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Measurement of the rate of lung volume changes during forced breathing is Forced Vital Capacity (FVC). Typically referred to as Spirometry, FVC is the most commonly performed pulmonary function test. While it is highly sensitive to the presence and severity of disease, not all symptomatic patients present with a clear cut FVC response to a bronchodilator (see Figure A). Therefore, further pulmonary function tests are essential for the diagnosis and management of lung disease.Lung Volume Measurements (LVM) - Some things to consider: With Forced Expiratory Volume in 1 second (FEV1) and the FEV1/FVC ratio borderline or within normal limits, Lung Volume Measurements (LVM) can determine if RV has expanded, and whether TLC has increased or remained the same. If the IC or VC decreases while the TLC remains the same, this could indicate an obstructive impairment of the small airways. If the FEV1/FVC ratio is borderline or within normal limits, LVM (Figure B) can determine if the TLC is reduced, suggesting restrictive disease. Furthermore, if single-breath diffusion is also reduced, this could suggest early interstitial lung disease. LVM that show a decrease in TLC in patients with evidence of airway obstruction via spirometry is suggestive of mixed obstructive-restrictive lung disease. The diagnosis of a restrictive lung disease process cannot be made without direct measure of TLC via LVM. Identifying the presence of early lung disease with the MiniBox+ can facilitate earlier and more effective therapy such as phosphodiesterase-4 inhibitors for chronic obstructive pulmonary disease. Diffusion capacity, which measures the transfer of gas from air in the lung to the red blood cells, can further help determine the severity of lung disease. With the MiniBox+ Complete Pulmonary Function Testing you can expand your practice with complete pulmonary function testing capabilities:Improve patient care Same day lung volumes and DLCO Grow the economic potential of your office ...

Measurement of Spirometry, Lung Volumes, and Diffusion typically require a 1-hour testing block. This allows for 6-8 complete pulmonary function tests in a given day, with much of the hour used for explaining the measurements to the patient, required wait-time between efforts, or allowing the patient to rest.PulmOne’s MiniBox+ is an innovative system that significantly reduces the amount of time needed for complete Pulmonary Function Testing (PFT). Using a sophisticated lung volume measurement (LVM) method, and streamlining data collection for spirometry and diffusion through intuitive touch-screen software, complete PFT can now be performed in half the time. The MiniBox+ makes everything easierThe time requirements and difficulties of coaching patients using LVM, such as gas dilution or body plethysmography, are well known. Nitrogen washout can last up to 7 minutes and requires a minimum 15-minute wait period between efforts. Body plethysmography requires controlled panting against a closed valve for 4-7 seconds, it may require multiple efforts and coaching to get the required depth and frequency of such efforts correct, and of course, it requires patients to climb into and sit inside a closed cabin.With the MiniBox+, patients only need to perform tidal breathing, during which several ~100 millisecond interruptions occur during inspiration. This mouth pressure data and its effect on the 15-liter internal box with known volume and pressure is combined into a data model and algorithm to determine thoracic gas volume. After six successful automatic interruptions, the patient performs a slow vital capacity to complete the measurement. The entire effort takes ~90 seconds to complete. No cabin to fit into and no gas to re-breathe....

Easier for the patient Technology is such that it can improve the experience for patients. Traditional methods, such as gas dilution and body plethysmography, require detailed patient cooperation and extensive technologist knowledge. PulmOne’s MiniBox+ has innovated Lung Volume Measurements with a unique interruption method requiring only tidal breathing from the patient followed by a slow vital capacity. The entire measurement takes only 90 seconds. It’s much easier not only for patients, but also for any technologist who can coach traditional spirometry. Simpler for the clinician With the MiniBox+, complicated and tedious complete PFT requiring a 1-hour block of time per patient is a thing of the past. With intuitive touch screen capabilities and streamlined settings and reports, you can analyze spirometry, lung volumes, diffusion, and post bronchodilator spirometry with the MiniBox+ in as little as 20 minutes. The experienced respiratory therapist will appreciate its ease of use and their freed-up time/energy to focus on good quality efforts and patient care.Its reliability, plus lower cost and space requirements than a body plethysmograph, makes the MiniBox+ a preferred complete PFT system for both office practices an hospital clinics....

