Spirometry is a common pulmonary function test that measures breath volume and flow. It can be used to detect lung disease, monitor occupational exposures, and assess medication effects. This document provides an overview of how to properly perform and interpret spirometry tests, including ensuring patient preparation and positioning, using correct technique, assessing test quality, and comparing results to reference values to determine if lungs are normal or abnormal. Quality is important for obtaining accurate and reproducible results.
This document discusses lung volumes and capacities as measured by pulmonary function tests (PFTs). It describes the key volumes and capacities including tidal volume, inspiratory reserve volume, expiratory reserve volume, residual volume, vital capacity, total lung capacity, and functional residual capacity. It provides the normal ranges for these measurements and explains their clinical significance in assessing lung function and the presence of obstructive or restrictive lung diseases. Spirometry is highlighted as the cornerstone PFT for measuring volumes like forced vital capacity (FVC) and flows like forced expiratory volume in 1 second (FEV1).
Demo Cum Lecture on the topic of Spirometry by Pandian M, Tutor, Dept. of Phy...Pandian M
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PY 6.8 Demonstrate the correct technique to perform & interpret Spirometry.
SLOs: After attending lecture & studying the assigned materials, the student will:
1.      State the principles of recording of Spirometry.
2.      Define & draw different lung volumes & capacities.
3.      Explain FEV (TVC) correctly with its clinical significance.
4.      Describe the helium dilution method to record the FRC.
5.      Demonstrate the correct procedure of recording the spirogram.
6.      Interpret the spirogram correctly
Spirometry is a diagnostic test that measures lung function using a spirometer. A spirometer measures and records the amount (volume) and/or speed (flow) of air that can be inhaled or exhaled. It consists of a mouthpiece, nose clip, and device that records airflow. The procedure involves taking deep breaths and exhaling fully into the mouthpiece three times. Measurements obtained include forced vital capacity (FVC) and forced expiratory volume (FEV1), which are used to diagnose respiratory conditions. While generally safe, risks include dizziness. Accurate results require patient effort and cooperation, with tests repeated if values differ.
Spirometry measures lung function by assessing the volume and speed of air inhaled and exhaled. It generates graphs of airflow and is used to diagnose respiratory conditions like asthma and detect obstructive and restrictive lung diseases. The test involves taking deep breaths into a mouthpiece and exhaling as forcefully as possible into the device multiple times. Results are analyzed to determine if values like forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) are within normal ranges, with abnormally low values indicating lung dysfunction.
Pulmonary function tests (PFTs) are useful for evaluating and monitoring patients with respiratory diseases. PFTs include assessments of patient history, physical examination, chest x-rays, arterial blood gases, spirometry, lung volumes, and peak flow. Specific PFTs indicate conditions like asthma, COPD, and restrictive lung diseases. Bedside lung function tests can help identify obstructive airway disease and include match blowing, breath holding, single breath counting, and chest expansion assessments. Spirometry precisely measures lung function values to diagnose conditions affecting the lungs.
Spirometry is a simple lung function test that measures how much air a person can exhale from their lungs after taking a deep breath. It can help diagnose and monitor conditions like asthma and COPD. The test involves blowing into a mouthpiece to measure exhaled volumes like FEV1 and FVC. The ratio of FEV1/FVC is used to identify obstructive or restrictive lung abnormalities. A reduced ratio below 70% indicates obstruction, while reduced volumes but a normal ratio suggest restriction. Spirometry is a valuable tool for physicians to assess respiratory conditions but should be interpreted along with clinical history and examination findings.
Spirometry is a test used to assess lung function by measuring airflow. It can help diagnose obstructive lung diseases like COPD and asthma by measuring airflow limitation through values like FEV1 and FEV1/FVC ratio. A spirometry report provides values for volumes of air inhaled and exhaled that are compared to predicted normal values to identify restrictive or obstructive lung abnormalities. Quality control measures ensure accurate spirometry administration and interpretation.
This document discusses lung volumes and capacities as measured by pulmonary function tests (PFTs). It describes the key volumes and capacities including tidal volume, inspiratory reserve volume, expiratory reserve volume, residual volume, vital capacity, total lung capacity, and functional residual capacity. It provides the normal ranges for these measurements and explains their clinical significance in assessing lung function and the presence of obstructive or restrictive lung diseases. Spirometry is highlighted as the cornerstone PFT for measuring volumes like forced vital capacity (FVC) and flows like forced expiratory volume in 1 second (FEV1).
Demo Cum Lecture on the topic of Spirometry by Pandian M, Tutor, Dept. of Phy...Pandian M
Â
PY 6.8 Demonstrate the correct technique to perform & interpret Spirometry.
SLOs: After attending lecture & studying the assigned materials, the student will:
1.      State the principles of recording of Spirometry.
2.      Define & draw different lung volumes & capacities.
3.      Explain FEV (TVC) correctly with its clinical significance.
4.      Describe the helium dilution method to record the FRC.
5.      Demonstrate the correct procedure of recording the spirogram.
6.      Interpret the spirogram correctly
Spirometry is a diagnostic test that measures lung function using a spirometer. A spirometer measures and records the amount (volume) and/or speed (flow) of air that can be inhaled or exhaled. It consists of a mouthpiece, nose clip, and device that records airflow. The procedure involves taking deep breaths and exhaling fully into the mouthpiece three times. Measurements obtained include forced vital capacity (FVC) and forced expiratory volume (FEV1), which are used to diagnose respiratory conditions. While generally safe, risks include dizziness. Accurate results require patient effort and cooperation, with tests repeated if values differ.
Spirometry measures lung function by assessing the volume and speed of air inhaled and exhaled. It generates graphs of airflow and is used to diagnose respiratory conditions like asthma and detect obstructive and restrictive lung diseases. The test involves taking deep breaths into a mouthpiece and exhaling as forcefully as possible into the device multiple times. Results are analyzed to determine if values like forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) are within normal ranges, with abnormally low values indicating lung dysfunction.
Pulmonary function tests (PFTs) are useful for evaluating and monitoring patients with respiratory diseases. PFTs include assessments of patient history, physical examination, chest x-rays, arterial blood gases, spirometry, lung volumes, and peak flow. Specific PFTs indicate conditions like asthma, COPD, and restrictive lung diseases. Bedside lung function tests can help identify obstructive airway disease and include match blowing, breath holding, single breath counting, and chest expansion assessments. Spirometry precisely measures lung function values to diagnose conditions affecting the lungs.
