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Philippine College of Chest Physician (PCCP

):
Consensus Statement on the Performance
and Reporting of Spirometry Testing
Executive Summary

Report of the Council on Diagnostics and Therapeutics
Philippine College of Chest Physicians
Primary Investigator: Tim S. Trinidad, MD, FPCCP
Secondary Investigators: Ma. Janeth T. Samson, MD, FPCCP
Celeste Mae L. Campomanes, MD, FPCCP
Marites A. Tan- Ang, MD,FPCCP
Geraldine C. Garcia, MD, FPCCP
Maria Peachy Lara L. Villanueva,MD,FPCCP
Lolita Brigida V. Micu, MD, FPCP
Rachel M. Lee-Chua,MD, FPCP
Maria Piedad R. Natividad, MD, FPCCP
PROPONENTS:
Chair: Ma. Janeth T. Samson, MD, FPCCP
Advisers: Camilo C. Roa, MD,FPCCP
Tomas M. Realiza, MD, FPCCP
Vincent M. Balanag Jr.,MD, FPCCP
Benilda B. Galvez, MD, FPCCP
Jennifer Ann M. Wi, MD, FPCCP
Ricardo C. Zotomayor, MD, FPCCP
Consultative Groups:
All hospitals and individuals who have participated in the meetings and voting forms and
have commented in one way or another.

Chinese General Hospital: Eden D. Chua, MD, FPCCP
Shirley Jane Chua-Panganiban, MD, FPCCP
Lung Center of the Philippines: Luisito F. Idolor, MD, FPCCP
Augusto S. Sablan, Jr. MD, FPCP
Araceli Pascual, RT
Manila Doctors Hospital: Dennis C. Teo, MD, FPCCP
Aileen M. David-Wang, MD, FPCCP

Philippine Heart Center: Rodolfo E. Tamse, MD, FPCCP

Irenee Faustina J. Casiño, MD, FPCP
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St. Luke’s Medical Center: Myrna N. Bañares,MD, FPCCP
Raphael Ryan R. Zantua, MD, FPCCP
Ma. Janeth T. Samson, MD, FPCCP
University of Perpetual Help Medical Center: Ricardo M. Salonga, MD, FPCCP
Jose Edzel V. Tamayo, MD, FPCCP
Mary Leslee Tabi,RT

Niño Jessielito N. Doydora, MD
University of the Philippines – Philippine General Hospital:
Ma. Bella R. Siasoco, MD, FPCCP
Jubert P. Benedicto, MD, FPCCP
University of Sto. Tomas Hospital: Tim S.Trinidad, MD, FPCCP
Celeste Mae L. Campomanes, MD, FPCCP
Apolonio G. Javier, JR., MD, FPCP
FPCCP
Veterans Memorial Medical Center: Eloisa S. De Guia, MD, FPCCP
PCCP- Central and North Luzon Chapter: Ruel G. Rivera, MD, FPCCP
PCCP-Cebu Chapter: Evan N. Mendoza,MD, FPCCP
PCCP-Iloilo Chapter: Malbar G. Ferrer, MD, FPCCP
PCCP-Negros Chapter: Ethel Marie B. Tangarorang-Lacson, MD, FPCCP
PCCP – Northern Mindanao Chapter: Eileen G. Aniceto, MD, FPCCP
PCCP-Southern Mindanao Chapter: Romulo T. Uy, MD, FPCCP
PCCP- Southern Tagalog Chapter: Violeta C. Reyes, MD, FPCCP

Key Opinion Leaders
Camilo C. Roa, MD,FPCCP
Joven Q. Tanchuco, MD, FPCCP
Abundio A. Balgos, MD, FPCCP
Jennifer Ann M. Wi, MD, FPCCP
Ricardo C. Zotomayor, MD, FPCCP

Council of Diagnostics and Therapeutics Members
Caburnay, Eloise Arabelle, MD, FPCCP
Campomanes, Celeste Mae L.,MD, FPCCP
Chavez, Christine L., MD, FPCP
Chua-Panganiban, Shirley Jane, MD, FPCCP
Claveria, Angelica, MD, FPCCP
Cristobal- Aquino, Ma. Flordeliza, MD, FPCCP

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FPCCP Reyes. MD. FPCCP Germar. MD. MD. Piedad R. FPCP Llanes-Gracia. Edwin I. Lyndon H. FPCCP Reside. Alfredo Romeo Q.A. Liza. Daisy. Peachy Lara. FPCCP Tan.. Mary Jane. MD. MD. Alvin. MD. Helarose M. FPCCP Samson. FPCCP Natividad. Evelyn Victoria E. MD. MD. FPCCP Tan. MD. MD. MD. Lolita Brigida. Andrew S. FPCCP Elisterio. Arnold G. Anna Tessa. Marites. Rachel. MD.FPCCP Zantua... FPCCP Ogbac. MD. Rosauro Vicente H. Raphael Ryan R. MD.. FPCCP Villasanta. Czarina J. William George. MD. FPCCP Santos. FPCCP Gonzales.FPCP Peñafiel.MD. FPCCP Mapanao. Florita.. FPCCP Villanueva. Ma.. Julius.MD. FPCCP Micu. FPCCP Garcia. MD. Tim S.FPCP Mora. MD.. Charissa.. MD.. Jr. FPCCP Villanueva. MD.. Geraldine. FPCCP Valenzuela.. MD.Dalupang. FPCCP iii . FPCCP Divinagracia. MD. FPCCP Lee-Chua. MD.. MD. MD. FPCCP Trinidad. Ma.

general practitioners. I hope that all users of this manual will benefit greatly from it and promote the use of spirometry more extensively. It is meant to be a working reference for chest specialists. recommend spirometry as the gold standard for accurate measurement of lung function. FPCCP President (2012-2013) Philippines College of Chest Physicians iv . I commend the Council on Diagnostics and Therapeutics under the leadership of Dr. medical trainees and paramedical personnel. disability testing. internists. MD. No uniform way of reporting the interpretation of spirometry results is also available in our country. BENILDA B. it has remained underutilized in clinical practice. However. despite the known usefulness of spirometry. Samson. Ma. primary care physicians. and screening people at risk in certain occupational environments.Message from the PCCP President Greetings from the Philippine College of Chest Physicians (PCCP) ! Spirometry is a useful tool in the assessment of lung function. National and international guidelines like the Global Initiative for Chronic Obstructive Lung Disease guidelines. determining the severity of lung disease. evaluation of patients with unexplained respiratory symptoms. GALVEZ. On behalf of the PCCP Executive Board of Directors. This spirometry manual was prepared by the PCCP Council on Diagnostics and Therapeutics with the aim of providing standards on the performance and reporting/interpretation of spirometry testing. Spirometry has many clinical applications in assessing and managing respiratory disease such as: detecting the presence of obstructive and restrictive lung defects. assessment of preoperative pulmonary risk. Janeth T. for their hard work and dedication in preparing this manual.

