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Spirometry workshop

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Spirometry workshop

  1. 1. Spirometry Workshop
  2. 2. Today…. <ul><li>Review Spirometry-Video Notes on BB </li></ul><ul><li>Indications/Contraindications </li></ul><ul><li>Informed Consent, How many? </li></ul><ul><li>ATS criteria for acceptability & reproducibility </li></ul><ul><li>Reporting Values & Looking at the Loops </li></ul><ul><li>Coaching with Efforts & Comments </li></ul><ul><li>Interpretation of Testing & Steps </li></ul><ul><li>Live Testing </li></ul>
  3. 3. Interpretation <ul><li>Remember interpretation is most meaningful if interpreter can address clinical diagnosis, chest x-ray, hemoglobin values previous history and reference values. </li></ul><ul><li>Height & Weight the day of testing. (with shoes off) </li></ul><ul><li>Appropriate reference equations to determine the lower limit of normal or < 5 th percentile </li></ul><ul><li>ATS says confidence interval is +/-2 standard deviations (95% of points within boundaries) </li></ul>
  4. 4. Step-wise Interpretation <ul><li>Step 1. Look at the forced vital capacity (FVC) to see if it is within normal limits. </li></ul><ul><li>Step 2. Look at the forced expiratory volume in one second (FEV 1 ) and determine if it is within normal limits. </li></ul><ul><li>Step 3. If both FVC and FEV 1 are normal, then you do not have to go any further - the patient has a normal PFT test. </li></ul>
  5. 5. Step-wise Interpretation <ul><li>Step 4. If FVC and/or FEV 1 are low, then the presence of disease is highly likely. </li></ul><ul><li>Step 5. If Step 4 indicates that there is disease then you need to go to the </li></ul><ul><li>FEV 1 /FVC . </li></ul><ul><li>If 85%-90% or higher, then the patient has a restricted lung disease. </li></ul><ul><li>If 69% or lower, then the patient has an obstructed lung disease. </li></ul>
  6. 6. Step-wise Interpretation <ul><li>Step 6. Take a look at the TLC % predicted </li></ul><ul><li>If below LLN(80%) confirms restrictive defect </li></ul><ul><li>If above LLN (120%) confirms obstruction and qualifies for hyperinflation </li></ul><ul><li>Step 7. Take a look at RV% predicted </li></ul><ul><li>If above LLN (120%) confirms air trapping or airway closure </li></ul>
  7. 7. Step-wise Interpretation <ul><li>Step 8. Compare Pre& Post Bronchodilator measurements: An increase in FEV1 and/or FVC greater than 12% and greater than or equal to 200mls is a positive response </li></ul><ul><li>Step 9. Take a look at the DLCO % predicted and grade the degree of severity and differentiate underlying disease </li></ul>
  8. 8. Degree of Severity FEV 1 <ul><li>Mild > 70 </li></ul><ul><li>Moderate 60-69 </li></ul><ul><li>Moderately severe 50-59 </li></ul><ul><li>Severe 35-49 </li></ul><ul><li>Very Severe <35 </li></ul>
  9. 9. Degree of Volume Impairment <ul><li>Ideally, we have SVC & FVC to compare in spirometry testing: </li></ul><ul><li>Use FVC % Predicted </li></ul><ul><li>Mild 65-80% and < LLN </li></ul><ul><li>Moderate 50-65% </li></ul><ul><li>Severe < 50% </li></ul>
  10. 10. Severity of DLCO % predicted <ul><li>Mild > 60% and < LLN </li></ul><ul><li>Moderate 40-60% </li></ul><ul><li>Severe < 40% </li></ul>
  11. 11. Spirometry Procedure <ul><li>Informed Consent </li></ul><ul><li>Perform Spirometry (complete loops) </li></ul><ul><li>Assess for Acceptability </li></ul><ul><li>Assess for Reproducibility </li></ul><ul><li>Demonstrate Effective Communication including coaching with results and use lay terminology & keeping patient informed </li></ul><ul><li>Document The Results of Testing </li></ul>
  12. 12. References <ul><li>The Ontario Lung Association-HC Providers </li></ul><ul><li>CD-Interactive Spirometry in Primary Care </li></ul><ul><li>ATS/ERS Interpretive Strategies for Lung Function Tests http://www.thoracic.org/sections/publications/statements/pages/pfet/pft5.html </li></ul>

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