Spirometry is a simple lung function test that measures how much air a person can exhale from their lungs after taking a deep breath. It can help diagnose and monitor conditions like asthma and COPD. The test involves blowing into a mouthpiece to measure exhaled volumes like FEV1 and FVC. The ratio of FEV1/FVC is used to identify obstructive or restrictive lung abnormalities. A reduced ratio below 70% indicates obstruction, while reduced volumes but a normal ratio suggest restriction. Spirometry is a valuable tool for physicians to assess respiratory conditions but should be interpreted along with clinical history and examination findings.
Spirometry is a test used to assess lung function by measuring airflow. It can help diagnose obstructive lung diseases like COPD and asthma by measuring airflow limitation through values like FEV1 and FEV1/FVC ratio. A spirometry report provides values for volumes of air inhaled and exhaled that are compared to predicted normal values to identify restrictive or obstructive lung abnormalities. Quality control measures ensure accurate spirometry administration and interpretation.
Spirometry is a test used to measure lung function by having a patient forcefully exhale into a spirometer. It measures volumes like forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) to diagnose and monitor conditions like COPD. The document discusses the different types of spirometers, normal values, how to interpret tests for obstructive, restrictive, and mixed lung disease patterns, and practical considerations for administering spirometry tests.
Pulmonary function tests (PFTs) objectively measure lung function through tests of lung volumes, airway function, and gas exchange. Key PFTs include spirometry, which measures volumes of air inhaled and exhaled over time; tests of static lung volumes like total lung capacity and functional residual capacity; diffusing capacity tests that evaluate gas exchange; and exercise tests. PFTs are used to detect and monitor respiratory diseases, evaluate treatments, and assess surgical risk. Spirometry specifically measures volumes like forced vital capacity and forced expiratory volume in one second to evaluate airway obstruction. Interpretation compares values to predicted normals. Bedside PFTs also exist to rapidly assess lung function at the point of care
This document provides guidance on using spirometry to diagnose chronic obstructive pulmonary disease (COPD) in primary care. It defines COPD and outlines how spirometry can help detect the disease earlier through measurements like FEV1. The document recommends training to properly perform and interpret spirometry. It provides tips for identifying at-risk patients and differentiating COPD from asthma using clinical features and reversibility testing.
1) Pulmonary function tests (PFTs) include spirometry, lung volume measurements, diffusing capacity tests, and arterial blood gases. Together these make up a complete pulmonary function survey.
2) Spirometry measures dynamic lung volumes like forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). The FEV1/FVC ratio is used to distinguish obstructive from restrictive lung diseases.
3) Acceptable spirometry requires maximal effort without hesitation, coughing, or early termination. The flow-volume loop and volume-time curve are analyzed to check for test quality issues.
Simple Interpretation of Pulmonary Function testsGamal Agmy
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This document discusses spirometry testing for obstructive lung diseases such as COPD and asthma. It provides information on the different measures assessed during spirometry including FEV1, FVC, and FEF25-75. It describes how to interpret the results and what values indicate restrictive versus obstructive lung disease. Guidelines for pre- and post-bronchodilator spirometry are covered as well as how to assess for reversibility and bronchial hyperresponsiveness. The importance of spirometry for diagnosing and monitoring lung diseases like COPD and asthma is emphasized.
A technique used to measure air flow in and out of the lungs.
A recording of lung volumes and capacities defined by the respiratory process. These recordings may be static (untimed) or dynamic (timed).
Assesses the integrated mechanical functions of lungs, chest wall and respiratory muscles.
The gold standard for diagnosis, assessment and monitoring of COPD.
Better than PEFR (which is effort dependent) for demonstrating airway obstruction in BA.
The most commonly used PFT
Pulmonary function tests (PFTs) objectively assess lung function using tests such as spirometry, lung volume measurements, and diffusing capacity measurements. PFTs can predict, diagnose, and monitor pulmonary dysfunction. They can distinguish between obstructive and restrictive lung diseases and determine disease severity and treatment responses. PFTs also assess surgical risk and postoperative pulmonary complications. Simple bedside tests include breath counts, cough strength tests, and peak flow measurements. Laboratory PFTs precisely measure volumes, flows, gas exchange, and generate flow-volume loops. Proper interpretation of PFTs involves comparing values to predicted normals.
Spirometry is a test that measures lung function by having the patient forcefully exhale air into a mouthpiece. It was originally developed in the 1840s and has since been improved with electronic devices. It is used to diagnose asthma and COPD by measuring airflow obstruction. The test involves withholding some medications beforehand, having the patient blow hard into the device multiple times, and may show a normal pattern or patterns indicating obstruction, restriction, or both. Reversibility testing with a bronchodilator helps distinguish asthma from COPD. Spirometry provides important information about lung health and disease.
The document describes various bedside pulmonary function tests that can be used to assess lung function and predict postoperative risk. Some of the tests described include the breath holding test to measure cardiopulmonary reserve, single breath count to measure vital capacity, match blowing test to measure maximum breathing capacity, cough test to evaluate cough strength, and tests using a respirometer or whistle to measure parameters like peak expiratory flow rate. The tests provide information on lung volumes, flows, and ability that can help identify patients at risk for pulmonary complications during or after surgery.
A spirometer is an apparatus for measuring the volume of air inspired and expired by the lungs. A spirometer measures ventilation, the movement of air into and out of the lungs. The spirogram will identify two different types of abnormal ventilation patterns, obstructive and restrictive.
The document summarizes a lab on the respiratory system and spirometry. It describes the parts of the respiratory system including the conduction zone for ventilation and respiratory zone for gas exchange. It examines histology samples of different parts of the respiratory system and how the structure relates to function. The document then discusses spirometry and how it is used to measure lung volumes and capacities like tidal volume, vital capacity, and residual volume. Procedures for calibrating and performing spirometry tests on the Biopac system are provided along with an example spirogram.
Pulmonary function tests_in_clinical_practicebabarali
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This document discusses pulmonary function tests, specifically spirometry. It defines key terms used in spirometry such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak expiratory flow, and others. It describes the volume-time curve and expiratory flow-volume curve produced during spirometry and what each can indicate about pulmonary function and disease. Spirometry is presented as the most essential part of pulmonary function testing for evaluating obstructive and restrictive lung diseases.
The document discusses interpretation of spirometry data. It provides normal values for measures like FEV1, FVC and FEF25-75. An obstructive pattern is defined as a decreased FEV1/FVC ratio below 0.7, with decreased FEV1 and possibly decreased FVC. A restrictive pattern shows a normal or mildly reduced FEV1 but reduced FVC. Acceptability and repeatability criteria for spirometry tests are outlined.
