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Spirometry by dr tasleem

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spirometry made concise and easy for students.

spirometry made concise and easy for students.

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  • 1. SPIROMETRY
    • Dr.Tasleem Arif
    • Dept.of Chest Medicine
    • SKIMS MC/H Bemina
    • By
  • 2. What is Spirometry?
    • Spirometry is a method of assessing lung function by measuring the volume of air the patient can expel from the lungs after a maximal expiration.
  • 3. Why Perform Spirometry?
    • Measure airflow obstruction to help make a definitive diagnosis of COPD
    • Confirm presence of airway obstruction
    • Assess severity of airflow obstruction in COPD
    • Detect airflow obstruction in smokers who may have few or no symptoms
    • Monitor disease progression in COPD
    • Assess fitness in divers
    • Assess prognosis (FEV 1 ) in COPD
    • Perform pre-operative assessment
  • 4. Types of Spirometers
    • Bellows spirometers:
    • Measure volume; mainly in lung function units
    • Electronic desk top spirometers:
    • Measure flow and volume with real time display
    • Small hand-held spirometers:
    • Inexpensive and quick to use but no print out
  • 5. Volume Measuring Spirometer
  • 6. Flow Measuring Spirometer
  • 7. Desktop Electronic Spirometers
  • 8. Small Hand-held Spirometers
  • 9. Standard Spirometric Indicies
    • FEV 1 - Forced expiratory volume in one second:
    • The volume of air expired in the first second of the blow
    • FVC - Forced vital capacity:
    • The total volume of air that can be forcibly exhaled in one breath
    • FEV 1 /FVC ratio:
    • T he fraction of air exhaled in the first second relative to the total volume exhaled
  • 10. Additional Spirometric Indicies
    • VC - Vital capacity:
    • A volume of a full breath exhaled in the patient’s own time and not forced. Often slightly greater than the FVC, particularly in COPD
    • FEV 6 – Forced expired volume in six seconds:
    • Often approximates the FVC. Easier to perform in older and COPD patients but role in COPD diagnosis remains under investigation
    • MEFR – Mid-expiratory flow rates:
    • Derived from the mid portion of the flow volume curve but is not useful for COPD diagnosis
  • 11. Spirogram Patterns
    • Normal
    • Obstructive
    • Restrictive
    • Mixed Obstructive and Restrictive
  • 12. Predicted Normal Values
    • Age
    • Height
    • Sex
    • Ethnic Origin
    Affected by:
  • 13. Criteria for Normal Post-bronchodilator Spirometry
    • FEV 1 : % predicted > 80%
    • FVC: % predicted > 80%
    • FEV 1 /FVC: > 0.7
  • 14. Normal Trace Showing FEV 1 and FVC 1 2 3 4 5 6 1 2 3 4 Volume, liters Time, seconds FVC 5 1 FEV 1 = 4L FVC = 5L FEV 1 /FVC = 0.8
  • 15. SPIROMETRY OBSTRUCTIVE DISEASE
  • 16. Spirometry: Obstructive Disease Volume, liters Time, seconds 5 4 3 2 1 1 2 3 4 5 6 FEV 1 = 1.8L FVC = 3.2L FEV 1 /FVC = 0.56 Normal Obstructive
  • 17. Spirometric Diagnosis of COPD
    • COPD is confirmed by post–bronchodilator FEV 1 /FVC < 0.7
    • Post-bronchodilator FEV 1 /FVC measured 15 minutes after 400µg salbutamol or equivalent
  • 18. Bronchodilator Reversibility Testing
    • Provides the best achievable FEV 1 (and FVC)
    • Helps to differentiate COPD from asthma
    • Must be interpreted with clinical history - neither asthma nor COPD are diagnosed on spirometry alone
  • 19. Figure 5.1-6. Bronchodilator Reversibility Testing in COPD
    • Preparation
    • Tests should be performed when patients are clinically stable and free from respiratory infection
    • Patients should not have taken:
      • inhaled short-acting bronchodilators in the previous six hours
