Spirometry
Anita Sharma, David Pitchforth, Gail Richards, Joyce Barclay in COPD in Primary Care, 2018
Spirometry is a method of assessing lung function, enabling the healthcare professional to make an accurate diagnosis and select an appropriate treatment for respiratory disease. As physicians, we would never treat hypertension without first measuring the patient’s blood pressure. We would never predict the severity of hypertension on the basis of symptoms alone. Furthermore, whether the antihypertensive treatment is effective or not, we continue to regularly monitor the patient’s blood pressure. So why treat a patient with COPD without using a test to measure lung function? Spirometry is crucial for the following reasons:
It allows early detection and accurate diagnosis of COPD.
Early detection enables smoking cessation to be targeted at the ‘at-risk patient.’
It provides an objective measurement of the severity and progression of COPD.
It is a useful guide to the management of COPD.
It is a reliable method of differentiating between chronic obstructive airways disease (COPD) and restricted airway disease (fibrosis).
Management of Pediatric Asthma
Jonathan A. Bernstein, Mark L. Levy in Clinical Asthma, 2014
The effective management of children with asthma is an ongoing process, requiring frequent reassessments to determine the degree of asthma control achieved with a treatment regimen. In addition to a general inquiry into parents’ and patients’ perceptions of the patients’ asthma status, several validated tools allow for the longitudinal quantification of asthma control, including the Test for Respiratory and Asthma Control in Kids (TRACK), the Childhood Asthma Control Test (C-ACT), and the Asthma Control Questionnaire (ACQ). The serial examination of the pulmonary function via spirometry is an integral component of asthma monitoring and can generally be performed well on children over 5 years of age, and occasionally on 4-year-old children. Spirometry measures the forced vital capacity (FVC), FEV, the ratio of FEV/FVC, as well as other measures of airflow including the forced expiratory flow between 25% and 75% of FVC (FEF). The FEV is the most commonly used and reproducible measure of pulmonary function, whereas the FEF demonstrates much more intrapatient variability. Standards are widely available for most spirometric measures and allow for correction based on the patient’s age, gender, race, and height. The FEV/FVC ratio is an indicator of airflow obstruction and may be more sensitive in identifying airflow abnormalities in asthma than the FEV is, as most children with asthma have an FEV within the normal range, even in the presence of severe disease (see Chapter 6). An effective asthma therapy should lead to an improvement in, and ideally a normalization of, the FEV1 and the FEV1/FVC ratio. An assessment of the level of asthma symptom control, asthma-related morbidity as reflected by activity limitation, and school absences should be an integral component of every asthma visit. The frequency of rescue albuterol use and how frequently a canister of albuterol needs to be refilled due to use of the contents of a canister (200 actuations = 100 doses) are effective surrogate indicators of asthma control. The effect on the clinical course caused when the patient misses a dose (or several doses) of medications often provides a valuable insight into the disease activity.
Common Office Tests and Procedures for the Allergist
Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial in Textbook of Allergy for the Clinician, 2021
Spirometry is a basic pulmonary function test which measures the volume of air inspired or expired as a function of time. It allows easy and direct measurement of FEV, FVC and FEV/FVC ratio. Spirometry cannot, however, measure lung volumes. Thus, information about FRC and lung volumes computed from FRC, such as total lung capacity and residual volume, require body plethysmography or gas dilution. The youngest age to perform spirometry with reproducible results varies between 5 and 7 years. Healthy young children may reach FVC in a few seconds, but it can take older patients much longer, especially those with airflow obstruction. In such cases, sustaining a maximal expiratory effort until achieving FVC may cause lightheadedness. In adults, FEV has been shown to be equivalent to FVC for identifying obstructive and restrictive patterns. Procedures. Calibration with a 3 L syringe should be performed each day of testing. Calibration should be repeated when the room temperature changes, when the equipment is disassembled and reassembled or when the equipment has been performing frequent tests for 4 hours.
