also facilitated deductive thematic analysis of interview transcripts. Implicit and explicit responses not aligned to these models were analyzed inductively. Results Twenty-two consumers (15 female, seven male) participated, 13 of whom were aged 26–35 years. Eighteen participants reported on apps used on iPhones. Apps were used to monitor diabetes, asthma, depression, celiac disease, blood pressure, chronic migraine, pain management, menstrual cycle irregularity, and fitness. Most were used approximately weekly for several minutes per session, and prior to meeting initial milestones, with significantly decreased usage thereafter. Deductive and inductive thematic analysis reduced the data to four dominant themes: engagement in use of the app; technical functionality of the app; ease of use and design features; and management of consumers’ data. Conclusions The semi-structured interviews provided insight into usage, benefits and challenges of health monitoring using apps. Understanding the range of consumer experiences and expectations can inform design of health apps to encourage persistence in self-monitoring.

/pdf/mobile-health-apps-to-facilitate-self-care-a-qualitative-9w7gpmjbry.pdf

Mobile Health Apps to Facilitate Self-Care: A Qualitative Study of User Experiences.

Background Asthma is one of the most common long-term conditions worldwide, which places considerable pressure on patients, communities
and health systems. The major international clinical guidelines now recommend the inclusion of self management programmes in
the routine management of patients with asthma. These programmes have been associated with improved outcomes in patients with
asthma. However, the implementation of self management programmes in clinical practice, and their uptake by patients, is still poor.
Recent developments in mobile technology, such as smartphone and tablet computer apps, could help develop a platform for the
delivery of self management interventions that are highly customisable, low-cost and easily accessible. Objectives To assess the effectiveness, cost-effectiveness and feasibility of using smartphone and tablet apps to facilitate the self management of
individuals with asthma. Search methods We searched the Cochrane Airways Group Register (CAGR), the Cochrane Central Register of Controlled Trials (CENTRAL),
MEDLINE, EMBASE, PsycINFO, CINAHL, GlobalHealth Library, Compendex/Inspec/Referex, IEEEXplore, ACMDigital Library,
CiteSeerx and CAB abstracts via Web of Knowledge. We also searched registers of current and ongoing trials and the grey literature.
We checked the reference lists of all primary studies and review articles for additional references. We searched for studies published
from 2000 onwards. The latest search was run in June 2013. Selection criteria We included parallel randomised controlled trials (RCTs) that compared self management interventions for patients with cliniciandiagnosed
asthma delivered via smartphone apps to self management interventions delivered via traditional methods (e.g. paper-based
asthma diaries). Data collection and analysis 
We used standard methods expected by the Cochrane Collaboration. Our primary outcomes were symptom scores; frequency of
healthcare visits due to asthma exacerbations or complications and health-related quality of life. Main results We included two RCTs with a total of 408 participants. We found no cluster RCTs, controlled before and after studies or interrupted
time series studies that met the inclusion criteria for this systematic review. Both RCTs evaluated the effect of a mobile phone-based
asthma self management intervention on asthma control by comparing it to traditional, paper-based asthma self management. One
study allowed participants to keep daily entries of their asthma symptoms, asthma medication usage, peak flow readings and peak flow
variability on their mobile phone, from which their level of asthma control was calculated remotely and displayed together with the
corresponding asthma self management recommendations. In the other study, participants recorded the same readings twice daily, and
they received immediate selfmanagement feedback in the form of a three-colour traffic light display on their phones. Participants falling
into the amber zone of their action plan twice, or into the red zone once, received a phone call from an asthma nurse who enquired
about the reasons for their uncontrolled asthma.
We did not conduct a meta-analysis of the data extracted due to the considerable degree of heterogeneity between these studies. Instead
we adopted a narrative synthesis approach. Overall, the results were inconclusive and we judged the evidence to have a GRADE rating
of low quality because further evidence is very likely to have an important impact on our confidence in the estimate of effect and is
likely to change the estimate. In addition, there was not enough information in one of the included studies to assess the risk of bias for
themajority of the domains. Although the other included study was methodologically rigorous, it was not possible to blind participants
or personnel in the study. Moreover, there are concerns in both studies in relation to attrition bias and other sources of bias.
One study showed that the use of a smartphone app for the delivery of an asthma self management programme had no statistically
significant effect on asthma symptom scores (mean difference (MD) 0.01, 95% confidence interval (CI) -0.23 to 0.25), asthma-related
quality of life (MD of mean scores 0.02, 95% CI -0.35 to 0.39), unscheduled visits to the emergency department (OR 7.20, 95% CI
0.37 to 140.76) or frequency of hospital admissions (odds ratio (OR) 3.07, 95% CI 0.32 to 29.83). The other included study found
that the use of a smartphone app resulted in higher asthma-related quality of life scores at six-month follow-up (MD5.50, 95%CI 1.48
to 9.52 for the physical component score of the SF-12 questionnaire; MD 6.00, 95% CI 2.51 to 9.49 for the mental component score
of the SF-12 questionnaire), improved lung function (PEFR) at four (MD 27.80, 95% CI 4.51 to 51.09), five (MD 31.40, 95% CI
8.51 to 54.29) and six months (MD 39.20, 95% CI 16.58 to 61.82), and reduced visits to the emergency department due to asthmarelated
complications (OR 0.20, 95% CI 0.04 to 0.99). Both studies failed to find any statistical differences in terms of adherence to
the intervention and occurrence of other asthma-related complications. Authors’ conclusions The current evidence base is not sufficient to advise clinical practitioners, policy-makers and the general public with regards to the use
of smartphone and tablet computer apps for the delivery of asthma selfmanagement programmes. In order to understand the efficacy of
apps as standalone interventions, future research should attempt to minimise the differential clinical management of patients between
control and intervention groups. Those studies evaluating apps as part of complex, multicomponent interventions, should attempt
to tease out the relative contribution of each intervention component. Consideration of the theoretical constructs used to inform the
development of the intervention would help to achieve this goal. Finally, researchers should also take into account: the role of ancillary
components in moderating the observed effects, the seasonal nature of asthma and long-term adherence to self management practices.