Spirometry is a common pulmonary function test that measures lung volume and airflow. It is performed using a spirometer to detect respiratory diseases like asthma and distinguish between obstructive and restrictive lung diseases. The test involves taking deep breaths and forcibly exhaling for 6 seconds to measure volumes like forced vital capacity and forced expiratory volume in 1 second. Spirometry is generally safe but may cause shortness of breath and is not performed following a heart attack or other heart conditions.
A plethysmograph is an instrument for measuring changes in volume within an organ or whole body. The word is derived from the Greek "plethysmos", and "graphos"
Spirometry for Primary Care Physician OfficeRandy Clare
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Step by step description of how to collect spirometry tests for Asthma and COPD. Quality control tips supported by literature with links to NIH, NIOSH and the Mayo Clinic. This is a presentation that I use to discuss hand held spirometry products from Carefusion. Micro Loop, Micro Lab, Micro 1 and Pulmolife
a detailed study on pulmonary function testmartinshaji
Â
this study details about all the aspects of pulmonary function test, lung volumes& capacities , tests such as spirometry , carbon monoxide diffusion capacity, chest x ray, body plethesmography , nitrogen washout etc
please comment
thank u
What are the pulmonary function tests used?
What are the indications?
What are the contraindications?
How to perform each and prepare patients?
How to interpret and reach a diagnosis?
How to clean and calibrate devices?
Spirometry is a simple, inexpensive pulmonary function test used to evaluate respiratory diseases. It measures how much air a person can inhale and exhale. Sir John Hutchinson invented the first spirometer to measure vital capacity. Spirometry can identify obstructive and restrictive lung diseases, establish reversibility in asthma, screen smokers for risk, and monitor treatment effectiveness. It involves maximal inhalation and exhalation into a mouthpiece to measure volumes like forced vital capacity and flows like forced expiratory volume in one second. Graphs of the results can indicate normal lung function or patterns suggestive of various respiratory conditions.
869 peak expiratory flow rate measurements final (2)nadahsalih
Â
This document provides guidelines for measuring peak expiratory flow rate (PEFR) in clinical practice. It outlines who is allowed to perform PEFR measurements, the proper technique for patients, and the procedure staff should follow. PEFR is an objective measure of lung function used to monitor patients with asthma or chronic obstructive pulmonary disease. Serial measurements allow clinicians to track a patient's condition and response to treatment over time. The guidelines aim to promote accurate and reproducible PEFR readings.
This document discusses pulmonary function tests (PFTs), which objectively measure lung function and are useful for diagnosing and monitoring respiratory disease. It describes various PFTs including spirometry, peak expiratory flow rate tests, body plethysmography, diffusion capacity tests, bronchoprovocation challenge tests, and six-minute walk tests. Spirometry specifically measures volumes of air inhaled and exhaled, while peak flow tests measure maximum exhaled airflow and diffusion capacity tests evaluate gas exchange in the lungs. Together these PFTs provide clinicians with quantitative data on lung volumes, capacities, flows, and gas exchange to aid in respiratory disease assessment.
Spirometry is a test used to measure lung function by having a patient forcefully exhale into a spirometer. It measures volumes like forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) to diagnose and monitor conditions like COPD. The document discusses the different types of spirometers, normal values, how to interpret tests for obstructive, restrictive, and mixed lung disease patterns, and practical considerations for administering spirometry tests.
Pulmonary function tests (PFTs) objectively measure lung function through tests of lung volumes, airway function, and gas exchange. Key PFTs include spirometry, which measures volumes of air inhaled and exhaled over time; tests of static lung volumes like total lung capacity and functional residual capacity; diffusing capacity tests that evaluate gas exchange; and exercise tests. PFTs are used to detect and monitor respiratory diseases, evaluate treatments, and assess surgical risk. Spirometry specifically measures volumes like forced vital capacity and forced expiratory volume in one second to evaluate airway obstruction. Interpretation compares values to predicted normals. Bedside PFTs also exist to rapidly assess lung function at the point of care
This document provides guidance on using spirometry to diagnose chronic obstructive pulmonary disease (COPD) in primary care. It defines COPD and outlines how spirometry can help detect the disease earlier through measurements like FEV1. The document recommends training to properly perform and interpret spirometry. It provides tips for identifying at-risk patients and differentiating COPD from asthma using clinical features and reversibility testing.
1) Pulmonary function tests (PFTs) include spirometry, lung volume measurements, diffusing capacity tests, and arterial blood gases. Together these make up a complete pulmonary function survey.
2) Spirometry measures dynamic lung volumes like forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). The FEV1/FVC ratio is used to distinguish obstructive from restrictive lung diseases.
3) Acceptable spirometry requires maximal effort without hesitation, coughing, or early termination. The flow-volume loop and volume-time curve are analyzed to check for test quality issues.
Simple Interpretation of Pulmonary Function testsGamal Agmy
Â
This document discusses spirometry testing for obstructive lung diseases such as COPD and asthma. It provides information on the different measures assessed during spirometry including FEV1, FVC, and FEF25-75. It describes how to interpret the results and what values indicate restrictive versus obstructive lung disease. Guidelines for pre- and post-bronchodilator spirometry are covered as well as how to assess for reversibility and bronchial hyperresponsiveness. The importance of spirometry for diagnosing and monitoring lung diseases like COPD and asthma is emphasized.
A technique used to measure air flow in and out of the lungs.
A recording of lung volumes and capacities defined by the respiratory process. These recordings may be static (untimed) or dynamic (timed).
Assesses the integrated mechanical functions of lungs, chest wall and respiratory muscles.
The gold standard for diagnosis, assessment and monitoring of COPD.
Better than PEFR (which is effort dependent) for demonstrating airway obstruction in BA.
The most commonly used PFT
Pulmonary function tests (PFTs) objectively assess lung function using tests such as spirometry, lung volume measurements, and diffusing capacity measurements. PFTs can predict, diagnose, and monitor pulmonary dysfunction. They can distinguish between obstructive and restrictive lung diseases and determine disease severity and treatment responses. PFTs also assess surgical risk and postoperative pulmonary complications. Simple bedside tests include breath counts, cough strength tests, and peak flow measurements. Laboratory PFTs precisely measure volumes, flows, gas exchange, and generate flow-volume loops. Proper interpretation of PFTs involves comparing values to predicted normals.
Spirometry is a test that measures lung function by having the patient forcefully exhale air into a mouthpiece. It was originally developed in the 1840s and has since been improved with electronic devices. It is used to diagnose asthma and COPD by measuring airflow obstruction. The test involves withholding some medications beforehand, having the patient blow hard into the device multiple times, and may show a normal pattern or patterns indicating obstruction, restriction, or both. Reversibility testing with a bronchodilator helps distinguish asthma from COPD. Spirometry provides important information about lung health and disease.
