Introduction The Asia Pacific region, especially its low- and middle-income countries (LMICs), experience a high burden of noncommunicable diseases (NCDs) that weaken their already overburdened health systems, aggravating the national and regional health disparities. Chronic respiratory diseases (CRDs)—prominently, chronic obstructive pulmonary disease, asthma, and occupational lung diseases—represent a key group of ailments that add significantly to the global burden of NCDs. In fact, COPD is the fourth most common cause of mortality globally, of which 86% of its cases are observed in the LMICs. Additionally, 262 million people globally suffer from asthma, of which the majority deaths occur in the LMICs. Figure 1. Chronic Respiratory Disease Status and Risk Factors in Asia Pacific Source: PATH. 2024. CRDs are particularly concerning in Asia and the Pacific (Figures 1a and 1b) as the risk factors—such as tobacco smoking, air pollution, allergens, occupational risks and vulnerability, etc.—(Figure 1c) are commonly encountered. The top factors contributing to high burden of CRDs in the region have been noted, including limited access to diagnostics for timely detection and early intervention; lack of skilled human resource for conducting the test and report interpretation; and inefficient mechanisms of care, monitoring, and management of the chronic condition. Why is there a need for smart spirometers in today's healthcare system? Chronic respiratory diseases (CRDs) not only affect the individual health but also have substantial implications on the social and economic cost to countries and their health systems. While the direct economic cost may vary and has more severe implications in low- and middle-income countries (LMICs), the social cost affects most countries alike. In LMICs, where access to tools such as spirometers for lung health screening is scarce, these costs are amplified by high rates of hospitalization and lost productivity. CRDs are generally regarded as non-curable, however, the complications and likelihood of re-admission/prolonged hospitalization, especially among pediatric or elderly population can be considerably avoided by making provisions for early disease identification and timely intervention. Introducing appropriate diagnostic tools like spirometers at primary healthcare (PHC) settings is a cost-effective approach to tackle CRDs at the first point of seeking care. However, the breathing test—which measures how the lungs are working—is often not readily available at the PHCs in many LMICs because of the high upfront cost of the device along with constraints of associated infrastructure. The information obtained from spirometry can also be misleading if stringent quality control is not followed in the selection of the appropriate device for the target setting or because of insufficient maintenance, calibration, operator competence, and patient performance. What are the advantages of a smart spirometer? Portable and digitally enabled spirometers improve access to lung health screening at primary healthcare and are suitable for low-resource, underserved, and remote settings. In the last few years, handheld spirometers have demonstrated several advantages over traditional devices, particularly in low-resource settings. Portability facilitates easy deployment at the point-of-care. Ease of use allows frontline health workers to perform the test. Speed of testing reduces burden on the healthcare providers specifically, in high volume settings. Spirometers with artificial intelligence/machine-based (AI/LM) learning integration show enhanced performance and precision as these can provide a comprehensive test interpretation. The devices take into consideration factors such as demographics and comorbidities, along with the breathed air volumes. Test reports from these devices are also auto-generated in a format that is easy to understand by a non-specialist. AI can further help identify patterns in lung function over time, assess and provide warnings for complications such as exacerbations in CRDs, and contribute to better disease management for improved quality of life. How can smart spirometers improve lung health outcomes in Asia–Pacific countries? Spirometry testing at the primary healthcare level not only improves diagnostic accuracy but has also led to better disease management, even without access to secondary care. In addition to reducing the time to diagnose diseases, next generation digital spirometers further support early detection of deteriorating lung function over time. Thus, such technologies allow timely course correction, reduce emergency visits and hospitalizations and result in better long-term prognosis, as well as survival rates. AI/ML-enabled spirometers further bridge gaps in primary care staff capacity by offering simple workflow and error safe alerts in real time. The AI/ML guided results help with clinical decision support, advancing the quality and reach of respiratory care in remote and underserved areas. In what ways have the smart spirometer been used in Asia and the Pacific? Case study 1: Feasibility assessment of digital spirometers Project overview: PATH, under the Asian Development Bank Technical Assistance on Technology for NCD and Mental Health, conducted a feasibility assessment to understand the usability, acceptability, and programmatic fit of a portable spirometer integrated with a digital application in different public healthcare settings across rural and urban areas of Bangladesh. Implementation: The study assessed the feedback from healthcare workers and programmatic stakeholders to provide a comprehensive evaluation of the scope of introduction with parameters like use-case identification, product market fit, ease of use, resource requirements, acceptability with the health workers, regulatory roadmap, and other programmatic considerations for introduction in the public health systems. Key Findings: A digitally enabled portable spirometry was desirable for screening of CRDs in an affordable and time-efficient manner. The small size, light weight, ease of use, local language interface, error checkpoints, AI/ML-guided interpretation and report generation were acknowledged as desirable attributes. The study also identified the need for in-country pilot clinical validation and considerations for data security, as well as integration with the national information systems. Case study 2: Operational pilot deployment of digital spirometers Project overview: The operational pilot was conducted to understand the field level nuances associated with the introduction of a digital spirometry device in primary care settings in the rural area of Satara district in