Electronic Spirometer for the Assessment of
Lung’s Functionality 1
K.A.Nagaraja, 2Nanda.S
Dept. of Instrumentation Technology, S.J.C.E., Mysore- 570 006
E-mail: 1 ka_nagaraj@hotmail.com, 2nanda_prabhu@yahoo.co.in.
Abstract
Electronic Spirometer is a device employed to diagnose
the disease processes that impairs the lung’s function.
Airflow obstruction, volume restrictions are the major
causes of lungs functional impairments that can be
diagnosed by electronic spirometry. Microcontroller
based single channel Spirometer has been designed and
developed for diagnosing the lung’s functionality for the
patients affected with obstructive or destructive diseases.
This spirometer has been designed to determine FEV
(Forced expiratory volume), FVC (Forced vital capacity)
and TV (Tidal volume) as basic maneuvers that are used
in spirometry analysis by the doctors. The designed
hardware uses personal computer with serial interface to
display the different parameters associated with this
electronic spirometer.
Key words: Spirometer, FEV, FVC, TV, Obstructive
and Destructive diseases.
I. INTRODUCTION
Spirometry is performed in order to diagnose and
classify the disease processes that impair the lung’s
function. Impairments in lung’s function can be broadly
classified as those resulting in airflow obstruction, volume
restriction, or a combination of obstructive and restrictive
defects. Chronic obstructive pulmonary diseases (COPD)
are the common diseases associated with lungs [1]. Asthma
and bronchitis are the common forms of COPD and are
found more often in men than women [15]. The incidence
of these diseases is more common among cigarette
smokers than people who do not smoke [14]. Asthma is a
disease characterized by attacks of wheezing and difficult
breathing. Spasms of the smooth muscles that lie in the
walls of the smaller bronchi and bronchioles bring on the
attacks and cause these passageways to close partially.
Asthma can be caused by environmental factors such as
dust or cold air. Asthma can also be caused by an infection,
exercise, or emotional upset. In an asthma attack, several
bodily changes make it difficult for air to go through
bronchi passageways. These changes include bronchi
constriction (bronchial muscles constricting), mucus
secretion in the bronchi, and edema (fluid retention) in the
bronchial wall. The difficulty in bringing air through those
Flow and
Instrumentation
passages accounts for a sign almost always associated with
differential
asthma wheezing. amplifier
Pressure
sensors
Fig. 1. Block Diagram of the Electronic Spirometer.
Power supply Personal
+5V, -5V, GND computer with
serial interface
Extrinsic (allergic) asthma, Intrinsic asthma, Triad
asthma and Nasal polyp asthma are the commonly
observed types of asthma.
Extrinsic (allergic) Asthma is a type of asthma usually
affects children and young adults who have a personal or
family history of being hypersensitive to substances in the
environment, foods, or air substances that are inhaled. An
individual can inherit the allergy to drugs, vaccines, and
anesthetic agents also. Intrinsic Asthma is a type of asthma
that is more common among adults over 35, especially
women. Upper and lower respiratory tract infections may
cause intrinsic asthma even though there has been no
family or childhood history of the disease. All these types
of diseases associated with lungs results in air way
obstruction. This airflow obstruction can be diagnosed
using spirometry and volume restriction can be diagnosed
by other PFT (Pulmonary Function Tests) like nitrogen
washout method and body plethysmography [7]. Since
Spirometer is a hand-held device, diagnosis of obstructive
lung disease can easily be made in an outpatient setting.
However, spirometry is accurate at predicting pulmonary
(Example. A low FVC seen on spirometry may be a clue to
a restrictive impairment) restriction but the initial
investment for the existing equipment is very high. It can
also be seen in patients with severe obstruction with air
trapping. If spirometry suggests a restrictive disorder,
patients with this pattern are usually referred for additional
PFT to confirm the diagnosis. Diagnosis of a restrictive
impairment depends on detecting a reduced total lung
capacity (TLC) by lung volume measurement; lung
volumes can be measured by plethysmography (“body
box”), by helium-dilution methods, or by the nitrogen-
washout method. Measurement of lung volumes is almost
exclusively done in licensed pulmonary function
laboratories [2]. With very few exceptions, measurements
of lung volumes are ordered to diagnose restrictive
pulmonary impairment with spirometry or to follow-up
patients with suspected restrictive pulmonary impairment.