FPCCP Council Chair PCCP Council of Diagnostics and Therapeutics v . MD. Samson. This project would not have been possible if not for the cooperation and support of executive board. in making this manuscript a reality. special thanks to the members of the council who painstakingly contributed their efforts and support . It is our objective that by promoting uniformity in the conduct and reporting of simple spirometry we will be able to create more understanding of the report eventually increasing its use to improve the quality of patient care. chapters and key opinion leaders. Janeth T. spearheaded by Dr. Likewise. resource persons from training institutions. The under utilization of this diagnostic tool may be because of its unavailability in the rural areas as well as the lack of understanding of the spirometry report among nonpulmonologist. This lack of understanding may stem from differences in the interpretation of the values in the report or in the manner of reporting these interpretations. Ma. Tim Trinidad.Message from the Council Chair Greetings! The Council of Diagnostics and Therapeutics of the Philippine College of Chest Physicians aims to promote awareness of the use of spirometry in the diagnosis of pulmonary diseases as well as to measure lung wellness.

Table of Contents Introduction -------------------------------------------------------------------------------- 1 Methodology ------------------------------------------------------------------------------- 1 Statements Performance of the Test ------------------------------------------------------------- 2 Quality Control ------------------------------------------------------------------------- 3 Parameters Measured --------------------------------------------------------------- 3 Test Result Selection ---------------------------------------------------------------- 3 Parts of the Report ------------------------------------------------------------------- 3 General Data -------------------------------------------------------------------------- 4 Technician’s Comment -------------------------------------------------------------- 4 Semantics in Interpretation --------------------------------------------------------- 5 Interpretation Algorithm -------------------------------------------------------------- 5 Use of other Parameters Not in Algorithm -------------------------------------- 5 Grading of Severity ------------------------------------------------------------------- 7 Lower Limit of Normality ------------------------------------------------------------ 7 Response to Bronchodilator -------------------------------------------------------- 8 Statement on Need for Additional Test ------------------------------------------ 9 Reference Equations ----------------------------------------------------------------- 9 Comments on the Quality of the Test -------------------------------------------- 10 Graphical Representation ----------------------------------------------------------- 11 Results in Tabular Graph ------------------------------------------------------------ 11 Interpreter’s Comments -------------------------------------------------------------- 12 Final Interpretation -------------------------------------------------------------------- 13 References ---------------------------------------------------------------------------------- 13 Appendix ------------------------------------------------------------------------------------- 14 vi .

Philippine College of Chest Physician (PCCP):
Consensus Statement on the Performance and
Reporting of Spirometry Testing
Introduction
Spirometry testing is an underutilized ancillary procedure. There are numerous
reasons for this observation. Perhaps one of the reasons is the non-uniformity and
complexity of the reports generated. It is for reason the Philippine College of Chest
Physician (PCCP) Council of Diagnostics and Therapeutics (DATS) came out with this
consensus document. It is envisioned that with these recommendations, PCCP Pulmonary
Fellowship Training Institutions (PFTI) will be able to come up with a recommended generic
spirometry report that is of good quality and simple enough for both the pulmonary and nonpulmonary specialist (general practitioner) to use. (Kindly see appendix A).

Methodology & Results
Generation of the List of Statements for Voting
From September till December of 2011, the PCCP PFTI pulmonary function lab
directors or resource persons were requested to answer a survey questionnaire on
performance and reporting of spirometry testing in their respective institutions. They were
likewise requested to submit a sample of their reports that shows the following results:
normal, obstructive, possible restrictive and possible combined defect. The composition of
the PCCP-PFTI and their corresponding pulmonary function lab director/resource persons
can be seen in appendix B.
On January 9, 2012 and February 20, 2012, the collected survey forms were tallied
and analyzed by DATS. Specifically, DATS evaluated the uniformity of the performance and
reporting of spirometry testing. From the results and statements of American Thoracic
Society and European Respiratory Society Task Force on Standardization of Lung Function
Testing (ATS-ERS-TFLFT), DATS came out with a list of proposed recommendations for the
different PCCP-PFTI in the performance and reporting of spirometry testing.
The initial list of statements was presented and deliberated upon by the
representatives of PCCP-PFTI on March 2, 2012. A revised list was presented to the
members of the PCCP during its annual convention on March 14 & 16, 2012. The
statements were further modified based on the suggestions during the annual convention.

Method Used in Voting and Grading of Consensus Statements
On April 2, 2012, DATS deliberated on the penultimate statements. Thereafter the
penultimate document was distributed to the different 11 PCCP PFTI, 4 PCCP Chapters and
3 key opinion leaders for voting. The form used for voting and the list of those who voted
can be seen in appendix K & L respectively.
After the votes were tallied (this can be seen in appendix M), the statements were
classified according to the following level of consensus:

1

Perfect consensus is defined as 100% of the voters agreeing with the statement and
none of the voters chose option D.
Very good consensus is defined as 80 to 99% of the voters agreeing with the
statement and there are less than 20% of the voters who chose option D.
Good consensus is defined as either
80 to 99% of the voters agreeing with the statement with more than 20% of
the voters choosing option D
60 to 79% of the voters agreeing with the statement with less than 20% of the
voters choosing option D
Some consensus is defined as 51 to 59% of the voters agreeing with the statement
No consensus is defined as less than 50% of voters agreeing with the statement
The computation of the parameters needed for the level of consensus classification can
be seen in appendix N.
Based on the level of consensus, the statements were modified based on the modal
auxiliary verbs: must, should and may. Statements classified as having either a perfect or a
very good consensus used the modal auxiliary verb “must”. Must is used in the context that
personnel involved in spirometry testing has a responsibility or an obligation to follow the
statement. Statements classified as having a good consensus used the modal auxiliary verb
“should”. Should is used in the context that personnel involved in spirometry testing are
advised to follow the statement.
There are 22, 25 & 4 statements with perfect, very good and good consensus
respectively. None of the statements were classified as some or no consensus.

Spirometry Testing Consensus Statements
Performance of the Test
 Statements:
(S1-1) Spirometry testing using the closed circuit technique must be performed based on
the standards set by the ATS-ERS-TFLFT1. Part of the procedure includes the
answering of the “PCCP DATS Spirometry Testing Information Sheet”. Kindly see
appendix I & J (very good consensus).
(S1-2) A referring physician must either request any of the following types of spirometry
testing (perfect consensus):
Simple spirometry
Spirometry with post bronchodilator study
Simple spirometry study with possible post bronchodilator study if initial result is
abnormal.
(S1-3) In a situation where in the referring physician requested only a simple spirometry
and it showed abnormal results, the technician in coordination with the doctor
(interpreter of the results) must try to seek permission from the referring physician to
proceed in performing a post bronchodilator study while the patient is still in the test site
(very good consensus) or may suggest Postbronchodilator study in the results.