Surprisingly, many Pulmonary Function Testing (PFT) devices still use technologies created 20, 30, and even 40 years ago.Just three years ago, PulmOne introduced the MiniBox+, a new PFT system that is both innovative and budget-conscious. Since then, this new PFT device manufacturer is making waves among Allergists and Pulmonologists interested in newer technologies that will help them provide the best possible patient care, while growing their practice. The MiniBox+: The way PFT is done in 2018 The MiniBox+ is a portable, complete PFT device that is both patient- and technologist-friendly.Its reliability, plus lower cost and space requirements, as compared to a body plethysmograph, makes the MiniBox+ a preferred complete PFT system for both office practices and hospital clinics. It has the ability to perform Spirometry, Lung Volume measurement, and DLCO. All measurements can be performed pre- and post-bronchodilator.Using only a single tank of gas for diffusion measurements, the MiniBox+ is easy to operate and maintain, minimizing the number of cables, cords, and hoses, and giving the device a clean and sophisticated look. It also incorporates intuitive touch-screen software allowing for technologists to learn and master the device in a matter of hours.With a typical return on investment of just 4 months*, the MiniBox+ is ideal for providing additional patient testing services, increasing your office/clinic revenue, and giving you more measured data to manage your patients.*based on complete PFT testing of 3 patients/day on average and CMS 2018 physician fee schedule...

The moment Nadine stepped into the pulmonary function room she became nervous. Seeing the body plethysmograph, she knew she would be placed into this box. Self-conscious about her size and somewhat claustrophobic, this was not her first time having to do this test and she knew it was going to be a long and uncomfortable 45 minutes for her.Nadine’s discomfort is common when it comes to Pulmonary Function Testing. Spirometry is tough enough for the patient to perform the Forced Vital Capacity (FVC) with maximum effort, but Lung Volume Measurements (LVM) are problematic as well for both patient and technologist. Body Plethysmography – Not so simple For body plethysmography measurements the patient must sit in the cabin for at least 1 minute for thermal equilibration, then the measurement begins with tidal breathing. At a certain point the patient will be asked to begin panting small puffs of air in and out at a rate of 30-60 breaths per minute. After several of these “panting” maneuvers, the breathing valve will close and this controlled “panting” must continue for approximately four seconds for determination of thoracic gas volume. When this test is performed and coached correctly, there is minimal turn-in volume and tangent artifact giving an accurate determination of functional residual capacity. However, many times this is not the case. It is common for the patient to struggle with “panting” without airflow and it is also common for the technologist to not recognize drift, artifact, and large turn-in volumes being applied to the body plethysmography effort. The MiniBox+ makes it so much easier Technology is such that we can improve the experience for patients. Why have them climb into this body cabin and ask them to perform a maneuver with specific amplitude and frequency, and then close off their airflow? PulmOne’s unique LVM system, the MiniBox+, does not require a large body plethysmograph or “closing off” of the patient’s airflow. And it does not require a specific “panting” maneuver.   With the tabletop MiniBox+, the patient sits comfortably in a chair and performs normal tidal breathing during the measurement. Using several 100 msec interruptions, the system obtains a number of mouth pressure measurements with which it implements a slow vital capacity, and LVM is complete – all in ~90 seconds. No cabin to climb into, no claustrophobia or size limitations, no difficult coaching situations. The MiniBox+ makes LVM easier for both patient and technologist, improving “customer service” for the pulmonary function testing world....

Many Internists, Allergists, and Pulmonologists perform spirometry in their office clinics. They do a good job of diagnosing or managing their respiratory patients. However, spirometry only gives information about the functioning airways. Patients are then typically referred out to hospital-based pulmonary function labs for complete Pulmonary Function Testing (PFT). Not only does this also “refer out” the complete PFT revenue, it also burdens the patient to make another appointment with another co-pay. Oftentimes this can take 4-6 weeks.Furthermore, measurement of lung volumes and diffusion capacity provides important additional clinical information beyond what spirometry can provide. Information on hyperinflation, restriction, and gas exchange allow for complete assessment of the respiratory system, management of therapeutic interventions, and tracking of disease progression.CPT codes for Pulmonary Function Testing (based on 2018 Physician Fee Schedule CMS.org National Reimbursement)CPT Code Description Average Reimbursement Spirometry Only (20 patients) Complete PFT (20 patients)94010 Spirometry (FVC) $36.9894060 Spirometry (Pre/Post FVC) $61.92 $61.92 $61.9294726 Lung Volumes, plethysmography $56.16$56.1694729 Diffusion Capacity $55.80$55.80Total $1,238.40 $3,477.60If you would like to provide further pulmonary function services for your patients and/or are looking for ways to increase your office practice revenue, a desktop, complete Pulmonary Function Testing device like the MiniBox+ is an ideal solution. It is affordable, portable with a small footprint, and easy to learn and use for both clinicians and patients....

