K Number
K141355
Device Name
VOLUMETRIC INCENTIVE SPIROMETER
Date Cleared
2014-09-03

(103 days)

Product Code
Regulation Number
868.5690
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Besmed Volumetric Incentive Spirometer is intended as an inspiratory deep breathing positive exerciser. Intended for single-patient, multi-use in a hospital or home care setting.
Device Description
The Besmed Volumetric Incentive Spirometer has a flexible tube and mouthpiece which the patient inhales through. This tube connects to the inspiration port of the unit. The chamber has a ball and piston which upon the patient inhaling, creates a vacuum, which causes the ball and piston to rise, the piston reflects the inspiratory volume while the ball is an indicator for the user to maintain the optimum inspiratory flow rate. Two (2) models are offered - 2500 cc and 5000 cc. It is a single patient, multi-use, disposable, non-sterile device. The mouthpiece may be removed and cleaned by the user as needed but the main device is not to be cleaned. As a patient improves their respiratory capacity or gets stronger they improve their inspiratory volume raising the piston. The principle of the ball indicator is to provide the user a visual indicator of their inspiratory flow rate and help them to improve the respiratory function with repeated uses. Incentive spirometers are commonly referred to as "lung exercisers". The Besmed Volumetric ICS achieves the therapeutic intent by helping the patient to improve their inspiratory volume. It is a relative improvement device that as described offers the patient the "incentive" to improve. This is the identical therapeutic intent of the predicate volume based incentive spirometer.
More Information

No
The device description details a purely mechanical device that uses a ball and piston to indicate volume and flow rate. There is no mention of any computational or data-driven components that would suggest the use of AI or ML.

Yes
The device is intended as an "inspiratory deep breathing positive exerciser" to help patients improve their inspiratory volume and respiratory function, which is a therapeutic goal.

No
The device is described as an "inspiratory deep breathing positive exerciser" and "lung exerciser" intended to help patients improve their inspiratory volume and respiratory capacity, without any mention of diagnosing a condition or disease.

No

The device description clearly outlines physical components like a flexible tube, mouthpiece, chamber, ball, and piston, indicating it is a hardware device, not software-only.

Based on the provided information, the Besmed Volumetric Incentive Spirometer is not an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The device is intended as an "inspiratory deep breathing positive exerciser" to help patients improve their respiratory capacity and inspiratory volume. This is a therapeutic and rehabilitative purpose, not a diagnostic one.
  • Mechanism of Action: The device works by providing visual feedback (ball and piston movement) to the patient during inhalation, encouraging them to take deeper breaths and improve lung function. It does not analyze biological samples (like blood, urine, or tissue) to diagnose a disease or condition.
  • Device Description: The description focuses on the mechanical aspects of the device and how it facilitates breathing exercises. There is no mention of reagents, assays, or any components used for analyzing biological samples.
  • Performance Studies: The performance studies described focus on volume accuracy and repeatability, comparing the device's ability to measure inhaled volume to a predicate device. This is relevant to the device's function as a breathing exerciser, not as a diagnostic tool.

IVD devices are specifically designed to perform tests on samples taken from the human body to provide information for the diagnosis, monitoring, or treatment of diseases or conditions. The Besmed Volumetric Incentive Spirometer does not fit this definition. It is a medical device used for therapeutic and rehabilitative purposes related to respiratory function.

N/A

Intended Use / Indications for Use

The Besmed Volumetric Incentive Spirometer is intended as an inspiratory deep breathing positive exerciser. Intended for single-patient, multi-use in a hospital or home care setting.

Product codes

BWF

Device Description

The Besmed Volumetric Incentive Spirometer has a flexible tube and mouthpiece which the patient inhales through. This tube connects to the inspiration port of the unit. The chamber has a ball and piston which upon the patient inhaling, creates a vacuum, which causes the ball and piston to rise, the piston reflects the inspiratory volume while the ball is an indicator for the user to maintain the optimum inspiratory flow rate. Two (2) models are offered - 2500 cc and 5000 cc. It is a single patient, multi-use, disposable, non-sterile device. The mouthpiece may be removed and cleaned by the user as needed but the main device is not to be cleaned.