2

Quality Control
 Statements:
(S2-1) Daily instrument calibration must be done (very good consensus).
(S2-2) The interpreter (lab medical director or pulmonary consultant on deck) must
give a feedback to the technician with regards to the quality of the test (perfect
consensus).
(S2-3) A log book must be maintained. It must contain the following (very good
consensus):
1. Daily calibration results
2. Anomalous events or problems encountered with the system
3.Feedback of the interpreter to the technician

Parameters Measured
 Statements:
(S3-1) The following must be measured and reported: FEV1/ FVC, FVC and FEV1
(perfect consensus).
(S3-2) If the spirometry machine is capable, the following should be measured and
reported (in order of decreasing importance) (very good consensus):
A. PEFR
B. FEF 25-75
C. FEF 75
D. MIF50/ MEF50
E. FEV1/FV6
F. MVV
G. MIF 50
H. MEF 50
I. FEV6
J. FEF 25
K. FEF 50
Test Result Selection
 Statement:
(S4-1) Test result selection must be based on the recommendations set by the ATSERS-TFLFT1 (perfect consensus).
1. Report the highest FVC and FEV1 obtained.
2. The spirogram with the highest sum of FEV1 & FVC is chosen as the best trial.
3. The other parameters reported are obtained from the best trial.
Parts of the Report
 Statements:
(S5-1) In the spirometry report, there must be 3 sections for the interpretation of the
results (perfect consensus):
A. Technician’s Comments

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Measured weight F. when was the last intake (perfect consensus). (S7-5) The technician’s comments must state the patient’s smoking history particularly the pack years and the last time the patient smoked cigarettes (perfect consensus). (S7-2) The technician’s comments must state if the test done satisfies the ATS-ERSTFLFT1 reproducibility criteria. Date of procedure H.B. Phone number of laboratory Components of the Report Technician’s Comment  Statements: (S7-1) The report must contain a section for the technician’s comments. Final Interpretation (S5-2) Clinical correlation should not be incorporated in the final interpretation (good consensus). General Data  Statement: (S6-1) The spirometry report must contain a section on general data which contains the following information (very good consensus): A. 4 . (S7-3) The technician’s comments must state if conditions that may alter the results are present or not (perfect consensus). Interpreter’s comments C. Name of referring physician L. Room temperature at time of testing J. Measured height E. it must state which of the criteria was not satisfied (perfect consensus). Name of the laboratory M. It should state the indication for doing the test and the information about previous spirometry testing (very good consensus). Room atmospheric pressure at time of testing K. Name of patient B. (S7-4) The technician’s comments must state if the patient is on respiratory drug and if so. Time of procedure I. Gender of patient D. If not. Race of patient G. Age of patient C.

Semantics in Interpretation  Statement: (S8-1) In the interpretation of the results.  Patient has no history of previous spirometry testing. Interpretation Algorithm  Statement: (S9-1) Spirometry results must be interpreted based on the ATS-ERS-TFLFT2 suggested algorithm.  The patient took his Indacaterol 16 hours prior to test  The test done satisfied the reproducibility criteria set by the ATS-ERS. His last intake of cigarette smoke was 10 years ago. If the spirometry software is not capable. 26: 948-968. (S10-2) In cases of possible upper airway obstruction interpretation.  There were no conditions present in the check list which may alter the results of this study. Pellegrino. all of the trial flow volume loops must be reported. the report must use the phrase “ventilatory defect” (not lung defect or ventilatory pattern) (very good consensus). 1 Interpretative strategies for lung function tests: R. V.  The patient is a previous smoker who has a 20-pack year of smoking history. Viegi. Brusasco. Eur Respi Respi J 2005. Use of other Parameters Not in the ATS-ERS-TFLFT Interpretation Algorithm  Statements: (S10-1) The best trial flow volume (pre and post-bronchodilator if done) must be part of the spirometry report (perfect consensus). et al. reproducibility 5 . G.For example: Technician’s Comments:  A spirometry test was done to confirm the diagnosis of COPD. Fig.

4. it must be stated that these parameters are suggestive but not definitive. The FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). 7. 6. These are suggestive of obstructive (small airways disease) ventilatory defect. FEF25-75 and “other spirometry parameters”. 5. 4. 2. The FEV1/FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). 3. Example: Interpreter’s Comments: 1. The FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). 5. These are suggestive of a variable intra thoracic upper airway obstruction. Flow volume shows a plateau shape of the expiratory limb which is reproducible in 3 acceptable trials. The severity of the probable obstructive ventilatory defect is mild. (S10-3) Slowing down of the terminal portion of spirogram must be described as “exaggerated concavity in the distal portion of the expiratory limb of the flow volume loop”. Use of the term “compatible” is discouraged (very good consensus). (S10-4) In cases where in the interpretation uses any of the following: flow volume loop’s configuration. The spirometry test is of good quality based on standards set by the ATSERS.of the flow volume loop must be mentioned in the interpreter’s comments (very good consensus). There is no significant response to bronchodilator. The normality of the parameters is based on the Morris Polgar equation Final Interpretation: Probable variable intra-thoracic upper airway obstruction Please correlate results with patient’s clinical data. There is (exaggerated) concavity of the flow volume loop. based on the post bronchodilator FEV1 % predicted of 80. 2. The FEF 25-75 and FEF 75 are low (using 65% of the predicted as the lower limit of normality). The spirometry test is of good quality based on standards set by the ATSERS. 3. 6 . Use of the term “scooping” is discouraged (perfect consensus). 6. There is no significant response to bronchodilator. The normality of the parameters is based on the Morris Polgar equation Final Interpretation: Probable mild obstructive ventilatory defect Please correlate results with patient’s clinical data. The FEV1/FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). The MIF50/MEF50 is greater than one. Example: Interpreter’s Comments: 1.

values < 5th percentile of the predicted should be flagged down (either a change of color or marked).com/dataform3. Table 1: Grading of Severity of Ventilatory Defect Degree of Severity FEV1 % Predicted (post bronchodilator if available) Mild 70 & above Moderate 60-69 Moderately Severe 50-59 Severe 35-49 Very Severe <35 Lower Limit of Normality  Statements: (S12-1) In the spirometry report. If not available. (S12-3) If the spirometer software is capable (optional). the value corresponding to the 95% CI of the predicted value must be written in the report (very good consensus).html (good consensus). 7 . it should be stated in the interpreter’s comments what cut off value was used for the lower limit of normality (good consensus). the technician or interpreter should derive this value by manual computation or uses an online calculator at http://www. (S12-5) Cut off value for the lower limit of normality must be stated in the interpreter’s comments (very good consensus). If the spirometer software is not capable.Grading of Severity  Statements: (S11-1) Grading of severity must be based on the criteria set by ATS-ERS-TFLFT2 (perfect consensus). (S12-4) The cut-off value for the FEV1/FVC ratio should be <5th percentile of predicted value.dynamicmt. (S11-2) FEV1% predicted (post bronchodilator value if available) must be used both for obstructive and restrictive ventilatory defect (perfect consensus). all parameters must have corresponding (perfect consensus):  Actual value (in BTPS)  Predicted value  % Predicted (S12-2) If the spirometer software is capable (optional).