The document describes various bedside pulmonary function tests that can be used to assess lung function and predict postoperative risk. Some of the tests described include the breath holding test to measure cardiopulmonary reserve, single breath count to measure vital capacity, match blowing test to measure maximum breathing capacity, cough test to evaluate cough strength, and tests using a respirometer or whistle to measure parameters like peak expiratory flow rate. The tests provide information on lung volumes, flows, and ability that can help identify patients at risk for pulmonary complications during or after surgery.
A spirometer is an apparatus for measuring the volume of air inspired and expired by the lungs. A spirometer measures ventilation, the movement of air into and out of the lungs. The spirogram will identify two different types of abnormal ventilation patterns, obstructive and restrictive.
The document summarizes a lab on the respiratory system and spirometry. It describes the parts of the respiratory system including the conduction zone for ventilation and respiratory zone for gas exchange. It examines histology samples of different parts of the respiratory system and how the structure relates to function. The document then discusses spirometry and how it is used to measure lung volumes and capacities like tidal volume, vital capacity, and residual volume. Procedures for calibrating and performing spirometry tests on the Biopac system are provided along with an example spirogram.
Pulmonary function tests_in_clinical_practicebabarali
Â
This document discusses pulmonary function tests, specifically spirometry. It defines key terms used in spirometry such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak expiratory flow, and others. It describes the volume-time curve and expiratory flow-volume curve produced during spirometry and what each can indicate about pulmonary function and disease. Spirometry is presented as the most essential part of pulmonary function testing for evaluating obstructive and restrictive lung diseases.
The document discusses interpretation of spirometry data. It provides normal values for measures like FEV1, FVC and FEF25-75. An obstructive pattern is defined as a decreased FEV1/FVC ratio below 0.7, with decreased FEV1 and possibly decreased FVC. A restrictive pattern shows a normal or mildly reduced FEV1 but reduced FVC. Acceptability and repeatability criteria for spirometry tests are outlined.
Spirometry is a common pulmonary function test that measures lung volume and airflow. It is performed using a spirometer to detect respiratory diseases like asthma and distinguish between obstructive and restrictive lung diseases. The test involves taking deep breaths and forcibly exhaling for 6 seconds to measure volumes like forced vital capacity and forced expiratory volume in 1 second. Spirometry is generally safe but may cause shortness of breath and is not performed following a heart attack or other heart conditions.
A plethysmograph is an instrument for measuring changes in volume within an organ or whole body. The word is derived from the Greek "plethysmos", and "graphos"
Spirometry for Primary Care Physician OfficeRandy Clare
Â
Step by step description of how to collect spirometry tests for Asthma and COPD. Quality control tips supported by literature with links to NIH, NIOSH and the Mayo Clinic. This is a presentation that I use to discuss hand held spirometry products from Carefusion. Micro Loop, Micro Lab, Micro 1 and Pulmolife
a detailed study on pulmonary function testmartinshaji
Â
this study details about all the aspects of pulmonary function test, lung volumes& capacities , tests such as spirometry , carbon monoxide diffusion capacity, chest x ray, body plethesmography , nitrogen washout etc
please comment
thank u
What are the pulmonary function tests used?
What are the indications?
What are the contraindications?
How to perform each and prepare patients?
How to interpret and reach a diagnosis?
How to clean and calibrate devices?
Spirometry is a simple, inexpensive pulmonary function test used to evaluate respiratory diseases. It measures how much air a person can inhale and exhale. Sir John Hutchinson invented the first spirometer to measure vital capacity. Spirometry can identify obstructive and restrictive lung diseases, establish reversibility in asthma, screen smokers for risk, and monitor treatment effectiveness. It involves maximal inhalation and exhalation into a mouthpiece to measure volumes like forced vital capacity and flows like forced expiratory volume in one second. Graphs of the results can indicate normal lung function or patterns suggestive of various respiratory conditions.
869 peak expiratory flow rate measurements final (2)nadahsalih
Â
This document provides guidelines for measuring peak expiratory flow rate (PEFR) in clinical practice. It outlines who is allowed to perform PEFR measurements, the proper technique for patients, and the procedure staff should follow. PEFR is an objective measure of lung function used to monitor patients with asthma or chronic obstructive pulmonary disease. Serial measurements allow clinicians to track a patient's condition and response to treatment over time. The guidelines aim to promote accurate and reproducible PEFR readings.
This document discusses pulmonary function tests (PFTs), which objectively measure lung function and are useful for diagnosing and monitoring respiratory disease. It describes various PFTs including spirometry, peak expiratory flow rate tests, body plethysmography, diffusion capacity tests, bronchoprovocation challenge tests, and six-minute walk tests. Spirometry specifically measures volumes of air inhaled and exhaled, while peak flow tests measure maximum exhaled airflow and diffusion capacity tests evaluate gas exchange in the lungs. Together these PFTs provide clinicians with quantitative data on lung volumes, capacities, flows, and gas exchange to aid in respiratory disease assessment.
1. Spirometry is a common pulmonary function test that measures how much air the lungs can hold and how quickly they can empty. It is used to diagnose and monitor respiratory conditions like asthma.
2. An on-site spirometry service called Pulmetrics provides trained respiratory scientists who visit general practices with portable spirometry equipment to perform the tests.
3. Spirometry results should be interpreted according to American Thoracic Society guidelines and reference values to determine if lung volumes and flows are normal or abnormal.
This document discusses pulmonary function tests (PFTs), including their goals, uses, limitations, procedures, and interpretations. PFTs are used to assess lung function before surgeries and characterize any pulmonary dysfunction. Key information obtained from PFTs includes measurements of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), their ratio (FEV1/FVC), and peak expiratory flow rate. Interpretations of these values can indicate restrictive or obstructive lung disease. The document outlines how PFTs are performed using portable devices or clinic spirometers and flow-volume loops.
Pulmonary function testing (spirometry ) Dr Emad efat
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Pulmonary function tests (PFTs) such as spirometry help diagnose and monitor respiratory diseases. Spirometry measures expiratory volumes and flow rates through forced inhalation and exhalation into a mouthpiece. For a test to be valid, exhalation must be smooth, continuous for 6 seconds, and meet reproducibility criteria of two largest FVC and FEV1 values within 0.2 L of each other. PFTs can detect restrictive and obstructive lung diseases and assess response to treatment.
PULMONARY FUNCTION TESTS PLAY A VERY IMPORTANT ROLE IN ESTIMATING THE FUNCTION OF LUNGS ESPECIALLY IN ASTHAMA AND COPD, One of the frequent reasons patients see their primary care physicians is for the symptom of dyspnea. Among the objective tests to quantify this symptom is the pulmonary function test
This presentation describes the indications, contraindications, methods of performing spirometry. It explains the interpretation of spirometry with examples.
