Biosafe Cabin for Spirometry in Response to COVID-19 Restrictions

INTRODUCTION Spirometry is the major screening and follow-up strategy for chronic respiratory conditions. COPD and asthma are public health issues in Brazil. PLATINO study reported a COPD prevalence of 15.8% and most patients (87.5%) are undiagnosed. For asthma, the overall prevalence is 10%, and 56% of them are undiagnosed. The Brazilian healthcare system is based on universal access which causes significant system overload. The main impact on spirometry is a waiting list longer than one year. Delaying access to this exam may cause sub-optimal disease management, significant prejudice to quality of life and reduction of life expectancy. This major obstacle to proper patient care inspired a public-private partnership that has been enabling broader access to spirometry since 2012. The tests are performed by technicians certified by the Brazilian Thoracic Society (SBPT) using Cosmed® MicroQuark® equipment. DESCRIPTION In March 2020, spirometry testing had to be discontinued after a formal recommendation by SBPT in face of COVID-19. This unexpected interruption with no predictable time for resuming activities was expected to impact quality of care. In order to overcome this emerging biologic hazard, we designed a portable cabin equipped with HEPA/ULPA filter to diminish the potential risk of virus spread. (Figure) The design prioritized safety, but also delivered easy assembly. The plastic cover is washable and must be sanitized after each spirometry assessment. The cabin is portable, fitting within a suitcase, an essential requirement since many technicians travel from town to town, all over the country. DISCUSSION The prototype was put to test and succeeded. We assessed interference to spirometry results, HEPA/ULPA filter functionality, easiness to assemble and sanitize the cabin, and active observation of air leakage. We started the production of 20 cabins that will be distributed among the technicians. SBPT already revised their positioning and recommended cautious resumption of the exams. When public health facilities decide to resume the spirometry tests, our technicians will be ready to safely perform them. We believe the biosafe cabin can be easily replicated by other countries, mainly developing ones, where access to healthcare is challenging and biologic hazards, such as tuberculosis, can be a significant hurdle to diagnosis and adequate management of chronic respiratory conditions. ∗Figure. Images illustrate the proportions of the cabin in comparison to an adult technician and a regular suitcase (left) and the actual prototype (right).