Variation in spirometry utilization between trained general practitioners in practices equipped with a spirometer
Published in Scandinavian Journal of Primary Health Care, 2006
Patrick J. P. Poels, Tjard R. J. Schermer, Annelies Jacobs, reinier P. Akkermans, Joliet Hartman, Ben J. A. M. Bottema, Chris van Weel
Objective. To explore spirometry utilization among general practitioners and identify practitioner and practice-related factors associated with spirometry utilization. Design. Multivariate multilevel cross-sectional analysis of a questionnaire survey. Setting. Some 61 general practices involved in a spirometry evaluation programme in the Netherlands. All practices owned a spirometer and were trained to perform spirometry. Subjects. A total of 144 general practitioners and 179 practice assistants. Main outcome measures. Extent of spirometry utilization for five indications from national COPD/asthma guidelines, practitioner and practice-related factors associated with spirometry utilization. Results. The response rate was 97%. General practitioners used spirometry mostly to evaluate treatment with inhaled steroids (58%). Significant practitioner-related factors associated with spirometry utilization were: general practitioners’ job satisfaction, general practitioners’ general interest in research, and prior participation in spirometry training. Practice-related factors associated with spirometry utilization were: presence of a practice nurse, delegation of medical tasks to practice assistants, use of spirometry in different rooms, and use of protocols in practice. Conclusion. Practitioner- as well as practice-related factors were associated with the extent of spirometry utilization. In particular, it is essential to improve practice-related factors (e.g. presence of a practice nurse, more delegation of medical tasks to the practice assistant).
Medication Use Patterns Associated with Spirometry in Diagnosing COPD
Published in COPD: Journal of Chronic Obstructive Pulmonary Disease, 2008
Min J. Joo, Todd A. Lee, David H. Au, Marian L. Fitzgibbon, Kevin B. Weiss
Spirometry is necessary to diagnose and assess severity of COPD, but is used infrequently. Therapy with inhaled medications can improve COPD outcomes, but are not without risks. The use of spirometry may help mitigate the therapy risks if treatment is appropriate based on spirometry results. Before determining benefits of spirometry use, it is important to examine use of medications and the use of spirometry. Our objective was to characterize the association between the use of spirometry and respiratory medications in newly diagnosed COPD. This is a retrospective, longitudinal study using data from the Department of Veterans Affairs. We identified patients with a new diagnosis of COPD (index date). Spirometry use was measured two years before to six months after the index date. Respiratory medications were measured within one year following the index date. The association between spirometry and medication use was evaluated using logistic regressions and stratified by quintiles of the propensity scores for the probability of having had spirometry performed. A total of 81,162 patients were included and 30.8% had a spirometry performed. Patients with spirometry were more likely to have been dispensed an inhaled corticosteroid (AOR = 1.22 (95% CI, 1.11–1.36) to 1.61 (1.45–1.79)), long-acting beta-agonists (AOR = 1.41(1.25–1.58) to 1.63(1.45–1.83)), and ipratropium bromide (AOR = 1.25(1.16–1.35) to 1.64 (1.49–1.81)) across quintiles. Patients with spirometry were more likely to have medications added. The use of spirometry around a new diagnosis of COPD was associated with higher likelihood of using and adding respiratory medications after diagnosis
The effect of bronchodilation and spirometry on fractional exhaled nitric oxide (FeNO50), bronchial NO flux (JawNO) and alveolar NO concentration (C
Published in Journal of Asthma, 2018
Theodoros Karampitsakos, Adonis Protopapas, Maria Gianoloudi, Vassileios P. Papadopoulos, Demosthenes Bouros, Athanasios Chatzimichael, Emmanouil Paraskakis
ABSTRACT Objective: Fractional exhaled nitric oxide (FeNO), bronchial nitric oxide (JawNO) and alveoar nitric oxide (CANO) are biomarkers of eosinophilic inflammation, usually measured simultaneously with spirometry and bronchodilation. Our aim was to investigate the effect of bronchodilation and spirometry on FeNO, CANO and JawNO in children and young adults with well-controlled asthma and in healthy volunteers. Methods: FeNO was measured in 95 subjects (62 controls, 33 asthmatics). CANO and JawNO were assessed in 41 of the subjects (35 healthy, 6 asthmatics.) Measurements were performed before spirometry (1), right after spirometry (2), 20 min after the first spirometry and bronchodilation (3), right after the post-bronchodilation spirometry (4) and 30 min after the last spirometry (5). Results: The presence of well-controlled asthma was not associated with different pattern of reaction after spirometry and bronchodilation. A statistically significant difference was observed only between FeNO4 and FeNO5, as well as between CANO1 and CANO3 (19.14 ± 1.68 vs 20.62 ± 1.85 ppb, p = 0.001 and 4.42 ± 0.40 vs 3.09±0.32 ppb, p = 0.001, respectively). Conclusions: Spirometry and bronchodilation have an insignificant effect on FeNO and JawNO. Even if a slight change occurs in FeNO and JawNO, this does not modify clinician's decision and therapeutic strategy. CANO values (CANO1) are significantly decreased 20 min after spirometry and bronchodilation.
Related Knowledge Centers
- Lung
- Chronic Obstructive Pulmonary Disease
- Cystic Fibrosis
- Asthma
- Pulmonary Fibrosis
- Obstructive Lung Disease
- Pulmonary Function Testing