Pulmonary function tests (PFTs) measure how well the lungs work by assessing things like lung volume, air flow, and gas exchange. PFTs can be used to diagnose respiratory diseases, monitor disease progression and treatment effectiveness, and evaluate patients for surgery. Common PFTs include spirometry, lung volume tests, diffusion tests, oximetry, and exercise tests. PFT results are analyzed to identify obstructive or restrictive lung patterns that can indicate conditions like asthma, COPD, or interstitial lung disease. PFTs provide quantitative data to help radiologists diagnose and grade various pulmonary conditions.
Pulmonary function tests (PFTs) measure how well the lungs work by assessing lung volumes, capacity, flow rates, and gas exchange. PFTs can detect obstructive or restrictive lung diseases and monitor treatment effectiveness. Common PFTs include spirometry, lung volume tests, diffusion tests, oximetry, and exercise tests. Spirometry measures airflow and lung size while breathing normally and forcefully. Lung volume tests directly measure lung capacity. Diffusion tests assess how well oxygen transfers to blood. Together, PFTs provide information on lung function and help diagnose and monitor respiratory conditions.
Discontinuing Mechanical Ventilation in ICUGamal Agmy
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This document discusses various methods and indices used to assess a patient's ability to be weaned from mechanical ventilation in the ICU, including minute ventilation, maximum inspiratory pressure, respiratory frequency, rapid shallow breathing index, tracheal airway occlusion pressure, and others. It provides recommendations for protocols to minimize sedation, use inspiratory pressure augmentation or preventive noninvasive ventilation for extubation. Diaphragm ultrasound measuring diaphragm thickness change during breathing is also discussed as a potential new method to guide weaning with a cutoff value of over 40% change indicating a likely successful spontaneous breathing trial.
This document provides information on lung transplantation and the role of physiotherapy. It discusses the types of lung transplants including single lung, double lung, lobar, and heart-lung transplants. The causes for transplantation and post-operative care are described. Pre-operative physiotherapy aims to prepare the patient while post-operative physiotherapy focuses on clearing secretions, expanding the lungs, and regaining mobility and fitness over several weeks of treatment and rehabilitation. Modalities like incentive spirometry, postural drainage, and positive pressure breathing may be used as needed.
This document discusses pulmonary function tests (PFTs) used to assess respiratory function. PFTs measure lung volumes, ventilation, breathing mechanics, diffusion, and gas exchange. They are useful for diagnosing respiratory diseases, monitoring disease progression and treatment response, and screening high-risk patients and those in hazardous work environments. PFTs are performed using a spirometer to simultaneously record breath volume and time. Spirometry is then discussed as a standard PFT that measures airflow in and out of the lungs to diagnose conditions like COPD and asthma.
Spirometry is a common test used to measure lung function by analyzing breathing patterns during a forced breath maneuver. It measures the total air volume exhaled (forced vital capacity or FVC) and the rate of exhaling during the first second (forced expiratory volume in one second or FEV1). These values are used to diagnose respiratory conditions, monitor treatment effectiveness, and detect airway obstruction. A spirometer is a device that records expiratory flow and volume over time to produce graphs of lung function parameters like FVC, FEV1, and their ratio (FEV1/FVC).
Chest physiotherapy involves techniques to clear secretions from the lungs and airways. It aims to improve respiratory efficiency by eliminating secretions, improving airway clearance, decreasing the work of breathing, and preventing lung collapse. Common techniques include postural drainage, percussion, vibration, and active cycle of breathing. Chest physiotherapy is indicated for patients unable to clear secretions effectively and those with conditions involving excessive secretions like cystic fibrosis. Contraindications include recent surgery or trauma involving the chest or head.
5-PFT- Dr BassamFFFFFFFFFFF Al- Selwey.pdfMosaHasen
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The document outlines a presentation on pulmonary function tests, specifically spirometry, discussing the history, equipment, procedures, normal values, and interpretation for obstructive, restrictive, and mixed lung disease patterns. It also covers indications, contraindications, and practical techniques for performing spirometry tests.
Liberation from mechanical ventilation involves gradually reducing ventilatory support as patients regain the ability to breathe spontaneously. There are several key stages in the process: assessing patient readiness using criteria like respiratory rate and oxygen levels; conducting a spontaneous breathing trial to test unsupported breathing; and finally removing the endotracheal tube if breathing is successful. Factors like underlying lung disease, secretions, and respiratory muscle strength can impact weaning outcomes. Close monitoring is needed to identify failures and prevent complications.
Spirometry is a common pulmonary function test that measures airflow in and out of the lungs through forced expiratory maneuvers. It is used to diagnose and monitor conditions like COPD by detecting and quantifying airflow limitation and distinguishing obstructive from restrictive patterns. The document provides details on how to properly perform spirometry, interpret the results, and evaluate for reversibility with bronchodilators.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
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In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
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GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
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Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
âEnvironmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the publicâ.The overall importance of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
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Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
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There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
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Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) Cosmetics
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Spirometry
1.
2. Spirometry: step by step
Educational aims
N To give an overview of what spirometry is, how to perform it and how to interpret it.
N To discuss the quality criteria to produce acceptable and reproducible results.
N To discuss the use of spirometry in the workplace.
Summary
Spirometry is easy to perform once trained and can be performed anywhere. It is
useful for detecting early change and disease progression. Quality is important
to ensure useful and reproducible results, otherwise results may be incorrectly
interpreted. Training from a reputable centre should be undertaken to ensure
the measures are understood as well as how to get the best results out of the
patient.
Introduction
Spirometry is the term given to the basic lung
function tests that measure the air that is
expired and inspired. There are three basic
related measurements: volume, time and flow.
Spirometry is objective, noninvasive, sensitive
to early change and reproducible. With the
availability of portable meters it can be
performed almost anywhere and, with the
right training, it can be performed by anybody.
It is performed to detect the presence or
absence of lung disease, quantify lung impair-
ment, monitor the effects of occupational/
environmental exposures and determine the
effects of medications.
The measures
Spirometric measures include the following.
N Forced expiratory volume in 1 s (FEV1)
N Forced vital capacity (FVC), the maximum
amount of air that can be exhaled when
blowing out as fast as possible
N Vital capacity (VC), the maximum amount of
air that can be exhaled when blowing out as
fast as possible
N FEV1/FVC ratio
N Peak expiratory flow (PEF), the maximal flow
that can be exhaled when blowing out at a
steady rate
Statement of Interest
None declared.