The spirometry test is of good quality based on standards set by the ATSERS. 6. If you want to assess the potential benefits of a different bronchodilator. 4. There is no significant response to bronchodilator. Re-assess lung function after 15 minutes. Procedure for Performance of Post-bronchodilator Study 1. 3. The spirometry test is of good quality based on standards set by the ATSERS. 4. 3. 5. Example 2: Interpreter’s Comments: 1.70 as the lower limit of normality).Example 1: Interpreter’s Comments: 1. The FEV1/FVC is normal (using a fixed cut-off value of 0. There is no significant response to bronchodilator. Assess lung function at baseline 2. Based on a low FEV1/FVC (using the 5th percentile of the predicted as the lower limit of normality). The normality of the parameters is based on the Morris Polgar equation Final Interpretation: Probable mild restrictive ventilatory defect with no significant response to bronchodilator. 6. The severity of the obstructive ventilatory defect is moderately severe. The FVC is low (using the 80% of the predicted as the lower limit of normality) which is probably due to a restrictive ventilatory defect or obstructive ventilatory defect (with residual volume hyperinflation). there is an obstructive ventilatory defect. Response to Bronchodilator  Statements: (S13-1) Performance of a post-bronchodilator study must be done based on the recommendations of ATS-ERS-TFLFT2 (perfect consensus). 2. based on the post bronchodilator FEV1 % predicted of 50. Administer salbutamol in four separate doses of 100 mg through a spacer 3. The normality of the parameters is based on the Morris Polgar equation Final Interpretation: Moderately severe obstructive ventilatory defect with no significant response to Bronchodilator Please correlate results with patient’s clinical data. The FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). use the same dose and the 8 . 2. 5. Please correlate results with patient’s clinical data. The severity of the restrictive ventilatory defect is mild. based on the post bronchodilator FEV1 % predicted of 70. We suggest requesting for a lung volume study to confirm presence of a restrictive ventilatory defect and rule out obstructive ventilatory defect.

Statement on Need for Additional Test  Statement: (S14-1) Interpretation must include suggestion/s on need for an additional test if warranted (very good consensus). response to bronchodilator must be labeled as “significant or no significant response to bronchodilator”. based on the post bronchodilator FEV1 % predicted of 50. 6. The normality of the parameters is based on the Morris Polgar equation Final Interpretation Moderately severe obstructive ventilatory defect with no significant response to bronchodilator Please correlate results with patient’s clinical data. (S13-4) To standardize the semantics. (S13-3) FEF 25-75 must not be used in the interpretation of the post bronchodilator response (perfect consensus). Criteria for Significant Response to Bronchodilator: An increase in FEV1 or FVC > 12% of control and > 200 mL.same route as used in clinical practice. there is an obstructive ventilatory defect. The severity of the obstructive ventilatory defect is moderately severe. 2. The use of other terms such as “poor or good response to bronchodilator” are discouraged (perfect consensus). 4. 3. (S15-2) A research study must be conducted by the Council of Diagnostics & Therapeutics to determine which reference equation is best fitted for the local Filipino population (very good consensus). The FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). 9 . Reference Equations  Statements: (S15-1) In the section on “Interpreter’s Comments” the report must state what reference equation was used in the interpretation of the results. There is no significant response to bronchodilator. Statement on the need to correlate clinically should be written in the section on “Final Interpretation” (very good consensus). Example: Interpreter’s Comments: 1. The wait time may be increased for some bronchodilators (S13-2) Interpretation of response to bronchodilator must be based on the criteria set by the ATS-ERS-TFLFT2 (perfect consensus). The spirometry test is of good quality based on standards set by the ATSERS. Based on a low FEV1/FVC (using the 5th percentile of the predicted as the lower limit of normality). 5.

The FEV1 is however reproducible and therefore the patient’s FEV1/FVC may overestimate the patient’s “real FEV1/FVC” 2. The severity of the obstructive ventilatory defect is moderately severe. obstructive ventilatory (with residual volume hyperinflation) or a concomitant restrictive ventilatory defect. Based on a low FEV1/FVC (using the 5th percentile of the predicted as the lower limit of normality). it must state the consequences of this deficiency in the parameters (very good consensus). 4. 2. The spirometry test is of good quality based on standards set by the ATSERS. (S16-2) If the test does not satisfy one of the acceptability or reproducibility criteria. This may be due to poor effort of the patient. the end of test criteria was not met. 3. The severity of the obstructive ventilatory defect is moderately severe. 5. 6. it must be stated if the test satisfies the reproducibility criteria set by the ATS-ERS-TFLFT1 or not (very good consensus). This may underestimate the “true FVC” of the patient. based on the post bronchodilator FEV1 % predicted of 50. 3. The normality of the parameters is based on the Morris Polgar equation Final Interpretation: Moderately severe obstructive ventilatory defect with no significant response to bronchodilator Please correlate results with patient’s clinical data. Despite several attempts. Interpreter’s Comments: 1. 10 . there is an obstructive ventilatory defect. 4. 5. 6.Comments on the Quality of the Test  Statements: (S16-1) In the reports section on “Interpreter’s Comments”. Based on a low FEV1/FVC (using the 5th percentile of the predicted as the lower limit of normality). based on the post bronchodilator FEV1 % predicted of 50. there is an obstructive ventilatory defect. The FVC is low (using the 5th percentile of the predicted as the lower limit of normality). There is no significant response to bronchodilator. There is no significant response to bronchodilator. The FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). Example1. The normality of the parameters is based on the Morris Polgar equation Example 2: Interpreter’s Comments: 1.

4. 5. 3. (S18-2) The first 3 rows of the tabular graph must be allotted for the most reliable spirometry parameter (MRSP) in the following order: {This order will facilitate the interpretation of the results based on the proposed algorithm of ATS-ERS-TFLFT2} (very good consensus). Flow volume shows a plateau shape of the expiratory limb which is reproducible in 3 acceptable trials. The FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). If the spirometry software is not capable.Components of the Report: Graphical Representation  Statements: (S17-1) The spirometry report must contain at least. Components of the Report: Results in Tabular Graph  Statements: (S18-1) The spirometry report must contain the measured parameters tabular graph (very good consensus). The FEV1/FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). PEFR B. (S17-2) The spirometry report must contain the flow volume loops of all trials if an interpretation of central airway obstruction (CAO) or upper airway obstruction (UAO) is made. These are suggestive of a variable intra thoracic upper airway obstruction. the reproducibility of the flow volume loop must be stated in the section on “Interpreter’s Comments” (very good consensus). FEF 25-75 11 . 2. The normality of the parameters is based on the Morris Polgar equation Final Interpretation: Probable variable intra-thoracic upper airway obstruction Please correlate results with patient’s clinical data. the pre (and post-bronchodilator if done) best trial flow volume loop/s (perfect consensus). The spirometry test is of good quality based on standards set by the ATSERS. The MIF50/MEF50 is greater than one. There is no significant response to bronchodilator. 6.  FEV1/FVC  FVC  FEV1 (S18-3) The succeeding rows maybe be allotted for the “other parameters” in the following order of priority (very good consensus): A. Example: Interpreter’s Comments: 1.