Maharashtra, India. Implementation: PATH, in partnership with the government of Maharashtra, deployed the spirometer at select primary heath care centers (PHCs), sub-district hospitals (SDH) and district hospitals (DH) in Satara after assessing the capabilities of medical and paramedical staff for conducting spirometry to diagnose COPD and asthma, followed by Standard Operating Procedures (SOP) development and training. Outcomes: The pilot successfully screened the population for obstructive, restrictive and mixed pattern of CRDs. Implementation of a state-of-the-art spirometer in the hard-to-reach facilities resulted in significant improvements in patient care and a substantial reduction in patient referrals to higher facilities. Conclusion Access to spirometry at primary care can be a game changer in lung health care and a significant step towards achieving the health-related Sustainable Development Goals. The digital ecosystem that comes along with the newer spirometers adds attributes, such as real-time data collection, cloud-based storage, opportunities for remote consultations, and timely follow-up. Investments in effective interventions to tackle the global burden of CRDs are therefore, strongly recommended for improved public health outcomes and substantial economic returns. Note: This work is supported by ADB Regional Technical Assistance: Strengthening Integrated Primary Health Care Management of Noncommunicable Diseases (Project 56072-001/TA10106). PATH acknowledges Dr. Saahil Khandelwal for his contribution in developing the infographics for the article. Resources Institute for Health Metrics and Evaluation, University of Washington, Seattle. 2024. GBD Compare Tool. Data Visualization Tool. J. Meghji et al. 2021. Improving Lung Health in Low-Income and Middle-Income Countries: From Challenges to Solutions. The Lancet. 397 (10277). pp. 928–940. J. Zhou, X. Li, and X. Wang. 2022. Accuracy of Portable Spirometers in the Diagnosis of Chronic Obstructive Pulmonary Disease: A Meta-Analysis. Nature Partner Journals Primary Care Respiratory Medicine. 32 (Article no. 15). p. 10. M. N. Uygun et al. 2024. The Reliability and Validity of a Portable Hand-held Spirometer for the Measurement of Various Lung Functions in Healthy Adults. Physical Therapy Rehabilitation Science. 13 (2). pp. 179–186. P. Yadav et al. 2024. Artificial Intelligence: A Promising Tool in Diagnosis of Respiratory Diseases. Intelligent Pharmacy. 97. p. 4. P. Zhou, L. Yang, and Y. X. Huang. 1019. A Smart Phone Based Handheld Wireless Spirometer with Functions and Precision Comparable to Laboratory Spirometers. Sensors. 19 (11). World Health Organization. 2022. Invisible Numbers: The True Extent of Noncommunicable Diseases and What to Do About Them. WHO. Ask the Experts Swati Mahajan Lead–Health Systems, PATH South Asia Swati provides overall strategic direction, leadership, management and expansion of PATH’s health systems, technology and innovations portfolio for the India country program and South Asia hub, comprised of Bangladesh, Myanmar, Nepal, and Sri Lanka. She is a medical doctor and public health professional with more than 15 years of public health experience. Her areas of expertise include health systems’ strengthening, primary healthcare, urban health, epidemic preparedness and response, and noncommunicable diseases. Follow Swati Mahajan on Priyanka Bajaj Specialist–Health Technology Innovations, PATH Priyanka supports and advises on technical, clinical, regulatory, and market access aspects of emerging health technologies to innovators and stakeholders. She also supports various cross-disciplinary public health projects at PATH India and global country offices. Recently, she joined as Executive Member of the World Health Innovation Forum Society hosted at Kalam Institute of Health Technology, a WHO Collaborating Centre. She holds a PhD in Microbiology from Delhi University with several publications in peer-reviewed journals of international repute. Follow Priyanka Bajaj on Divya Wahi Malik Program Officer–Technology and Innovations, PATH Divya manages technology piloting, deployment assessment, commercial validation of technologies, and comprehensive health system strengthening via deployment of viable innovations in the area of Public Health as well as Climate change cross cutting Health. Her work primarily involves implementation, monitoring and evaluation of innovative technology rollout/deployment programs in the Health Systems strengthening programs with cross cutting and interdisciplinary exchange of technical advisory to other PATH country offices. She holds a PhD in Biotechnology from Jawahar Lal Nehru University, Delhi. Follow Divya Wahi Malik on Jae Kyoun Kim Health Specialist, Human and Social Development Office, Sectors Group, Asian Development Bank Dr. Jae Kyoun Kim focuses on advancing health sector operations in ADB developing member countries. His career encompasses roles with the World Health Organization, various government and non-government agencies, consulting firms, and academic institutions. He has a bachelor's degree in environmental science and ecological engineering from Korea University, a master’s degree in public health from Johns Hopkins Bloomberg School of Public Health, a PhD in Korean medicine from Pusan National University, and a PhD in Public Health from Kyung Hee University. Follow Jae Kyoun Kim on Vasoontara Sbirakos Yiengprugsawan Senior Universal Health Coverage Specialist (Service Delivery), Human and Social Development Office, Sectors Group, Asian Development Bank Vasoontara Sbirakos Yiengprugsawan oversees ADB’s technical assistance on strengthening primary healthcare and management of chronic noncommunicable diseases and mental health. She has held senior health research positions in Australia, a WHO Fellowship with the Asia Pacific Observatory on Health Systems and Policies, and worked in policy and research with a UN Migration Agency in Geneva. She holds a PhD in Epidemiology, Economics and Population Health from Australian National University and MA in International Development from Syracuse University. Follow Vasoontara Sbirakos Yiengprugsawan on Asian Development Bank (ADB) The Asian Development Bank is committed to achieving a prosperous, inclusive, resilient, and sustainable Asia and the Pacific, while sustaining its efforts to eradicate extreme poverty. Established in 1966, it is owned by 69 members—49 from the region. Its main instruments for helping its developing member countries are policy dialogue, loans, equity investments, guarantees, grants, and technical assistance. Follow Asian Development Bank (ADB) on Leave your question or comment in the section below: View the discussion thread.