Implementation of telespirometry in primary health care units in Brazil

Spirometry is essential for the diagnosis and follow-up of patients with noncommunicable chronic respiratory diseases; however, it was not available in primary health care in Brazil. This article describes the implementation of telespirometry in primary health care units across 163 Brazilian cities. The program was a collaborative effort between the Brazilian Ministry of Health and the Telehealth Center of the Hospital das Clínicas of the Federal University of Minas Gerais/EBSERH and was conducted in several stages, including team formation and selection of participating municipalities; selection of spirometry equipment; development of software for test transmission; training of nonmedical primary care professionals to perform spirometry and pulmonologists to provide teleconsultations; system implementation; delivery of virtual and onsite training; and continuous monitoring with periodic reevaluation. A total of 163 municipalities were selected according to predefined criteria. Since the implementation of telespirometry on 1 January 2022, 203 technicians have been qualified through virtual and in-person training. By 1 November 2024, a total of 31 982 spirometry tests had been performed. Test quality improved substantially over time, with the proportion of exams classified as category A or B increasing from 54.4% in the first three months to 81.2% in the final three months of the program. These findings indicate that expanding access to spirometry is feasible through a structured, short-term training program combined with close monitoring of primary care staff and a remote quality-control system supported by appropriate electronic resources.