HERMES syllabus links:
A.1.2, B.1.1, B.1.4, B.6.1,
D.1.1
Breathe | March 2012 | Volume 8 | No 3 233
DOI: 10.1183/20734735.0021711
V.C. Moore Occupational Lung Disease
Unit, Dept of Respiratory
Medicine, Birmingham
Heartlands Hospital,
Birmingham, UK
Occupational Lung Disease
Unit, Dept of Respiratory
Medicine, Birmingham
Heartlands Hospital,
Bordesley Green East,
Birmingham, B9 5SS, UK
vicky.c.moore@heartofengland.nhs.uk
3. N Forced expiratory flow, also known as mid-
expiratory flow; the rates at 25%, 50% and
75% FVC are given
N Inspiratory vital capacity (IVC), the max-
imum amount of air that can be inhaled after
a full expiration
Performing spirometry
Calibration
Before performing spirometry, the equipment
used must be calibrated, or at least the
calibration checked at the beginning of the
session. Depending on the type of equipment,
this is achieved using either a 3-L syringe that is
pumped through to check that the meter is
reading correctly (within a tolerance of 3%) or
using a 1-L syringe that is pumped a litre at a
time to a maximum of 7 L, which checks the
linearity as well as the centre point of the
volume measurement. Many spirometers also
allow linear calibration, i.e. the volume is
checked at different flows. Some portable
meters do not require calibration, for example
those that use ultrasound technology. With
many meters, the calibration is a checking
function and if the calibration is out, the meter
needs to be returned to the manufacturer for
repair. There is an exception to this where some
of the more sophisticated equipment, such as
you would find in a lung function laboratory,
can update its output based on the calibration.
Spirometric values should also be checked
on a weekly basis using a biological control (a
healthy person working in the laboratory).
Flow is very difficult to calibrate and is not
calibrated routinely. It requires a sophisticated
computer-driven syringe to reproduce forced
expiration.
Prior to testing
Prior to performing spirometry, the patientâs
identification should be checked, their height
without shoes or boots and weight measured
(if scales are available, as this is not used in
prediction equations but is useful to know, as
volume may be restricted in obese patients),
and their age, sex and race recorded. If
the patient is unable to stand to have their
height measured, arm span can be used as
an estimate. Table 1 gives a checklist of what
should be avoided by the patient before
spirometry.
If inhalers have been taken within the times
stated above when reversibility testing, a true
assessment may not be made as the effect of
the administered therapy will be weakened. For
general testing, however, normal medication
should be documented so that it is known what
the patientâs lung function is like on and off
therapy, and if spirometry is going to be
repeated over time, conditions can be kept
the same. Many centres perform longitudinal
measurements post-bronchodilator to mini-
mise variability in recent bronchodilator use.
Contraindications
If any of the following have occurred recently,
then it may be better to wait until the patient has
fully recovered before carrying out spirometry.
N Haemoptysis of unknown origin
N Pneumothorax
N Unstable cardiovascular status, recent myo-
cardial infarction or pulmonary embolism
N Thoracic, abdominal or cerebral aneurysms
N Recent eye surgery
N Acute disorders affecting test performance,
such as nausea or vomiting
N Recent thoracic or abdominal surgical
procedures
Table 1 Checklist of factors that the patient should avoid prior to
spirometry
Activity
Length of time to
stop before
spirometry
Drinking alcohol 4 h
Eating a large meal 2 h
Vigorous exercise 30 min
Smoking .1 h
Medication use Document
treatment and when
last taken
For reversibility testing
Taking short-acting bronchodilators 6 h
Taking long-acting bronchodilators (including
combination inhalers) or twice-daily preparations
24 h
Taking tiotropium or once-daily preparations 48 h
Spirometry
Breathe | March 2012 | Volume 8 | No 3
234
4. Patient positioning
Correct measurement posture is as follows.
N Sit upright: there should be no difference in
the amount of air the patient can exhale
from a sitting position compared to a stand-
ing position as long as they are sitting up
straight and there are no restrictions.
N Feet flat on floor with legs uncrossed: no use
of abdominal muscles for leg position.
N Loosen tight-fitting clothing: if clothing is
too tight, this can give restrictive pictures
on spirometry (give lower volumes than are
true).
N Dentures normally left in: it is best to have
some structure to the mouth area unless
dentures are very loose.
N Use a chair with arms: when exhaling
maximally, patients can become light-headed
and possibly sway or faint.
Infection control
Hands must be washed between patients.
Bacterialâviral filters should be used for all
patients and thrown away by the patient at the
end of testing. If an infectious patient requires
testing, this should be performed at the end
of the session and the equipment should be
stripped down and sterilised/parts replaced
(depending on what is being used) before
being used again.
Technique
There are a number of different techniques
for performing spirometry.
N Before performing the forced expiration,
tidal (normal) breaths can be taken first,
then a deep breath taken in while still using
the mouthpiece, followed by a further quick,
full inspiration.
N Alternatively, a deep breath can be taken in
then the mouth placed tightly around the
mouthpiece before a full expiration is
performed.
N The patient can be asked to completely
empty their lungs then take in a quick full
inspiration, followed by a full expiration.
The latter technique can be useful in
patients who may achieve a larger inspiration
following expiration.
N For FVC and FEV1, the patient takes a deep
breath in, as large as possible, and blows
out as hard and as fast as possible and
keeps going until there is no air left.
N PEF is obtained from the FEV1 and FVC
manoeuvre.
N For VC, the patient takes a deep breath in,
as large as possible, and blows steadily for
as long as possible until there is no air left.
Nose clips are essential for VC as air can
leak out due to the low flow.
N The IVC manoeuvre is performed at the end
of FVC/VC (depending on what type of
equipment is used) by taking a deep, fast
breath back in after breathing all the way out.
Encouragement makes a big difference, so
donât be afraid to raise your voice to encourage
the patient, particularly near the end of the
manoeuvre. The patient needs to keep blowing
until no more air comes out and the volumeâ
time trace reaches a plateau with ,50 mL
being exhaled in 2 s [1]. Some patients,
particularly those with obstructive disease,
may find it difficult to exhale completely on a
forced manoeuvre. A relaxed VC may produce
better results in this case.
Quality
A number of criteria for acceptable quality
spirometry have been published. Guidelines
from the American Thoracic Society (ATS)/
European Respiratory Society (ERS) Task Force
[1] suggest that three acceptable manoeuvres
should be achieved. An acceptable manoeuvre
is defined as follows.
N An explosive start (no hesitation or sigmoid
curve) with a back-extrapolation volume
,150 mL (fig. 1) [1].