% Predicted (pre & post if done) E. Actual Values (pre & post if done) B. each parameter below the 5th percentile should be flagged down (good consensus). % Change from baseline of post-bronchodilator measurement (if the spirometry software is capable) (S18-5) In the tabular graph (if the spirometry software is capable). Based on a low FEV1/FVC (using the 5th percentile of the predicted as the lower limit of normality). D. Predicted C. Criteria for Severity C. FEF 75 MIF50/ MEF50 FEV1/FV6 MVV MIF 50 MEF 50 FEV6 FEF 25 FEF 50 (S18-4) In the tabular graph. Interpretation algorithm B. If the test did not satisfy the criteria. the interpreter must state the consequences of this deficiency (very good consensus). 12 . K. 2. 4. The severity of the obstructive ventilatory defect is moderately severe.C. Specifically it must apply. J. (S19-3) The IC section must also contain the basis for the interpretation. there is an obstructive ventilatory defect. 95% Confidence Interval Limit (if the spirometry software is capable) D. E. F. each parameter must have its corresponding (perfect consensus): A. based on the post bronchodilator FEV1 % predicted of 50. I. Response to Bronchodilator Example: Interpreter’s Comments: 1. (S19-2) The IC section must state if the test satisfied the ATS-ERS-TFLFT1 reproducibility criteria. H. The spirometry test is of good quality based on standards set by the ATS-ERS. G. Components of the Report: Interpreter’s Comments  Statements: (S19-1) The report must contain a section for the interpreter’s comments (IC) of the results (perfect consensus). The FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). 3. the ATS-ERS-TFLFT2 (very good consensus): A.

V. We suggest requesting for a lung volume study to confirm presence of a restrictive ventilatory defect and rule out obstructive ventilatory defect. Eur Respi Resepi J 2005. Viegi. Miller.philchest. Interpretative strategies for lung function tests: R. American Thoracic Society/ European Respiratory Society. There is no significant response to bronchodilator. 2. Brusasco.” Printed Name and Signature of the Interpreter/s Example Final Interpretation: Probable mild restrictive ventilatory defect with no significant response to bronchodilator. F. G. 6. J. Eur Respi Respi J 2005. NB: Full document and Executive Summary of the PCCP: Consensus Statement of Spirometry Testing can be down loaded at the PCCP website http://www. 26: 319-338. (S20-2) The FI must contain the following information (very good consensus):       Presence or absence of Obstructive Ventilatory Defect and severity if present Presence or absence of probable Restrictive Ventilatory Defect and severity if present Significant or No Significant Response to Bronchodilator if done Suggestion for specific additional test if indicated A generic sentence “Please correlate results with patient’s clinical data. 26: 948-968.5. 13 . Pellegrino. V. Hankinson. The normality of the parameters is based on the Morris Polgar equation Components of the Report: Final Interpretation  Statements: (S20-1) The spirometry report must contain a section for the final interpretation (FI) of the results (perfect consensus). Please correlate results with patient’s clinical data.org/ References: 1. Brusasco. American Thoracic Society/ European Respiratory Society.R. et al. et al. Stardization of Spirometry: M.

Appendices 14 .

2. There is no significant response bronchodilator response. The test done satisfied the reproducibility criteria set by the ATS-ERS. 6. The patient took his Indacaterol. The patient is a previous smoker who has a 20-pack year of smoking history. MD . There were no conditions present in the check list which may alter the results of this study. The severity of the obstructive ventilatory defect is moderately severe. 3. based on the post bronchodilator FEV1 % predicted of 50. Pedro Andres Weight (lbs): 135 Name of the laboratory: PCCP PFT Lab Race: Asian Phone number of laboratory: 723-30-80 Date: 11/20/09 Technician’s Comments: 1. 5. A spirometry test was done to confirm the diagnosis of COPD. 3. 16 hours prior to test. there is an obstructive ventilatory defect. SGD Charlie Go. 2. His last intake of cigarette smoke was 10 years ago. 5. 4. 4. Diego Tigas.APPENDIX A Name: Juan Cruz Time of procedure: 10:00 AM Age: 55 Room temperature: 30 Gender: Male Room atmospheric: 760 Height (inch): 64 Referring physician: Dr. The normality of the parameters is based on the Morris Polgar equation Final Interpretation: o Moderately severe obstructive ventilatory defect with no significant response to bronchodilator o Please correlate results with patient’s clinical data. The spirometry test is of good quality based on standards set by the ATS-ERS. RT Interpreter’s Comments: 1. 6. The FVC is normal (using the 5th percentile of the predicted as the lower limit of normality). Based on a low FEV1/FVC (using the 5th percentile of the predicted as the lower limit of normality). Patient has no history to previous spirometry testing.

Benedicto.RT Niño Jessielito N. Campomanes. MD. FPCCP Celeste Mae L. FPCCP Mary Leslee Tabi. Sablan. FPCCP Aileen M. MD. MD. Janeth T. FPCCP . FPCCP Luisito F. MD. MD. Samson. Bañares. De Guia. FPCP FPCCP Ricardo M. Javier. RT Dennis Teo. Siasoco. FPCCP Shirley C. MD Eloisa S. MD. FPCCP Raphael Ryan R. Chua. MD. MD. FPCCP Irenee Faustina J. Idolor. JR.MD. Tamayo. FPCCP Tim S. MD. Panganiban Chua.. FPCCP Apolonio G. David-Wang. Salonga.Philippine General Hospital University of Santo Tomas Hospital University of Perpetual-H. FPCP Myrna N. Tamse. FPCCP Rodolfo E. D. Luke’s Medical Center UP. MD. MD.Trinidad. FPCP Araceli Pascual. FPCCP Ma.APPENDIX B Institution Chinese General Hospital Lung Center of the Philippines Manila Doctors Hospital Philippine Heart Center St. MD. FPCCP Jubert P. MD. MD. Zantua. MD. FPCCP Ma. MD. Doydora. MD. Casiño. FPCCP Augusto S. Medical Center Veterans Memorial Medical Center Resource Person Eden D. Jr. MD. FPCCP Jose Edzel V. Bella R.