Smartphone and tablet self management apps for asthma

Background Self-management of asthma may improve asthma outcomes. The Internet has been suggested as a tool for the monitoring and self-management of asthma. However, in a recent study we found that a Web interface had some disadvantages and that users stopped using the application after a short while. Objective The primary objective of this study was to evaluate, from a user perspective, the feasibility of using short message service (SMS) for asthma diary data collection through mobile phones. The secondary objective was to investigate patient compliance with an SMS diary, as measured by response rates over time. Methods The study included quantitative response rate data, based on SMS collection, and qualitative data from a traditional focus group setting. In a period of 2 months, the participants received 4 SMS messages each day, including a medication reminder, a request to enter peak flow, data on sleep loss, and medication dosage. Participants were asked to reply to a minimum of 3 of the messages per day. Diary inputs were collected in a database and the response rate per patient was expressed as the number of diary inputs (SMS replies) divided by diary requests (product of number of days in the study and the number of diary questions per day) for each participant. After the study period, the participants were invited to a focus group interview addressing the participants' attitudes to their disease, their experience with the SMS asthma diary, and their future expectations from the SMS asthma diary. Results Twelve patients with asthma (6 males, 6 females) participated in the data collection study. The median age was 38.5 (range: 13 – 57) years. The median response rate per patient was 0.69 (range: 0.03 – 0.98), ie, half the participants reported more than about two thirds of the requested diary data. Furthermore, response rates were relatively steady during the study period with no signs of decreasing usage over time. From the subsequent focus group interview with 9 users we learned that, in general, the participants were enthusiastic about the SMS diary – it became an integrated part of their everyday life. However, the participants wished for a simpler diary with only one SMS message to respond to and a system with a Web interface for system customization and graphical display of diary data history. Conclusion This study suggests that SMS collection of asthma diary data is feasible, and that SMS may be a tool for supporting the self-management of asthma (and possibly other chronic diseases) in motivated and self-efficacious patients because mobile phones are a part of people's everyday lives and enable active requests for data wherever the patient is. The combination of SMS data collection and a traditional Web page for data display and system customization may be a better and more usable tool for patients than the use of Web-based asthma diaries which suffer from high attrition rates.