As a patient improves their respiratory capacity or gets stronger they improve their inspiratory volume raising the piston. The principle of the ball indicator is to provide the user a visual indicator of their inspiratory flow rate and help them to improve the respiratory function with repeated uses. Incentive spirometers are commonly referred to as "lung exercisers".

The Besmed Volumetric ICS achieves the therapeutic intent by helping the patient to improve their inspiratory volume. It is a relative improvement device that as described offers the patient the "incentive" to improve. This is the identical therapeutic intent of the predicate volume based incentive spirometer.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

hospital or home care setting.

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

The proposed device was exposed to various environmental conditions of high and low temperatures over time and the performance evaluated and compared before and after these tests to confirm that the proposed device met it performance specifications.

We performed volume accuracy / repeatability and comparative volume accuracy and the results demonstrated equivalent (or better) performance demonstrating the proposed device is equivalent to the - K801199 - Hudson RCI Voldyne incentive spirometer.

Multiple samples of each device were tested multiple times and then evaluated for consistency of performance.

Key Metrics

Volume accuracy
2500 cc – 4 – 15%
5000 cc – 3 – 12%

Predicate Device(s)

K801199

Reference Device(s)

K133873

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 868.5690 Incentive spirometer.

(a)
Identification. An incentive spirometer is a device that indicates a patient's breathing volume or flow and that provides an incentive to the patient to improve his or her ventilation.(b)
Classification. Class II (performance standards).

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Image /page/0/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized representation of a human figure in profile, with three overlapping faces suggesting community and support. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the figure, emphasizing the department's role and national scope. The logo is simple, using a single color, and is designed to be easily recognizable.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

September 3, 2014

Besmed Health Business Corporation C/O Mr. Paul Dryden President ProMedic, Inc. No. 5. Lane 116, Wu-Kong 2nd Rd. Wu-Ku District, New Taipei City TAIWAN

Re: K141355

Trade/Device Name: Besmed Volumetric Incentive Spirometer Regulation Number: 21 CFR 868.5690 Regulation Name: Spirometer, therapeutic (incentive) Regulatory Class: Class II Product Code: BWF Dated: August 4, 2014 Received: August 5, 2014

Dear Mr. Dryden:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food. Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/Resourcesfor You/Industry/default.htm. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

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Tejashri Purohit-Sheth, M.D. Clinical Deputy Director DAGRID/ODE/CDRH FOR

Erin I. Keith, M.S. Director Division of Anesthesiology, General Hospital, Respiratory, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

510(k) Number (if known)

K141355

Device Name

Besmed Volumetric Incentive Spirometer

Indications for Use (Describe)

The Besmed Volumetric Incentive Spirometer is intended as an inspiratory deep breathing positive exerciser. Intended for single-patient, multi-use in a hospital or home care setting.

Type of Use (Select one or both, as applicable)

|× Prescription Use (Part 21 CFR 801 Subpart D)

__ Over-The-Counter Use (21 CFR 801 Subpart C)

PLEASE DO NOT WRITE BELOW THIS LINE – CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

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Anya C. Harry -S 2014.08.29 07:11:29 -04'00'

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510(k) Summary Page 1 of 4

Date Prepared:20-Aug-2014
Besmed Health Business Corp.
No. 5, Lane 116, Wu-Kong 2nd Rd,
Wu-Ku District, New Taipei City, TaiwanTel - 011-886-2-2290-3959
Fax - 011-886-2-2299-9076
Official Contact:Winnie Chung, Regulatory Affairs
Proprietary or Trade Name:Volumetric Incentive Spirometer
Common/Usual Name:Incentive spirometer
Classification Name:21CFR 868.5690, Class 2
BWF - spirometer, therapeutic (incentive)
Predicate Devices:K801199 – Hudson RCI Voldyne

Device Description:

The Besmed Volumetric Incentive Spirometer has a flexible tube and mouthpiece which the patient inhales through. This tube connects to the inspiration port of the unit. The chamber has a ball and piston which upon the patient inhaling, creates a vacuum, which causes the ball and piston to rise, the piston reflects the inspiratory volume while the ball is an indicator for the user to maintain the optimum inspiratory flow rate. Two (2) models are offered - 2500 cc and 5000 cc. It is a single patient, multi-use, disposable, non-sterile device. The mouthpiece may be removed and cleaned by the user as needed but the main device is not to be cleaned.