N The manoeuvre was performed with a
maximal inspiration and expiration.
N No glottis closure or cessation of airflow
occurred during the manoeuvre (e.g. by
hesitation or blocking the mouthpiece).
N No coughs (particularly during the first
second), inspirations during the trace or
evidence of leaks.
N The manoeuvre should meet the end-of-test
criteria (exhaling for o6 s with ,50 mL
being exhaled in the last 2 s).
The best two measurements must fulfil
the reproducibility criteria.
Spirometry
Breathe | March 2012 | Volume 8 | No 3 235
5. N For FEV1 and FVC, the best two values
should be within 5% or 150 mL of each
other, whichever is greater. If FVC is ,1.0 L,
then the values should be within 100 mL.
N The best FEV1 and FVC can be taken from
different manoeuvres.
If this is not achieved, more manoeuvres
are required. There is usually an upper limit of
eight manoeuvres, as performing forced exha-
lations is extremely tiring and the patient
is unlikely to obtain better values after this
point.
There can be problems with reproducibi-
lity: forced expiration can cause bronchocon-
striction, so there must be o30 s between
manoeuvres. For some patients, particularly
asthmatics, several minutes may need to be
left. However, full inspiration can cause bronch-
odilation, so it is important to keep going until
there is no further improvement.
BTPS correction
Spirometry should be corrected for body
temperature and ambient pressure saturated
with water vapour (BTPS). This is to correct
for the difference in the volume of air in the
lungs (at 37uC) to the volume measured by
the spirometer (at room air temperature).
Where barometric pressure cannot be inputted,
the spirometer should have a pressure range for
the correction factor used.
Reversibility testing
Reversibility testing is usually performed for the
diagnosis of asthma. Spirometry is performed,
after which a bronchodilator is given that can
either be a short-acting b-agonist or other
agents, such as anticholinergics. For the former,
46100 mg salbutamol are recommended via
a spacer device and 15 min is given before
retesting, and for the latter, 4640 mg ipratro-
pium bromide is recommended, leaving 30 min
before retesting [1]. There are a number of
publications [2â5] that all have slightly different
criteria for what constitutes a significant im-
provement in lung function to determine that
the individual has reversed. The combined ATS/
ERS Task Force [4] recommends that there
should be at least a 12% from baseline and 200-
mL improvement in FEV1. The British Thoracic
Society (BTS)/Association of Respiratory Techni-
cians and Physiologists (ARTP) guidelines
suggest .160 mL for FEV1 and .330 mL for
FVC [5]. These measures of reversibility show
that the change is outside the 95% confidence
limits for repeat spirometry without any bronch-
odilator [6] and do not relate to diagnosis or
usefulness of the drug in everyday use.
Reversibility is the defining characteristic of
asthma and it separates asthma from other
causes of airflow obstruction. An increase of
o400 mL in FEV1 post-bronchodilator is strong-
ly suggestive of asthma in adults, but a lack of
reversibility does not exclude asthma [2].
Equipment
A number of spirometers are available, ranging
from desktop portable devices to large, less
portable versions. Most measure flow directly
using pneumotachographs, turbines or other
technology and calculate volume, but the
wedge bellows spirometer measures volume
directly and calculates flow. The choice of
equipment depends on your service needs.
Larger equipment tends to be more stable, but
there are now some very usable hand-held
devices that store flowâvolume loops, have
built-in quality control and measure all spiro-
metric indices. Some of these have printing
capacity as well, whereas others require attach-
ment to a computer for this.
Interpreting spirometry
Normal lung function
Results obtained from lung function tests have
no meaning unless they are compared against
1.0
0.8
0.6
0.4
0.2
EV
0.0
Volume
L
0.50
0.25
New time zero
Time s
0.00
Figure 1
Expanded version of the early part of a subjectâs
volumeâtime spirogram, illustrating back-extrapola-
tion through the steepest part of the curve, where flow
is peak expiratory flow (PEF), to determine the new
time zero. Forced vital capacity (FVC): 4.291 L; back
extrapolated volume (EV): 0.123 L (2.9% FVC). -----:
back extrapolation line through PEF. Reproduced
from [1] with permission from the publisher.
Spirometry
Breathe | March 2012 | Volume 8 | No 3
236
6. reference values or predicted values. There are
a number of reference values available that
have been equated in slightly different ways, but
for studies comparing different European com-
munities, the equations from the European
Community for Coal and Steel (ECCS) are often
used [7]. Reference values are derived from
reference equations that contain data from
population surveys. The population in the
survey is ideally very large, and data is gathered
about the subjectsâ height, weight, age, sex,
ethnic origin, smoking habits, environment,
working conditions and physical fitness. The
current ECCS equations are linear in nature but
in reality, lung function change is a nonlinear
process. Reference values given can, therefore,
be unrepresentative of the person being tested
in some situations. There will be new equations
available in the near future which should
overcome these issues.
In adults, age, height, sex and race are the
main determinants of the reference values for
spirometric measurement.
N Age Lung function generally increases with
age up to ,25 years, then declines with
increasing age afterwards. Unfortunately,
some lung function equipment will give
patients aged ,25 years larger predicted
values than at age 25 years. To avoid majorly
overestimating the predicted value for
patients ,25 years of age, the best course
of action is input the subject9s age as
16 years and then 25 years. If the predicted
is larger at 16 years, then use the value for
25 years.
N Sex Pre-pubescent males and females gen-
erally have the same lung function, but post-
puberty, the growth of the thorax is greater in
males, giving marked differences in lung
volumes.
N Height The taller the person, the bigger the
lungs.
N Weight Certain reference equations use
weight to calculate reference values. Weight
affects lung function in that increasing
weight causes increasing lung function until
obesity is reached, after which it has the
opposite effect.
N Ethnic origin This factor becomes more
difficult to include as a multiethnic society
develops. The BTS/ARTP guidelines sug-
gest that for Japanese, Polynesian, Indian,
Pakistani and African patients, and those of
African descent, reference values multiplied
by a factor of 0.90 should be used [5]. This is
due either to body shape (i.e. African people
tend to have longer legs and shorter bodies
than Caucasians) or lack of nutrition for
those born in poorer countries. As many
different ethnicities are now born in richer
countries, nutrition is likely to be less of an
issue and as a general rule, by the second
generation after immigration, adjustment
for race is not usually required. Flow
measurements are not affected.
N Smoking This can cause a more rapid
decline in lung function compared with
nonsmokers over time. It should not be
Volume L
1 2 3 4 5 6 7
14 Flow L·s-1
12
10
Act 8
6
4
2
-2
-4
-6
Figure 2
Flowâvolume loop of a normal subject. Forced expiratory volume in 1 s (FEV1): 105%
predicted; forced vital capacity (FVC): 103% pred; FEV1/FVC ratio: 89%. The plot shows
the predicted flowâvolume loop (-----) and predicted ranges for the peak and
mid-expiratory flow rates and the FVC.