Patient preparation A. etc Inhaled long acting B agonist (LABA) (Salmeterol. formoterol) YES YES NO NO NA NA Oral bronchodilator (Salbutamol. dexamethasone) Antileukotrienes (Zafirllukast. methylprednisolone.g. Patient Details 1) 2) Name of patient Patient Identifier (e. montilukast) Acute IgE antagonist (omalizumab) 4) Time the above medications were last taken 5) History of following particular symptoms Chest or abdominal pain of any cause YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NA NA NA NA NA NA NA NA YES YES NO NO NA NA Dementia or confusional status 6) Position of the patient while performing the test YES YES NO NO NA NA 7) Use of restrictive clothing during test 8) History of doing particular activities immediately prior to test YES YES NO NO NA NA YES YES NO NO NA NA 9) Name of Referring physician 10) Vital signs of patient (BP. theophyllines Inhaled steroids (Flumetasone. albuterol. budesonide) Oral corticosteroids (prednisone. RR) prior to test B. CR. Patient Considerations 1) Symptoms of the patient 2) Smoking history - Duration of smoking (# of pack years) Smoking status (Current or former) # of years stopped 3) Medicines taken by patient - - - Oral or facial pain exacerbated by mouthpiece Stress maintenance Smoking within 1 hour Alcohol intake within 4 hours . formoterol. personal PIN) YES YES NO NO NA NA 3) 4) Gender of patient Age of patient YES YES NO NO NA NA 5) 6) Measured (not stated) Height Estimated Height of a patient with limb deformity YES YES NO NO NA NA 7) 8) Measured (not stated) weight Race of patient YES YES NO NO NA NA YES YES NO NO NA NA YES NO NA YES YES NO NO NA NA YES NO NA Short acting B agonist (SABA) salmeterol. Date of birth. DO YOU INCLUDE THE FOLLOWING DETAILS IN YOUR REPORT? I.APPENDIX C -1- PCCP Council on Diagnostics Descriptive Survey Form for Use and Reporting of Spirometry Name of Institution: ______________________________ Equipment used (type and model): ________________________________ Please encircle your appropriate response. (NA means not at all times).

Procedure Do you perform the following for recording Forced Vital Capacity: 1) Check the spirometer calibration 2) Explain the test 3) Prepare the subject a. Spirograms are free from artifacts st  Cough during 1 sec of exhalation  Glottis closure  Early termination  Submaximal effort  Leaks  Obstructed mouthpiece b. place mouthpiece in month and close lips around the mouthpiece c. Test results have good starts  Extrapolated volume <5% of FVC or 0.APPENDIX C - Performing vigorous exercise within 30 minutes Eating large meals within 2 hours II. Attack nose clip c. Have subject assume the correct posture b. whichever is greater c. Inhale completely and rapidly with a pause of <1 sect at >LC d. Check for reproducibility 6) Perform maneuver (open circuit method) a. Position of the mouthpiece d. Place mouthpiece in mouth and close lips around mouthpiece e.  Both criteria are met OR  A total of eight test have been performed  Subject can no longer continue d. to include a. No more than eight trials h.150 L of each other b. Exhale with maximal force 5) Maneuvers proper (closed-circuit method) a. Repeat for a minimum of 3 trials.150 L of each other  The 2 largest values of FEV1 must be within 0. If both criteria are meet. Attack nose clip. Methods A. Repeat for a minimum of 3 trials. Exhale maximally for <6 sec until no more air can be expelled while maintaining an upright posture e. Check for acceptability i. Check for reproducibility Do you check for the following? * Acceptability Criteria a. 3 satisfactory maneuver -2YES YES NO NO NA NA YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA YES YES NO NO NA NA YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA YES YES NO NO NA NA YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NA NA NA NA NA NA NA NA . Have subject assume the correct posture b. do you apply the following?  The 2 largest values of FVC must be within 0. No more than eight trials h. Check for acceptability i. Inhale rapidly and maximally c. After 3 acceptable spirograms have been obtained. Correct posture with head slightly elevated b. Coach vigorously g. Test shows satisfactory exhalation  Duration of ≥ 6s (3s for children) or a plateau in the volume-time curve or if the subject cannot continue to exhale Reproducibility Criteria a. Inhale completely and rapidly with a pause of <1 sec at TLC d. continue testing until …. Measure weight and height without shoes 4) Instruct and demonstrate the test to the subject. Repeat instructions as necessary f.. as a minimum. Coach vigorously g.15 L. Ask about: Smoking history Recent illness Medication use Reason for test b. If both criteria are not met. Save. Repeat instructions as necessary f. conclude test series c.

APPENDIX C Test Result Selection Do you select  The largest FVC. actual and % predicted of FEV1 Predicted. actual and % predicted of FVC Predicted. kindly state the correction factor that your laboratory is using? -3YES YES YES YES NO NO NO NO NA NA NA NA YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO NA NA NA NA NA NA NA NA NA NA YES NO NA YES YES YES YES YES NO NO NO NO NO NA NA NA NA NA YES YES NO NO NA NA YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO NA NA NA NA NA NA NA NA NA NA YES YES YES YES NO NO NO NO NA NA NA NA YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NA NA NA NA NA NA NA NA NA YES NO NA YES NO NA . PEF f. Roa. actual and % predicted of FEF25 Predicted. DLCO. FEV1 / FEV6 c. etc) Predicted. actual and % predicted of MEF 50 Predicted. Crapo. actual and % predicted of FEV1/FVC Predicted. FEF 25-75% e. Knudson. restrictive or mixed) Severity of ventilatory defect Response to bronchodilators Need for additional test (LV. and largest FEV1 of the same curve  The average of FVC and FEV1 even if the don’t come from the same curve  The maneuver with the largest sum of FVC and FEV1 Aside from FEV1. actual and % predicted of MIF 50 Predicted. actual and % predicted of FEF75 Predicted. actual and % predicted of FEF50 Predicted. FEV1 / VC d. actual and % predicted of FEV6 Predicted. MVV III. Interpretation and Reporting Are the following data included in you report? 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) Graphical representation of the best trial flow volume loop Graphical representation of all trials flow volume loop Graphical representation of best trials flow volume loop Graphical representation of all trials flow volume loop Super imposed (overlay) graphical representation of pre and post bronchodilator best trial Graphical representation of MVV maneuver of best trial Reference equation used in predicted values (ex. FVC and FEV1/FVC Do you routinely determine the following a. actual and % predicted of MIF 50/ MEF 50 MVV (error code) Tabulation of serial PTT (if with previous spirometry) Technologist comments Name of results interpreter In the interpretation of results are the comments on the following included Quality of the test Ventilatory pattern of flow volume loop Parameters which are abnormal Type of ventilatory defect (objective. post bronchodilator test serial testing) Clinical correlation with patients signs and symptoms Need to correlate with clinical data Please tick the appropriate box and fill up the blank if needed 1) Is the format of results released to patient different from what is interpreted by the physician? 2) What reference equation is your laboratory test result interpreter using for classifying the normality or abnormality of the measured parameters? If using a foreign equation. Maximal expiratory flow-volume loop g. actual and % predicted of FEF25-75 Predicted. FEV6 b.

