AM1 Plus Spirometer & Post Transplant Spirometry

It is very important for you to check your lung function daily after you have had a lung transplant. To do this, you may do a spirometry twice a day with an AM1 Plus. The AM1 Plus is battery operated. It can send your data through the phone lines to your transplant clinic. With the AM1 Plus, you will be watching these levels:

• Forced Expiratory Volume in One Second (FEV1): This measures the volume of air that is blown during the first second that you are forcing air out of your lungs.
• Peak Expiratory Flow (PEF): This measures how fast the air comes out of your lungs when you force it out.

How to Use the AM1 Plus (AM1+)

1. Take the cap off the AM1+ and attach the blue flexible adapter and mouthpiece. Make sure the white plastic side of the mouthpiece is on top.
2. Press the gray key in the lower left hand corner that is labeled with a white circle. This will turn on the AM1+.
3. Make sure you sit up very straight.
4. When you are ready to do your spirometry test, push the gray (OK) button with a green circle on it in the lower right hand corner.
5. "Take a very deep breath and exhale as fast a possible!" will show on the screen. You now have about 15 seconds to complete the test.
6. As soon as this message is displayed, fill your lungs up with as much air as you can. Once your lungs are full of air, blow all the air out of your lungs as fast and as hard as you can until you cannot blow any more out.
7. When you have completed the test, the AM1+ will beep twice and display the results (FEV1 and PEF). Use the up and down arrows to scroll through your results.
8. You need to do two more tests now. When you are ready, push the on/off button in the lower left hand corner and then the OK button in the lower right hand corner.
9. When you have completed three tests, the results of your best test will be displayed on the screen. Record these values on the Spirometry Record sheet.
10. Shut your AM1+ off by pushing the on/off button in the lower left hand corner once.
11. You should do three spirometry tests each morning and evening.

Batteries

Three AA batteries power the AM1+. If the screen appears to be dim of the spirometer will not turn on, release the three batteries in the back of the AM1+.

How to Check Your Spirometry Results

Transplant clinics will often request that you test your spirometry daily. You will be looking for a 10% change in your results. Patients often have no clue that they are rejecting their new lungs until the rejection has been going on for a few days. Many patients who are going through rejection do not feel any differently. They do have a decrease in their lung volumes. The decrease in lung volumes occurs because rejection causes swelling in the air passages of the lungs.

Swelling in the lungs may be caused by things other than rejection. For instance, a cold or infection can also cause swelling. If you notice that you have a 10% change, you need to call your transplant coordinator as soon as you can. The transplant clinic will need to figure out what is causing the drop. If it is rejection, the sooner treatment is started, the smaller the change that you will have permanent damage.

To figure out if you have a 10% change:

1. Compare your morning and evening Forced Expiratory Volume in One Second (FEV1) values for yesterday. Select the highest value and circle it.
2. Now select the highest value for today's FEV1 and circle it.
3. Compare the "best" FEV1 value for both days. If the "best" FEV1 today is higher than the "best" for yesterday, good for you!
4. If your "best" FEV1 for today is lower than the "best" for yesterday, refer to your FEV1 Chart.
5. To use the FEV1 Chart, find your FEV1 value from yesterday in column "A". Now look at the number next to it in column "B". If the FEV1 value for today is equal to or less than the value in column "B", you have had a 10% change.
6. Now follow the same steps for your PEF values.
7. If you have had a 10% drop:

• Change the mouthpiece and the batteries of your spirometer.
• Repeat the spirometry and re-check your FEV1 and PEF values (steps 1-6 above).
• If your spirometry values are still down 10%, call your transplant coordinator as soon as you can.

Sending in Data

It is very important that you transmit the data at least once a week. It works best if you pick a certain day of the week and always send your data on that day. you will need to send your spirometry results by phone to the transplant hospital. You will need to use the UR Robotics modem and a special cable. The AM1+ is programmed to dial the hospital. Your data will be sent to the transplant clinic's database automatically.

After your data is sent, a respiratory therapist and your transplant coordinator will review it to make sure that there are no changes in your values that you may have missed. There are two other values that are recorded on your spirometer that can be seen at the hospital when your data is sent, but that you will not be able to see.

How to Send your Data

1. Plug the US Robotics modem into an electrical outlet. Turn the power switch to ON.
2. Plug the US Robotics modem into the telephone outlet. use the tan adaptor that has two phone jacks. It is usually included with your spirometer. If you do not use this adaptor, data will not transmit correctly. if you wish, you may leave it in your phone jack at all times. The phone line will go into one jack and the US Robotics modem will attach to the other.
3. Shut the AM1+ off. Attach the AM1+ to the modem using the cable that is attached to the back of the US Robotics modem. The end of the cable should be inserted into the green adaptor port on the side of the AM1+.
4. Once the AM1+ is attached to the cable, two pictures of phones will be displayed on the screen as well as an OK button.
5. Check to make sure that the picture of the phone on the left is highlighted and then press the OK button.
6. A message will appear on the AM1+ screen stating "Connection to host. Transferring data please wait." Once the transfer is complete, the screen will display a message stating "Transfer OK".
7. During the time that data is being transmitted, you cannot use the phone. Once done, the phone can be used again.

Changing the Internal Phone Number Settings

When you are in the hospital, the AM1+ is programmed to dial out of your hospital room and into your lung transplant database. This allows us to check to see if the US Robotics modem is working correctly as well as tech you how to use it. When you leave the hospital, you will need to change the number in the AM1+ so that you will be able to send your data in from home or the hotel. The AM1+ is preprogrammed with all of the phone numbers you should need. When you arrive at your hotel room or home, you will need to reprogram you AM1+. Follow these steps:

1. Attach the US Robotics to the AM1+ using the cable.
2. Select the button below the phone with the word TEST above it.
3. Now push the OK button.
4. The modem will try all of the number that are programmed into your AM1+ until it finds the correct number to use. This may take a while. You may notice that a busy signal goes on for quite a while, but don't be alarmed. This is part of the function of the software. When the correct number is found, it will be permanently stored in the memory of the AM1+ until you reprogram it again.
5. Use the steps listed under "How to Send Your Data" above to send your data into the transplant database.