Spirometry
Indications
Assisting with diagnostic evaluations
Monitoring of pulmonary function
Evaluating disability or impairment
Providing public health information
Contraindications
Unstable cardiovascular status, unstable angina, recent MI <1/12, PE
Haemoptysis of unknown origin
Recent PTX
Thoracic abdominal or cerebral aneurysms
Recent thoracic, abdominal or eye surgery
Acute disorders such as nausea or vomiting
Severe respiratory distress
Physical limitations
Cognitive impairment, dementia
Preparation
Carry out infection control measures – hand washing
Document if the patient has withheld bronchodilator
Ceased smoking > 1 hour prior, no alcohol > 4 hours prior, no vigorous exercise > 30 mins prior, no
large meal > 2 hours prior
Measure height and weight
Technique
Perform FVC and FEV1 manoeuvre – repeat x 3
o Correct use of mouthpiece and nose clip
o Correct posture with head slightly elevated
o Position of mouthpiece, including tight mouth seal over the mouthpiece
o Complete inhalation prior to FVC and FEV1
o Rapid and complete exhalation with maximal force
If flow-volume loop is being preformed (to measure forced inspiratory vital capacity)
o The patient will exhale rapidly and forcefully until end of test criteria are achieved aadn then
inhale as rapidly as possible back to TLC
Performing the VC testing
o Slow, complete and relatively constant flow inhalation for VC
o Slow, complete and relatively constant flow exhalation for VC
o Emphasis on complete filling and emptying of the lungs
Post bronchodilatory therapy
4 puffs (4 x 100mcg) salbutamol via spacer, perform 15 mins post
An increase in FEV1 and/or FVC of ≥ 12% compared with pre-bronchodilator spirometer and ≥200ml
increase in FEV1 and FVC compared with a pre-bronchodilator spirometry
= Tweet
Lung volumes
FLOW VOLUME LOOP
PARAMETERS
• VC = 70mL/kg
= IRV + TV + ERV
• IRV = 45mL/kg
• TV = 10mL/kg – volume breathed in & out during a normal
breath (without extra effort)
• ERV = 15mL/kg – extra volume beyond normal expiration
• RV = 15mL\kg (not measured by spirometer)
• TLC = 85L\kg
• FRC = 30mL\kg
• FEV1 = forced expiratory volume in 1 second (normally 4L)
• FVC = forced vital capacity (a little lower than VC because of
dynamic airway closure; normally ~5L)
• PEFR = peak flow rate over an expiration (normally 500L/min)
• FEV1/FVC (normal = 80%)
Obstructive disease = FEV1 reduced more than FVC, low
FEV1/FVC
Restrictive disease = FEV1 & FVC reduced but FEV1/FVC normal or increased
After a relatively small amount of gas has been exhaled -> flow is limited by airway compression
determined by (1) elastic recoil force of lung & (2) resistance of airways upstream of the collapse
point.
• FEF50%
• FIF50%
• FEF/FIF50 = if > 1 -> inspiratory flow is affected more than expiratory -> extrathoracic site of obstruction
OBSTRUCTIVE DISEASE
flow rate very low in relation to lung volume (c/o resistance to flow – scooped out appearance often
seen following the point of maximum flow)
total lung capacity is large, but expiration ends prematurely c/o early airway closure from increased
smooth muscle tone of bronchi (asthma) or loss of radial traction from surrounding parenchyma
(emphysema).
equal pressure point is close to the alveolus and the transmural pressure gradient can become
negative quickly -> collapse.
encroachment of VC by an increased RV caused by hyperinflation (‘air trapping’)
Severity Features Respiratory funciton
Mild Exertional symptoms FEV1 and PEFR >60% predicted
Able to speak normally
Good response to usual therapy
Moderate Dyspnoeic at rest FEV1 and PEFR 40 – 60% predicted
Able to speak in short sentences PEFR 200 – 300L/min
Chest tightness
Wheeze
Partial or short-term relief with usual therapy
Nocturnal symptoms
Severe Laboured respiration FEV1 and PEFR unable or <40% predicted
Sweating, restless SPO2 <90% on RA
Tachycardia, HR >120bpm PEFR <200L/min
Tachypnoea, RR >25/minute
Difficulty speaking – words or short sentences
Near death Exhaustion FEV1 and PEFR in appropriate
Confusion, coma SPO2 <90% despite supplemental O2
Cyanosis
Sweating
Silent chest
Inabilty to speak
Reduced respiratory effort
Dysrhythmia, bradycardia
Hypotension
RESTRICTIVE DISEASE
total volume exhaled and flow rate reduced
inspiration limited by reduced compliance of lung/chest wall or weakness of inspiratory muscles