In the present work, we have designed and
developed a simple low cost electronic Spirometer to
measure lung volumes and lung capacity namely forced
vital capacity (FVC), Forced expiratory volume (FEV) [11]
Active
and Maximum voluntary ADC ventilation (MVV).
(Analog to
Band pass
filter digital
converter)
8 bit
Micro controller
II. DESIGN OF ELECTRONIC SPIROMETER
In order to maximize the potential information from
Spirometer [3], individual variables as well as
combinations of variables are taken into consideration at
the time of design and development. To be practical for
most busy clinicians, and to effectively direct patient
management, the algorithm used is having clear guidelines
for interpretation and be applicable to almost all patients
presenting for spirometry. An impetus toward development
of this algorithm was to significantly reduce the number of
unnecessary lung volume measurements that were being
ordered in the hospital to screen for restrictive disease.
Figure 1 shows the block diagram of low cost
Spirometer which includes flow sensor, [8] differential
pressure sensor, instrumentation amplifier, low pass filter,
ADC, microcontroller and personal computer. In this basic
set up, the flow sensor is a Pitot tube type [8]. The basic
equation governing the output of a Pitot tube device is
Bernoulli’s theorem that relates the kinetic energy to the
potential energy in a flow streamline. By decelerating the
flow, kinetic energy (velocity) is converted to potential
energy (pressure). Thus a standard Pitot tube senses the
impact or total pressure caused by stopping the flow. If the
static pressure in the duct is measured and subtracted from
the total pressure, the result is related to the density and
velocity of the flowing fluid (or air).
The basic equation is:
ΔP = 1/2Kρ V2----------------------(1)
Where ΔP = Differential Pressure, K = Calibration Factor,
ρ= Gas Density and V = Actual Velocity.
After the flow sensor part, differential pressure
sensor is used. This sensor works on the principle of
Pneumo-tacometer. It uses a non-invasive method to
measure the capability of pulmonary functionality that may
be evaluated from flux/volume curve of pulmonary system.
Again Pneumo-tacograph principle is based on Poiseuille’s
law, that from relationship between pressure difference and
volume-flow rate, measurement of difference in pressure
yields an estimate of flow (liter/min.). Here the flow is
laminar and going to be governed by Poiseuille’s law.
Importantly, halving the radius of a tube will increase the
resistance by sixteen times. Note that with laminar flow,
the drop in pressure is related to the flow rate, and so we
can talk about the "resistance" of a tube, independent of
flow [9]. i.e.,
Pressure drop α Flow---------------- (2)
The differential sensor gives the electrical
quantity corresponding to the flow. In order to eliminate
noise and amplify signal level, instrumentation amplifier is
used. The design involves computation of gain. The gain
equation for instrumentation amplifier is as follows:
G = 5+ (80KΩ/RG) ------------------- (3)
Where G is the gain; 80KΩ is internal feedback resistor
value, RG external gain adjustment resistor.
This amplified signal is fed to the band pass filter
with pass band frequency between 0.05Hz to 13Hz. The
Spirometer signal lies in the range of 0.1 to 12Hz. Hence
the filter is designed for above frequency and it uses
Butterworth second order filter due to its flat response in
the pass band and low ripples. Output of ADC is the digital
equivalent of the measured parameters related to lung’s
function. ADC used in our work is 14-bit Successive
Approximation type.
Microcontroller is programmed for particular
sampling rate to read the data from the ADC (analog to
digital converter) depending on the signal frequency. In
this work, we have used a sampling rate of 500Hz for
signal frequency of 13Hz. The Microcontroller used in our
work is AT89S8253. The AT89S8253 is a low-power high
performance CMOS 8-bit Microcontroller based on the
RISC architecture. The architecture of this microcontroller
is more code efficient while achieving throughputs up to
ten times faster than conventional CISC microcontroller.