Volume L
1 2 3 4 5 6 7 8
14 Flow L·s-1
12
10
8
6
4
2
-2
-4
-6
-8
-10
Act
Figure 3
Moderate airflow limitation in a subject with asthma. Forced expiratory volume in 1 s
(FEV1): 73% predicted; forced vital capacity (FVC): 109% pred; FEV1/FVC ratio: 53%.
Spirometry
Breathe | March 2012 | Volume 8 | No 3 237
7. adjusted for in predicted equations, since
any reduction is abnormal.
Currently, a fixed ratio of FEV1 % predicted
is used to define normality, with 80% pred
being the lower limit, but this may be incorrect
in some populations. It has therefore been
proposed that the 95th percentile for a popula-
tion should be used for the limits of normality
[4]. Reference equations and longitudinal data
for this are awaited. Figure 2 shows an example
of a normal flowâvolume loop.
Obstruction
Obstruction is characterised by airflow limita-
tion; there is a decreased airway calibre through
either smooth muscle contraction, inflamma-
tion, mucus plugging or airway collapse in
emphysema.
Obstruction is characterised by:
N reduced FEV1;
N normal (or reduced) VC;
N normal or reduced FVC;
N reduced FEV1/FVC ratio; and
N concave flowâvolume loop (fig. 3).
Asthma is an obstructive disease but
because it is reversible, spirometry may be
normal when the person is not experiencing an
exacerbation. Chronic obstructive pulmonary
disease is also an obstructive disorder but
tends not to be reversible in most cases. There
are grades for the amount of obstruction seen
[8], as shown in table 2.
Restriction
Restrictive disorders are characterised by a loss
in lung volume and are much rarer. This occurs
in pulmonary fibrosis, pleural disease, chest wall
disorders (kyphoscoliosis), neuromuscular dis-
orders, pneumonectomy, pulmonary oedema
and obesity, to name a few. Many so-called
restrictive spirometry traces are due to failure to
reach the end of expiration, falsely reducing
FVC.
Restriction is characterised by:
N reduced FVC;
N normal-to-high FEV1/FVC ratio;
N normal looking shape on spirometry trace
(fig. 4); and
N possibly a relatively high PEF.
Mixed patterns
If a person is a heavy smoker and has a fibrotic
disease, for example, they may show a mixed
picture on spirometry, which is harder to
interpret. Further lung function tests may be
useful in these cases to analyse static lung
volumes (total lung capacity, functional resi-
dual capacity and reserve volume) and gas
transfer (transfer factor of the lung for carbon
monoxide).
Spirometry in the workplace
Certain occupations may involve exposure to
respiratory irritants or sensitisers; in which
Table 2. Assessment of severity of airflow
obstruction in chronic obstructive pulmon-
ary disease according to forced expiratory
volume 1 s (FEV1) % predicted (% pred)
FEV1 % pred Category#
o80 Mild
50â79 Moderate
30â49 Severe
,30 Very severe
#
: values are post-bronchodilator and used in
combination with an FEV1/FVC ratio of ,0.7.
Volume L
1 2 3 4 5 6 7 8
14 Flow L·s-1
12
10
8
6
4
2
-2
-4
-6
Act
Figure 4
Example of a typical restrictive defect. Forced expiratory volume in 1 s (FEV1): 82%
predicted; forced vital capacity (FVC): 85% pred; FEV1/FVC: 84%; peak expiratory flow:
157% pred.
Spirometry
Breathe | March 2012 | Volume 8 | No 3
238
8. case, surveillance is indicated, with pre-employ-
ment and regular (usually annual after the first
year) spirometry. If accelerated lung function
decline occurs, it is important to refer the
worker to a specialist occupational clinic. If
asthmatic symptoms occur (with or without
the presence of lung function decline), simple
spirometric measurements (usually PEF) should
be performed 2-hourly from waking to going
to bed, on days at work and away from work,
for 4 weeks to assess any diagnostic patterns
for occupational asthma [9]. PEFs should be
completed using specialised forms that allow
the worker to write down their work times, wake
and sleep times, jobs done during the day
and treatment taken. These can be downloaded
from www.occupationalasthma.com. Once the
worker has performed the measurements, they
can be inputted in a computer program, such as
Oasys (Occupational Asthma System; freely
available for download from www.occupationa
lasthma.com) [10â12] for analysis (fig. 5). When
serial PEFs are of good quality, the mean pooled
sensitivity for the diagnosis of occupational
asthma is 82% and specificity is 89% [13].
FEV1 is the main measure used in specia-
lised testing, such as specific inhalation
challenge tests for the diagnosis of occupa-
tional asthma. Spirometry also aids in the
diagnosis of lung diseases such as asbestosis,
giving a measure of respiratory impairment for
compensation or disability benefits.
Training
The key to getting useful, reproducible results is
good training. Although written documents are
useful, these should be used for reference rather
than as a sole learning resource. It is essential to
have practical training in spirometry to under-
stand how to get the best from the patient and
how to deal with the variety of patients you may
come across. Several courses are available,
including one run by the ARTP in association
with the BTS. Details can be found at www.artp.
org.uk.
Summary
Spirometry is a useful measure for detecting
early change in disease and provides physiolo-
gical confirmation for diagnoses. When per-
formed correctly, it can be used to assess
disease progression and response to therapy.
With the introduction of portable meters, it can
be performed anywhere and by anyone with
good training.
References
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50%
DV
PEF
L·min
-1
20%
620
600
580
560
540
520
500
480
460
440
420
400
380
Date
Readings
Work hours
Additional
Figure 5
Serial peak flow plot showing occupational asthma in a worker exposed to
formaldehyde. The top part of the plot shows the diurnal variation (DV), the middle
section shows the highest peak expiratory flow (PEF), mean PEF and lowest PEF each
day. Shaded areas are work days and white areas are days away from work. The Oasys
complex scores (a complex is either a restâworkârest or workârestâwork pattern) are
shown and the predicted PEF line of 519 L?min-1
. The bottom section shows the date,
number of readings per day and number of hours worked. The overall Oasys score is 3.93
(o2.51 is positive for occupational asthma). The area between curves score is
80.4 L?min-1
?h-1
(o15 L?min-1
?h-1
is positive for occupational asthma) and time-point
analysis is positive for occupational asthma.
Spirometry
Breathe | March 2012 | Volume 8 | No 3 239
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