MEF 50. Does your laboratory test interpreter follow this classification? Mild Moderate Moderately severe Severe Very severe YES NO NA YES NO NA YES NO NA YES NO NA YES NO NA YES NO NA YES NO NA FEV1 % Predicted > 70 60 – 69 50 – 59 35 – 49 < 39 IV. Quality Control A. MIF 50/MEF 50.7 [ ] < 80% of the predicted [ ] < percentile of the normal range 6) Aside from the FEV1. FEV1/PEF and FEV1/FEV6 [ ] If yes. kindly state the criteria your laboratory uses. FEV1/FEV6 as abnormal? [ ] < 0. does your laboratory test results interpreter use the “other parameters” routinely (example FEF 25-75. FVC and FEV1/FVC.APPENDIX C -4- [ ] We are using _____________________________________________ with a correction factor of ___________________________ 3) Was the decision of your laboratory interpreter in choosing your reference equation based on a local study that you had done in your institution? 4) Does your laboratory results interpreter use only one reference equation for all the measured parameters? If no. Which parameters? __________________________________ __________________________________________________________ 7) Are the criteria that your laboratory results interpreter uses for a positive (significant/good) response to a bronchodilator as follows: an increase in FEV1 or FVC ≥ 12% and 200 ml increase from baseline value? [ ] If not. routinely comments on the MVV? 9) The criteria for the classification of ventilatory dysfunction suggested by the ATS/ERS are tabulated below. we use the following reference equations __________________ _______________________________________________________________ _______________________________________________________________ ___________________________________________________ 5) When does your laboratory results interpreter classify the FEV1/FVC. Laboratory Details 1) Name of laboratory 2) Address of laboratory 3) Phone number of laboratory 4) Name of technician who conducted the test 5) Date of procedure 6) Time of procedure 7) Room temperature at time of testing 8) Room atmospheric pressure at time of testing 9) Indication for procedure 10) Possible order for undertaking lung function tests B. [ ] if no. kindly explain. Personal Qualifications 1) Who interprets the result a) Pulmonary fellow b) Pulmonary function laboratory director c) Pulmonary consultant on deck d) Patients’ attending pulmonary consultant PFT techniques and Procedures YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA . ____________ _______________________________________________________________ _______________________________________________________________ ___________________________________________________ 8) Does your laboratory test result interpreter. MIF 50.

quarterly.Record of results of evaluation and feedback provided by medical director .Safety 12) Are these manuals readily accessible? -5- YES YES YES YES YES YES NO NO NO NO NO NO NA NA NA NA NA NA YES NO NA YES YES YES YES NO NO NO NO NA NA NA NA YES YES NO NO NA NA YES NO NA YES NO NA YES YES NO NO NA NA YES NO NA YES NO NA YES NO NA YES YES NO NO NA NA YES YES YES YES YES NO NO NO NO NO NA NA NA NA NA V.Procedures .Equipments . monthly.Calibration procedure .Record of anomalous events involving either patients / subjects or technicians and result of subsequent evaluation and responses to event .Policies . others ) . weekly.Schedule of instrument calibration ( daily.APPENDIX C 2) Do you have a manual of procedure which contain the following: .Reference values source .Correction action required . Hygiene and Infection Control Do you perform the following precautions when performing spirometry? 1) Strict hand washing in between patients 2) Wearing gloves when handling body fluids 3) Require suspected potential active infection patients tested on an isolation room or negative pressure room 4) Prepare testing rooms with filtration or UV decontamination device 5) Require patients with suspected infection airborne disease to wear barrier protection 6) Require technicians to wear barrier protection 7) Flushing of air in a volume displacement spirometer at least 5x in between subjects YES YES YES YES YES NO NO NO NO NO NA NA NA NA NA YES YES NO NO NA NA YES YES NO NO NA NA . LV and diffusing capacity? 6) Is there a schedule for specific quality control procedures for each procedure done? 7) Are tolerance limits deprived for quality control checks for each procedure? 8) Is there a plan for corrective action when tolerance limits are exceeded? 9) Are standard subjects tested monthly? 10) Is there evidence of review by medical director or head of pulmonary laboratory? 11) Are manuals available for: .Calculations Criteria .Record of continuing education of personnel .Problems encountered with the system .Test performance procedures .Schedule and procedures for routine maintenance of all equipment in the facility .Action to be taken when “panic” values are observed 3) Do you have a record which documents the following? .Record of contact phonee numbers of appropriate maintenance personnel for each equipment used in the facility 4) Is there a protocol and frequency for calibration? 5) Is there a protocol for testing standard subjects monthly to supplement spirometry.Systems hardware and software upgrades .

APPENDIX C 8) Require potentially infected patients with airborne disease be tested at end of day or week 9) Require use of disposable mouthpiece of disinfection of tubing or any parts that come into direct contact with subjects 10) Do you use an open circuit technique? (open circuit means no rebreathing through mouthpiece of through breathing tube) If answer is YES: a) Do you change the mouthpiece between patients? b) Do you change the breathing tube between patients? 11) Do you use the closed circuit technique (closed circuit means subject rebreaths into the mouthpiece or through breathing tube and spirometer)? If answer is YES a) Do you dispose of or disinfect the mouthpiece between patients? b) Do you dispose of or disinfect the breathing tube between patients? 12) Do you use a flow sensing system in which no breathing tube is interposed between subject and device? a) Is the flow sensing element and interior tubing disinfected between patients? b) Is inspiration from the device avoided? 13) Do you use in-line bacterial filters? If answer is yes… a) Do you calibrate machine with the filters? b) Do you discard the filter after use on a single subject? c) Do you still do regular cleaning and disinfection despite the filters? -6YES NO NA YES NO NA YES NO NA YES YES YES NO NO NO NA NA NA YES YES YES NO NO NO NA NA NA YES NO NA YES YES YES YES YES YES NO NO NO NO NO NO NA NA NA NA NA NA Comments: _____________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____ Completed by: Noted by: ______________________________ Name and Position Laboratory ______________________________ Head of the Pulmonary .

Vmax Spectra 3 Equipment 4 Do you include the following details in your report (Are information about the following noted?) 5 Patient Preparation 6 Patient Details 7 1) Name of patient 8 2) Patient identifier 9 3) Gender of patient 10 4) Age of patient 11 5) Measured height 12 6) Estimated Height of a patient with limb deformity 13 7) Measured weight 14 8) Race of patient 15 9) Name of referring physician 16 10) Vitas signs of patient (BP. CR.Appendix D Tally of Responses to the Survey Questions 1 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry 2 SLMC CGH UST UP-PGH Vmax Jaeger. RR) prior to test 17 Patient Considerations 18 1) Symptoms of the patient 19 2) Smoking history 20 Duration of smoking (# of pack years) 21 Smoking status (current or former) 22 # of years stopped 23 3) Medicines taken by patient 24 Short acting B agonist 25 Inhaled long acting B agonist 26 Oral bronchodilator 27 Inhaled steroids 28 Oral corticosteroids 29 Antileukotrienes 30 Anti-IgE antagonist 31 4) Time the above medications were last taken 32 5) History of the following particular symptoms 33 Chest or abdominal pain of any cause LCP PHC VMMC UPHDMC MDH Viasys Vmax Spectra Microloop Vmax YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES Spectra Master Screen 22 YES YES YES YES YES YES YES YES YES NO YES YES YES YES YES YES YES YES YES NO YES YES YES YES YES YES YES YES YES NO YES YES YES YES YES YES YES YES YES NO YES YES YES YES YES YES YES YES YES NA YES YES YES NO YES YES YES NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO YES YES YES NO YES NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NA YES YES YES YES YES NO NO NO YES YES YES NO NO NO NO YES YES YES YES YES YES YES NO YES YES YES YES YES YES YES YES NO NA NA NA NA NA NA NA YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NA NO YES YES NO YES YES YES YES .

