How to…… Diagnose earlier andaccurately: spirometry andhistory taking     Chris LoveridgeRespiratory Practice Nurse Spirom...
Importance of History5%              History              Spirometry     95%                           2
0               Chronic obstructive               pulmonary disease                      Implementing NICE guidance       ...
Diagnose COPD: 3• Assess severity of airflow obstruction using reduction in FEV1                                   NICE cl...
Diagnose COPD: 2                – The presence of airflow obstruction should be confirmed by                  performing p...
Identification and diagnosisRecommendation 8: A diagnosis of COPD should be confirmed by qualityassured spirometry and oth...
Quality assuranceVolume/Time Trace          Flow/Volume Trace The curve must be           Almost vertical rise to  smoot...
Spirometry patterns - flow/volume                                               Peak expiratory flow            Peak expir...
Quality Assured Diagnostic Spirometry                                        9
Repeatability/Reproducibility                                10
Thank youQUESTIONS ?              11
Upcoming SlideShare
Loading in …5
×

Breakout 3.1 How to…… Diagnose earlier and accurately: spirometry and history taking - Chris Loveridge

751 views

Published on

Breakout 3.1 How to…… Diagnose earlier and accurately: spirometry and history taking - Chris Loveridge
Respiratory Practice Nurse Spirometry Clinical Lead
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
751
On SlideShare
0
From Embeds
0
Number of Embeds
9
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Breakout 3.1 How to…… Diagnose earlier and accurately: spirometry and history taking - Chris Loveridge

  1. 1. How to…… Diagnose earlier andaccurately: spirometry andhistory taking Chris LoveridgeRespiratory Practice Nurse Spirometry Clinical Lead 1
  2. 2. Importance of History5% History Spirometry 95% 2
  3. 3. 0 Chronic obstructive pulmonary disease Implementing NICE guidance June 2010 NICE clinical guideline 101 Definition of COPD• Airflow obstruction is defined as reduced FEV1/FVC ratio (< 0.7)• It is no longer necessary to have an FEV1 < 80% predicted for definition of airflow obstruction• If FEV1 is ≥ 80% predicted, a diagnosis of COPD should only be made in the presence of respiratory symptoms, for example breathlessness or cough FEV1 = forced expiratory volume in 1 second FVC = forced vital capacity 3
  4. 4. Diagnose COPD: 3• Assess severity of airflow obstruction using reduction in FEV1 NICE clinical ATS/ERS 2004 GOLD 2008 NICE clinical guideline 12 guideline 101 (2004) (2010) Post- FEV1 % Post- Post- Post- bronchodilator predicted bronchodilator bronchodilator bronchodilator FEV1/FVC < 0.7 80% Mild Stage 1 (mild) Stage 1 (mild)* < 0.7 50–79% Mild Moderate Stage 2 Stage 2 (moderate) (moderate) < 0.7 30–49% Moderate Severe Stage 3 (severe) Stage 3 (severe) < 0.7 < 30% Severe Very severe Stage 4 (very Stage 4 (very severe)** severe)** * Symptoms should be present to diagnose COPD in people with mild airflow obstruction ** Or FEV1 < 50% with respiratory failure [new 2010] Diagnose COPD Consider a diagnosis of COPD for people who are: – over 35, and – smokers or ex-smokers, and – have any of these symptoms: - exertional breathlessness - chronic cough - regular sputum production, - frequent winter ‘bronchitis’ - wheeze[2004] 4
  5. 5. Diagnose COPD: 2 – The presence of airflow obstruction should be confirmed by performing post-bronchodilator spirometry [new 2010] – All health professionals involved in the care of people with COPD should have access to spirometry and be competent in the interpretation of the results [2004] Spectrum of COPD Screening, Detection and Diagnosis The earliest point at which airflow obstruction may be detected by spirometry •Improve Diagnostic accuracy •Implement case finding strategies •Consider the case for screening ‘Lower ‘Upper limits of limits of normal’ normal’ DamageUnaware of Aware of No symptoms Symptoms but MILD MODERATE SEVERE VERY SEVERElung health lung health no diagnosis stage stage stage stage Well At-risk With COPD diagnosis •Identify those with A1AT deficiency •Establish accurate disease registers 5
  6. 6. Identification and diagnosisRecommendation 8: A diagnosis of COPD should be confirmed by qualityassured spirometry and other investigations appropriate to the individual. Standards for spirometry in primary care.  The spirometer must be able to record FEV1, FVC, FEV1/FVC ratio, and display a graph of volume against time  The spirometrist must be trained in the use of the spirometer and in assessing technical adequacy of readings  The patient should be prepared, including written advice on stopping bronchodilators in advance of reversibility testing Levy et al. Prim Care Respir J 2009; 18,:130-147 What is quality spirometry? 6
  7. 7. Quality assuranceVolume/Time Trace Flow/Volume Trace The curve must be  Almost vertical rise to smooth, upward and PEF free of irregularities  ‘Sharp’ point at PEF The curve must reach a  Trace free of plateau irregularities  Trace ‘merges’ with horizontal axis Spirometry patterns 7
  8. 8. Spirometry patterns - flow/volume Peak expiratory flow Peak expiratory flow FVC Volume (litres Volume (litres Predicted normal Predicted normal curve curve Volume (litres Volume (litres So spirometry....top ten tips• Patient demographics• Technical acceptability of blows• Number of blows performed• Quality of blows• Reproducibility/repeatability• Measuring airflow obstruction• Severity of airflow obstruction• Limitations of machine interpretation• Reversibility• Supports history/fits clinical presentation 8
  9. 9. Quality Assured Diagnostic Spirometry 9
  10. 10. Repeatability/Reproducibility 10
  11. 11. Thank youQUESTIONS ? 11

×