Performing complete Pulmonary Function Testing (PFT) is a great way to increase revenue for your office, but it is also a great service to your patients. If the patient is new to you - complete PFT gives a more comprehensive picture of their respiratory status. If already diagnosed - annual, bi-annual, and post-exacerbation periods help in their disease management. In addition, on a practical level - they will not need to schedule another appointment at another location. MiniBox+: LVM in a class of its own With Spirometry (Forced Vital Capacity) and Single-Breath Diffusion Testing (DLCO) performed similarly by different devices, the lung volume measurement (LVM) of the MiniBox+ sets us apart. It’s designed for all patient types and disease status. There is no need for patients to climb into a body plethysmography cabin and/or breathe dry gas for several minutes, as in nitrogen washout.With the MiniBox+, performing and collecting LVM is much easier for both patients and technicians, as it does not require panting against a closed shutter as in body plethysmography. If your technologists can get good spirometry efforts, they will be able to coach lung volume and diffusion efforts with the MiniBox+ and only add about several minutes to your testing workflow of pre/post spirometry. How does it work? Our innovative method requires only resting tidal breathing for ~6-10 breaths followed by a slow vital capacity maneuver. The entire effort takes approximately 90 seconds.MiniBox+’s Lung Volume Measurement During the tidal breathing portion, we interrupt the inspiration with a 100-msec shutter closure to measure mouth pressure and its effect on our internal 15-liter box. A data model algorithm is used to determine Thoracic Gas Volume (TGV). Once the slow vital capacity is completed, the MiniBox+ has all the lung sub-volumes measured:  TLC, VC, IC, FRC, ERV, and RV.At significantly less cost than a body plethysmograph and requiring much less space, the MiniBox+ is an ideal pulmonary function system for clinics and hospitals. Return on InvestmentBased on the CMS 2018 Fee Schedule, measuring complete PFT (Pre/Post spirometry, Lung Volumes, and DLCO) for three patients a day would cover the device cost in only 4 months.  Over the course of a year, this would generate ~$130,000 in revenue. This calculates to a 214% return on investment in a single year, when including the cost of disposables.Not only can you provide additional testing services for your patients, you can also significantly increase revenue for your business or hospital.  If your patient volume is such that you can test 8 patients a day, $1.6 million can be generated in 5 years.The MiniBox+ comes with a 1 year warranty.  With PulmOne’s “buy 3 years of extended warranty, get the 4th year free” offer (a 25% savings), this will give you 5 years of worry-free coverage.Don’t hesitate - start generating revenue and providing the testing and care your patients deserve....

Lung Volume measurements go beyond the flow rate and volume that spirometry can measure and gives further volume information about a patient’s lungs. Lung Volume measurement determined by gas dilution methods are nearly 100 years old with the original method using hydrogen. Obviously due to safety concerns hydrogen use did not last long and two methods – nitrogen washout and helium dilution – became the standard. Gas dilution methods for determining FRC are well accepted, but very few talk about the difficulty, effort, and time it takes to get good efforts. Both methods require a wait time between efforts with nitrogen washout having a recommended 60-minute wait period between efforts for patients with obstructive lung disease. Body Plethysmography is not so simple Lung volume measurement by body plethysmography have been around since the 1950’s. It is based on Boyle’s Law and its pressure-volume relationship. With a known pressure and volume of a box, the patient sits inside and performs a series of panting maneuvers during occlusion of the breathing apparatus. It is the mouth pressure during this occlusion and the subsequent change in pressure and volume of the box that is used to determine thoracic gas volume (TGV). TGV equals FRC when measured at end-expiratory breathing level.The body plethysmograph is considered the “gold” standard for lung volume measurement; however, without an extremely well-trained technologist, there are a host of errors that can and do occur. Panting at end-expiratory level for 4 to 7 seconds is not easy, the temperature gradient between box air temperature and lung temperature causes drift that must be accounted for, it is not necessarily viable for claustrophobic and large-size patients, and there is potential for technologist bias when it comes to adjusting the PBox /PMouth loops. The MiniBox+: Easier for Patients and Technologists PulmOne’s MiniBox+™ is an innovative, desktop device for gasless LVM, as well as spirometry and diffusion testing, designed to improve ease of use and access to complete Pulmonary Function Testing (PFT).The MiniBox+ developed by PulmOne is an innovative device developed to change the pulmonary function testing field from a cumbersome, difficult, and expensive practice to one that makes it easier for patients and technologists; and assist in reducing the cost of healthcare via smaller footprint and lower cost of ownership. The MiniBox+ is a desktop, gasless lung volume measurement system that can also perform spirometry and diffusion delivering a new and modern device improving ease of use and access to complete pulmonary function testing.The MiniBox+ uses several ~100 millisecond interruptions during normal tidal breathing. This mouth pressure data and its effect on the 15-liter internal box with known volume and pressure is combined into a data model and algorithm to determine thoracic gas volume. After six successful automatic interruptions the patient performs a slow vital capacity to complete the measurement. We now have the TLC, VC, FRC (TGV), ERV, and RV parameters. The entire effort takes ~90 seconds to complete.The advantages of the MiniBox+ are:The patient needs to only tidal breath for ~6 -10 breaths followed by a slow vital capacity It does not require specific panting maneuver or rebreathing gases Does not require a patient to fit into a body box where they may be too big or claustrophobic Repeated efforts can be done sequentially, as there is no wait time between efforts.The MiniBox+ provides an innovative solution to the traditional lung volume methods and brings testing to more patients at a lower cost....