As a patient improves their respiratory capacity or gets stronger they improve their inspiratory volume raising the piston. The principle of the ball indicator is to provide the user a visual indicator of their inspiratory flow rate and help them to improve the respiratory function with repeated uses. Incentive spirometers are commonly referred to as "lung exercisers".

The Besmed Volumetric ICS achieves the therapeutic intent by helping the patient to improve their inspiratory volume. It is a relative improvement device that as described offers the patient the "incentive" to improve. This is the identical therapeutic intent of the predicate volume based incentive spirometer.

Indications for Use:

The Besmed Volumetric Incentive Spirometer is intended as an inspiratory deep breathing positive exerciser. Intended for single-patient, multi-use in a hospital or home care setting.

Patient Population:

Patients requiring inspiratory exercise.

Environments of use:

Hospital and home care settings

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510(k) Summary

Comparison to Predicates

| Attribute | Hudson RCI
K801199 | Proposed
Besmed Volumetric ICS |
|---------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Indications for Use | Intended as an inspiratory deep breathing positive exerciser.

Intended for single-patient, multi-use in a hospital or home care setting. | The Besmed Volumetric Incentive Spirometer is intended as an
inspiratory deep breathing positive exerciser.

Intended for single-patient, multi-use in a hospital or home care setting. |
| Environments of use | Home care settings and hospitals | Home care settings and hospitals |
| Prescriptive | Yes | Yes |
| Patient population | Patients requiring inspiratory exercise | Patients requiring inspiratory exercise |
| Single patient, multi-use | Yes | Yes |
| Patient interface | Mouthpiece (maybe removed and cleaned) | Mouthpiece (maybe removed and cleaned) |
| Basic components | Housing
1 ball / piston
Tubing
Mouthpiece | Housing
1 ball / piston
Tubing
Mouthpiece |
| Volume range | 2500 and 5000 cc | 2500 and 5000 cc |
| Accuracy | Not reported but ~ 21% when comparative testing performed | +/- 15% |
| Performance testing | Volume accuracy
2500 cc – 14 – 21%
5000 cc – 16 – 21% | Volume accuracy
2500 cc – 4 – 15%
5000 cc – 3 – 12%
Age Testing
Pre and post- exposure
Environmental Testing
High / Low and Humidity conditions
Drop test |

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510(k) Summary Page 3 of 4 20-Aug-2014

Substantial Equivalence Discussion

Table 1 compares the key features of the proposed Besmed Volumetric incentive spirometer with the identified predicate and demonstrates that the device can be found to be substantially equivalent.

In summary one can conclude that substantial equivalence is met based upon the following:

Indications for Use -

The indications for use are identical for the proposed device when compared to the predicate -K801199 - Hudson RCI Voldyne incentive spirometer.

Discussion - Each device is indicated for use volumetric inspiratory deep breathing positive exerciser.

Technology and construction -

The design, components, shape, size, etc., are equivalent to the predicate - K801199 - Hudson RCI Voldyne incentive spirometer.

Discussion - The design is a 1 ball / piston volume based system that upon the patient inhaling raises the piston to indicate the volume of inspired air while there is a ball which indicates the inspiratory flow rate that the patient should try and maintain.

Environment of Use -

The environments of use are identical to predicate - K801199 - Hudson RCI Voldyne incentive spirometer.

Discussion - The environments of use are identical to the predicate K801199 - Hudson RCI Voldyne incentive spirometer.

Patient Population -

The patient population of patients requiring inspiratory exercise is equivalent to the predicate -K801199 – Hudson RCI Voldyne incentive spirometer.

Discussion - The patient populations are equivalent to the predicate - K801199 - Hudson RCI Voldyne incentive spirometer.

Non-Clinical Testing Summary -

Materials:

The materials are identical to our reference Besmed TriBall ICS cleared under K133873. We consider the device as External Communicating (Indirect gas pathway) and Surface Contact (direct skin) with limited duration of use (