Again the same microcontroller is used to communicate
with the personal computer through the serial port. Serial
port is configured for particular baud rate depending on
serial port standards.
III ALGORITHM
The software used in this work will classify the type of
lung impairments. The steps involved in the algorithm are
as follows:
 Determine if the test is interpretable.
 If interpretable, Assess FVC, FEV and absolute
FEV/FVC ratio.
 Compare these values with standard FVC, FEV
and FEV/FVC ratio.
 Determine whether it is restrictive, obstructive
ventilatory impairment or normal spirometry.
 If it is normal end the test.
 If it is restrictive ventilatory impairment refers to
MVV check and determines the severity.
 If it is obstructive ventilatory impairment
performs other tests and determines severity.
IV RESULTS
The more commonly measured parameters to assess
the lung’s function using our Spirometer are: Forced vital
capacity (FVC), Forced expiratory volume (FEV) [11] and
tidal volume (TV). FVC is the amount of air that can be
exhaled with force after the deep inhalation. FEV is the
amount of air that the subject can exhale with force in one
breath. TV is the amount of air that can be inhaled and
exhaled during normal respiration.
Other derived parameters are as follows: The amount
of air that the subject can exhale may be measured at 1
second (FEV1), 2 seconds (FEV2), or 3 seconds (FEV3).
FEV1/FVC ratio can also be determined [12]. Forced
expiratory flow between 25% to 75% measures the air flow
halfway through an exhale (FVC). Peak expiratory flow
(PEF) gives an indication of how quickly the subject can
exhale. It is usually measured along with forced vital
capacity (FVC). Maximum voluntary ventilation (MVV) is
a measure of maximum amount of air the subject can
breathe in and out during a period of one minute. Total
lung capacity (TLC) measures the amount of air present in
the lungs after the deep breadth.
We have tested the ability of the Spirometer to detect
restriction for the patients with suspected parenchyma,
pleural, or chest wall restriction. Out of the 40 patients
tested with our spirometer whose referral diagnosis
indicated suspected restrictive impairment, 24 patients
ultimately had a restrictive pulmonary impairment
confirmed by body-box lung volume testing [6]. All 24
patients picked up by the spirometer are recommended for
further lung volume testing.
Patients with moderate-to-severe obstructive defects were
also analyzed as a subgroup. These are a group of patients
with at least moderate airflow obstruction, for whom the
spirometer does not recommend lung volume testing.
The following two graphs show the output waveforms of
the spirometer. This graph was obtained for FEV. From this
we can derive FEV, Peak Flow, and FVC etc. In our work,
the designed spirometer gives very accurate readings with
the small deviation of 0.1% error and this is due to very
small change in Pitot tube angle [9]. This can be eliminated
by proper placement of the Pitot tube (maintaining 900). As
per ATS (American thoracic society) the normal values are
shown in the table [5].
Figure 2 Acquired raw data.
Figure 3 Data after filtration.
Table 1 Normal values of spirometry [16].
FEV 80% to 120%
FCV 80% to 120%
Absolute FEV1/FVC With in 5%of the predicted
value
TLC 80% to 120%
FRC 75% to 120%
RV 75% to 120%
V DISCUSSION
The objective of this work is to design and development of
simple and low cost spirometer that would help rural
primary health care centers, private clinicians and
pulmonary function laboratories to procure low cost
spirometer with minimal investment. Also, to decide which
patients should undergo measurement of lung volumes
following spirometry. Since lung volume measurements
are almost always ordered to diagnose restrictive
pulmonary disease, [4] the spirometer was designed to
predict the presence or absence of pulmonary restriction.
