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Transcript of Spirometry
LRMC Pulmonary Clinic
SSG Griffith Pulmonary Clinic NCOIC
SGT Rosario SPIROMETRY STANDARDS Spirometry is a pulmonary function test that measures the volume of air an individual inhales or exhales over a period of time.
Spirometry measures how much and how quickly air can be expelled following a deep breath.
Flow, or the rate at which volume is changing as a function of time, can also be measured with spirometry. What is Spirometry? Simply put... spirometry measures how much air one breathes in, out, how hard, and how fast. Is an effort-dependent maneuver that requires understanding, coordination, and cooperation.
Good coaching from the tech is the most important step in order to obtain maneuvers that are reproducible and acceptable. Spirometry
-To evaluate symptoms, signs, or abnormal laboratory tests
-To measure the effect of disease on pulmonary function
-To screen individuals at risk of having pulmonary diseases
-To assess preoperative risk
-To assess prognosis Indications for Spirometry Values to Look For Forced Vital Capacity (FVC) - the maximal volume of air forcibly exhaled from the point of maximal inhalation
Forced Expiratory volume in 1 second (FEV 1) - the volume of air exhaled during the first second of the FVC. (Blasting out)
FEV1/FVC - ratio of FEV1 to FVC, expressed as a percentage
Peak Expiratory Flow Rate (PEFR) is the maximum air flow (rate) during forced exhalation As the test administrator, your goal is to get as many reproducible trials as possible. (Minimum of 3)
FEV1 and FVC readings should be within 15% or less from each other in each attempt to validate test. Coaching the Patient -Position patient - preferably sitting, if possible, sitting tall, neck slightly extended, chin level.
-Ask patient to put on nose clips and get good seal around mouthpiece (meaning teeth and lips).
- Have patients breath for at least 3-5 normal/ relaxed breaths.
- Upon completion of normal exhalation, command patient to take a deep breath in, as FAST and as DEEP as possible. Using voice inflexion and emphasis is key. (Use phrase, "Deep breath in!")
-When maximum exhalation is achieved, have patient exhale all their air as FORCEFULLY and as FAST as possible, for at least 6 seconds, if possible. Instruct them to use a "ha", or "huh" sound when exhaling, as opposed to blowing. ( Use phrase, "Blast it out!")
-Once exhalation reaches 6 sec, ask patient to take a deep and fast breath as aforementioned.
-Have patient return to normal breathing, and repeat steps above. Overview -What is Spirometry?
-Why conduct Spirometry?
-Coaching the patient
-How to perform maneuver Algorithm Used In Our Clinic to Help Identify Obstructive Vs Restrictive In Conclusion... We discussed:
-What basic spirometry is
-Why we do it
-How we coach patients when performing maneuvers
-Brief visual of obstructive vs restrictive Questions?? Information derived using American Thoracic Society (ATS) standards and teachings. Performing Maneuver Mixed Pattern
Obtain Lung Volumes, DLCO and Post BD test. Obstructed Disease
Obtain Post BD Test No Yes FVC
Is FVC ≥ 80% Predicted? No Yes FVC
Is FVC ≥ 80% Predicted? No Yes FEV1/FVC Ratio
Is Ratio ≥ 90% of Predicted Restricted Pattern Obtain Lung Volumes and DLCO Normal Baseline Spiro Any other questions not addressed, see ATS handout previously dispersed to personnel.