      • long-acting bronchodilator in the previous 12 hours
      • sustained-release theophylline in the previous 24 hours
  • 20. Figure 5.1-6. Bronchodilator Reversibility Testing in COPD
    • Spirometry
    • FEV 1 should be measured (minimum twice, within 5%) before a bronchodilator is given
    • The bronchodilator should be given by metered dose inhaler through a spacer device or by nebulizer to be certain it has been inhaled
    • The bronchodilator dose should be selected to be high on the dose/response curve
    • (…..continued)
  • 21. Figure 5.1-6. Bronchodilator Reversibility Testing in COPD
    • Spirometry (continued)
    • Possible dosage protocols:
    • 400 µg β 2 -agonist, or
    • 80-160 µg anticholinergic, or
    • the two combined
    • FEV 1 should be measured again:
    • 10-15 minutes after a short-acting  2 -agonist
    • 30-45 minutes after the combination
  • 22. Figure 5.1-6. Bronchodilator Reversibility Testing in COPD
    • Results
    • An increase in FEV 1 that is both greater than 200 ml and 12% above the pre-bronchodilator FEV 1 (baseline value) is considered significant
    • It is usually helpful to report the absolute change (in ml) as well as the % change from baseline to set the improvement in a clinical context
  • 23. SPIROMETRY RESTRICTIVE DISEASE
  • 24. Criteria: Restrictive Disease
    • FEV 1: % predicted < 80%
    • FVC: % predicted < 80%
    • FEV 1 /FVC: > 0.7
  • 25. Volume, liters Time, seconds FEV 1 = 1. 9 L FVC = 2 .0 L FEV 1 /FVC = 0. 95 1 2 3 4 5 6 5 4 3 2 1 Spirometry: Restrictive Disease Normal Restrictive
  • 26. Mixed Obstructive/Restrictive
    • FEV 1 : % predicted < 80%
    • FVC: % predicted < 80%
    • FEV 1 /FVC: < 0.7
  • 27. Mixed Obstructive and Restrictive Volume, liters Time, seconds Restrictive and mixed obstructive-restrictive are difficult to diagnose by spirometry alone; full respiratory function tests are usually required ( e.g., body plethysmography, etc) FEV 1 = 0.5 L FVC = 1.5 L FEV 1 /FVC = 0. 30 Normal Obstructive - Restrictive
  • 28. PRACTICAL SESSION Performing Spirometry
  • 29. Withholding Medications
    • Before performing spirometry, withhold:
      • Short acting β 2 -agonists for 6 hours
      • Long acting β 2 -agonists for 12 hours
      • Ipratropium for 6 hours
      • Tiotropium for 24 hours
    Optimally, subjects should avoid caffeine and cigarette smoking for 30 minutes before performing spirometry
  • 30. Performing Spirometry
    • Breath in until the lungs are full
    • Hold the breath and seal the lips tightly around a clean mouthpiece
    • Apply nose clips
    • Blast the air out as forcibly and fast as possible . Provide lots of encouragement!
    • Continue blowing until the lungs feel empty
  • 31.
    • Watch the patient during the blow to assure the lips are sealed around the mouthpiece
    • Check to determine if an adequate trace has been achieved
    • Repeat the procedure at least twice more until ideally 3 readings within 100 ml or 5% of each other are obtained
    Performing Spirometry
  • 32. Spirometry - Possible Side Effects
    • Feeling light-headed
    • Headache
    • Getting red in the face
    • Fainting: reduced venous return or vasovagal attack (reflex)
    • Tran s ient u rinary incontinence
    Spirometry should be avoided after recent heart attack or stroke
  • 33. Spirometry – Common Problems
    • Inadequate or incomplete blow
    • Lack of blast effort during exhalation
    • Slow start to maximal effort
    • Lips not sealed around mouthpiece
    • Coughing during the blow
    • Extra breath during the blow
    • Glottic closure or obstruction of mouthpiece
    • by tongue or teeth
    • Poor posture – leaning forwards
  • 34. THANKS