The patients with an FVC of 85% and FEV1/FVC ratio of
55% require further lung volume measurements to confirm
the diagnosis of restrictive lung disease. Those patients
with an FVC 85% predicted are unlikely to be restricted
and do not require lung volume measurements. Similarly,
patients with a low vital capacity, but who also have
obstructive disease on spirometry (ie, FVC 85% of
predicted and an FEV1/FVC 55%), have a reduced vital
capacity because of air trapping, with impingement on
their vital capacity by a high residual volume. These
patients are also very unlikely to have true restrictive
pulmonary disease and do not require measurements of
lung volumes. Developed Spirometer is economical than
the currently available spirometer in the market. The
results obtained were consistent and reproducible [10]
when compared with the standard spirometers [13].
 VI. ACKNOWLEDGEMNT 16. Goldman HI, Becklake MR. Respiratory function tests:
Authors would like to take this opportunity to hearty thank normal values at median altitudes and the prediction of normal
to all those who have helped in the successful completion results. Am Rev Respir Dis 1969; 79:457–467
of this work. It is a matter of immense pleasure to express
our sincere thanks to Mr.Sameer Sawarkar, CEO Mr.
Rajeev Kumar, MD and also Mrs.Richa Kumar, HR
Neurosynaptic Communications Pvt Ltd, for considering
and giving this opportunity for completing this work. We
render heartfelt thanks to Mr.M.Shiva Kumar, Asst Prof
Department of Instrumentation Technology, B.I.E.T.,
Davangere for his help.

VII REFERENCES

1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS;
GOLD Scientific Committee. Global strategy for the diagnosis,
management, and prevention of chronic obstructive pulmonary
disease. NHLBI/WHO Global Initiative for Chronic Obstructive
Lung Disease (GOLD) Workshop summary. Am J Respir Crit
Care Med2001; 163:1256-76.
2. Ries A. Measurement of lung volumes. Clin Chest Med 1989;
10:177–186
3. Ferguson GT, Enright PL. Office spirometry for lung health
assessment in adults. Chest 2000; 117:1146–1161
4 Aaron SD, Dales RE, Cardinal P. How accurate is spirometry at
predicting restrictive pulmonary impairment? Chest 1999;
115:869–873.
5. American Thoracic Society. Lung function testing: selection of
reference values and interpretative strategies. Am Rev Respir Dis
1991; 144:1202–1218.
6. Kilburn KH, Miller A, Warshaw RH. Measuring lung volumes
in advanced asbestosis: comparability of plethysmographic and
radiographic versus helium rebreathing and single breath
methods. Respir Med 1993; 87:115–120
7. Gold WM. Pulmonary function testing. In: Murray JF, Nadel
JA, eds. Textbook of respiratory medicine, 3d ed. Philadelphia:
Saunders, 2000:781-871.
8."Filtrete.TM. Air Filter Media Type G, GS and GSB"
(Technical Data of 3M Filtration Products of St. Paul, MN), 4
pgs. International Search Report for PCT/US01/46787.
9. Ingram RH, Schilder DP: Effect of gas compression on
pulmonary pressure flow and volume relationship; J Appl Physio,
21:1821-2826, 1966.
10. Celli BR, MacNee W; ATS/ERS Task Force.Standards for the
diagnosis and treatment of patients with COPD: a summary of the
ATS/ERS position paper. Eur Respir J. 2004 Jun; 23(6):932-46.
11. Swanney MP, Jensen RL, Crichton DA, Beckert LE, Cardno
LA, Crapo RO. FEV6 is an acceptable surrogate for FVC in the
spirometric diagnosis of airway obstruction and restriction. Am J
Respir Crit Care Med 2000; 162:917-919.
12. Enright PL, Connett JE, Bailey WC. The FEV1/FEV6
predicts lung function decline in adult smokers. Resp Med 2000;
96:444-449.
13. American Thoracic Society. Standardization of spirometry.
Am Rev Respir Dis 1987; 136:1286–1296
14. Crapo RO, Morris AH, Clayton PD, et al. Lung volumes in
healthy nonsmoking adults. Bull Eur Physiopath Respir 1982;
18:419–425
15. Morris JF, Koski A, Johnson LC. Spirometric standards for
healthy non-smoking adults. Am Rev Respir Dis 1971; 103:
57–67