Feasibility of Collecting Diary Data From Asthma Patients Through Mobile Phones and SMS (Short Messa

One stop mycology

Adenylyl Cyclase G, an Osmosensor Controlling Germination of Dictyostelium Spores

BACKGROUND: Collaborative self-management is a core recommendation of national asthma guidelines; the written action plan is the knowledge tool that supports this objective. Mobile health technologies have the potential to enhance the effectiveness of the action plan as a knowledge translation tool.

https://downloads.hindawi.com/journals/crj/2013/906710.pdf

Development and pilot testing of a mobile health solution for asthma self-management: Asthma action plan smartphone application pilot study

Cellular communication dictates all stages of growth and development in the cellular slime molds Dictyostelium discoideum utilizes a number of signal molecules for cell-to-cell communication, incl

Patterning of development in Dictyostelium discoideum: factors regulating growth, differentiation, spore dormancy, and germination.

Quality problem International guidelines establish evidence-based standards for asthma care; however, recommendations are often not implemented and many patients do not meet control targets. Initial assessment Regional pilot data demonstrated a knowledge-to-practice gap. Choice of solutions We engineered health system change in a multi-step approach described by the Canadian Institutes of Health Research knowledge translation framework. Implementation Knowledge translation occurred at multiple levels: patient, practice and local health system. A regional administrative infrastructure and inter-disciplinary care teams were developed. The key project deliverable was a guideline-based interdisciplinary asthma management program. Six community organizations, 33 primary care physicians and 519 patients participated. The program operating cost was $290/patient. Evaluation Six guideline-based care elements were implemented, including spirometry measurement, asthma controller therapy, a written self-management action plan and general asthma education, including the inhaler device technique, role of medications and environmental control strategies in 93, 95, 86, 100, 97 and 87% of patients, respectively. Of the total patients 66% were adults, 61% were female, the mean age was 35.7 (SD = ± 24.2) years. At baseline 42% had two or more symptoms beyond acceptable limits vs. 17% (P< 0.001) post-intervention; 71% reported urgent/emergent healthcare visits at baseline (2.94 visits/year) vs. 45% (1.45 visits/year) (P< 0.001); 39% reported absenteeism (5.0 days/year) vs. 19% (3.0 days/year) (P< 0.001). The mean follow-up interval was 22 (SD = ± 7) months. Lessons learned A knowledge-translation framework can guide multi-level organizational change, facilitate asthma guideline implementation, and improve health outcomes in community primary care practices. Program costs are similar to those of diabetes programs. Program savings offset costs in a ratio of 2.1:1.

/pdf/using-a-knowledge-translation-framework-to-implement-asthma-3ty7o076ee.pdf

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.

Signalling mechanisms involving cAMP have a well-documented role in the coordination of multicellular development and differentiation leading to spore formation in the social amoeba, Dictyostelium discoideum. The involvement of cAMP in the poorly understood developmental stages of spore dormancy and germination have been investigated in this study. Dormant spores contained up to 11-fold more cAMP than nascent amoebae. The spore cAMP levels were not constant, but typically underwent a surge at 14-18 d when spores acquired the ability to germinate spontaneously. The high cAMP levels decreased only during successful spore germination, i.e. emergence of nascent amoebae. The temporal pattern of cAMP decrease was complex and unique to the method of spore activation, supporting our hypothesis that exogenously (e.g. heat) activated and autoactivated spores germinate by different mechanisms. During heat-induced activation, transcription of acg (a gene encoding adenylyl cyclase associated with germination) correlated well with spore cAMP content. Young wild-type spores, incapable of spontaneous germination, maintained a uniformly high cAMP level, and spore cAMP levels also remained high if germination was inhibited. When activated spores were deactivated by applying increased osmotic pressure, cAMP concentrations rose and ultimately levelled off at the high levels typical of dormant spores. The correlation between high cAMP and failure to germinate was also evident when autoactivation was inhibited by the cAMP analogue, 8-bromo-cAMP. Also, spores from a strain (HTY217) with unrestrained protein kinase A activity were incapable of spontaneous germination. Overall, our experiments provide evidence for continued cAMP signalling in spores up to 18 d after sporulation and for linkages between elevated cAMP, spore deactivation and inhibition of spontaneous germination.

Todd W. Sands

Papers

Adenylyl Cyclase G, an Osmosensor Controlling Germination of Dictyostelium Spores

Development and pilot testing of a mobile health solution for asthma self-management: Asthma action plan smartphone application pilot study

Patterning of development in Dictyostelium discoideum: factors regulating growth, differentiation, spore dormancy, and germination.

Using a knowledge translation framework to implement asthma clinical practice guidelines in primary care.

High cAMP in spores of Dictyostelium discoideum: association with spore dormancy and inhibition of germination.