place mouthpiece in mouth and close lips YES YES YES YES around the mouthpiece 63 Inhale completely and rapidly with a pause of <1sec at TLC YES YES YES YES 64 Exhale maximally for <6secs until no more air can be expelled YES YES YES YES while maintaining an upright posture LCP NO NO NO NO NO PHC NO NO NO NO NO VMMC YES YES YES YES YES UPHDMC MDH YES YES YES YES YES YES YES NO YES NO NO NO NO NO NO NO NO NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES . to include Correct posture YES YES YES Inhale rapidly and maximally YES YES YES YES Position of the mouthpiece YES YES YES YES Exhale with maximal force YES YES YES YES 5) Maneuvers proper (closed-circuit method) Have subject assume the correct posture YES YES YES YES Attach nose clip.Appendix D Tally of Responses to the Survey Questions 1 2 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry SLMC CGH UST UP-PGH Oral or facial pain exacerbated by mouthpiece YES NO NO NO Stress incontinence NA NO NO NO Dementia or confusional status YES NO NO NO 6) Position of the patient while performing the test YES YES NO YES 7) Use of restrictive clothing during the test YES NO YES NO 8) History of doing particular activities immediately prior to test Smoking within 1 hour YES NO YES NO Alcohol intake within 4 hours YES NO YES NO Performing vigourous exercise within 30 mins YES NO YES YES Eating large meals within 2 hours YES NO YES NO Methods Procedure Do you perform the following for recording FVC 1) Check the spirometer calibration YES YES YES YES 2) Explain the test YES YES YES YES 3) Prepare the subject Ask about: Smoking history YES YES YES YES Recent illness YES YES YES YES Medication use YES YES YES YES Reason for test YES YES YES YES Measure weight and height without shoes YES YES YES YES 4) Instruct and demonstrate the test to the subject.

15L. No more than 8 trials YES YES YES YES Check for acceptability YES YES YES YES Check for reproducibility YES YES YES YES Do you check the following Acceptability Criteria a) Spirograms are free from artifacts Cough during 1st second of exhalation YES YES YES YES Glottis closure YES YES YES YES Early termination YES YES YES YES Submaximal effort YES YES YES YES Leaks YES YES YES YES Obstructive mouthpiece YES YES YES YES b) Test results have good starts Extrapolated volume <5% of FVC or 0.Appendix D Tally of Responses to the Survey Questions 1 2 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry SLMC CGH UST UP-PGH Repeat instructions as necessary YES YES YES YES Coach vigorously YES YES YES YES Repeat for a minimum of 3 trials. No more than 8 trials YES YES YES YES Check for acceptability YES YES YES YES Check for reproducibility YES YES YES YES 6) Perform maneuver (open circuit method) Have subject assume the correct posture YES YES YES YES Attach nose clip YES YES YES YES Inhale completely and rapidly with a pause of <1sec at TLC YES YES YES YES Place mouthpiece in mouth and close lips around mouthpiece YES YES YES YES Repeat instructions as necessary YES YES YES YES Coach vigorously YES YES YES YES Repeat for a minimum of 3 trials. do you apply the following? YES YES YES YES YES YES YES YES LCP YES YES YES YES YES PHC YES YES YES YES YES VMMC YES YES YES YES YES UPHDMC MDH YES YES YES YES YES YES YES YES YES YES NA NA NA NA NA NA NA NA NA NO NO NO NO NO NO NO NO NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NA YES YES YES YES NA YES YES YES YES YES YES YES YES . whichever is greater YES YES YES YES 91 c) Test shows satisfactory exhalation 92 Duration of >= 6 secs or a plateau in the volume-time curve or if the subject cannot continue to exhale 93 Reproducibility Criteria 94 a) After 3 acceptable spirograms have been obtained.

150L of each other b) If both criteria are met.150L of each other YES YES YES YES LCP YES PHC YES VMMC YES 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 The 2 largest values of FEV1 must be within 0.Appendix D Tally of Responses to the Survey Questions 1 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry 2 SLMC CGH UST UP-PGH 95 The 2 largest values of FVC must be within 0. continue testing until Both criteria are met OR A total of eight tests have been performed Subject can no longer continue d) Save. conclude test series c) If both criteria are not met. do you routinely determine the following a) FEV6 b) FEV1/FEV6 e) PEF g) MVV Are the following data included in your report? Are the following data included in your report? Are the following data included in your report? 1) Graphical representation of the best trial flow volume loop 2) Graphical representation of all trials flow volume loop 3) Graphical representation of best trials flow volume loop (SAME AS #1) 3) Superimposed (overlay) graphical representation of pre and post bronchodilator best trial UPHDMC MDH YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES * YES NA YES YES YES NO NO YES YES YES YES YES YES YES YES YES YES YES YES YES NO NO YES YES YES YES YES NO NO YES YES YES YES YES YES YES YES NA NO NO YES NO YES YES NO NO YES YES NO NO YES YES NO NO YES YES NO NO YES YES YES NO YES YES NO NO YES YES YES YES YES YES NO NO YES YES YES YES YES NO YES YES YES YES YES NO YES NO YES YES YES NO YES YES YES YES YES YES YES YES YES YES YES YES . do you routinely determine the following Aside from FEV1. as a minimum. FVC and FEV1/FVC. FVC and FEV1/FVC. 3 satisfactory maneuvers Test Result Selection Do you select (SELECT ONE ONLY) The largest FVC and the largest FEV1 of the same curve The average of FVC and FEV1 even if they don't come from the same curve The maneuver with the largest sum of FVC and FEV1 Aside from FEV1.

88 OF ABS VALUE ATS Morris Polgar YES NO . Roa. DLCO. actual and % predicted of FEF25-75 YES YES YES YES YES 129 14) Predicted. postbronchodilator test YES YES YES YES YES serial testing) 142 Clinical correlation with patients signs and symptoms YES YES NO YES NA 143 Need to correlate with clinical data YES YES YES YES NA 144 Please tick the appropriate box and fill up the blank if needed 145 1) Is the format of results released to patient different from what is NO NO NO NO NO interpreted by the physician? Morris ECCS Morris 146 2) What reference equation is your laboratory test result interpreter Morris Morris Polgar Polgar Polgar Polgar using for classifying the normality or abnormality of the measured parameters? If using a foreign equation. actual and % predicted of MEF50 YES YES NO NO NO 131 16) Predicted. 0. YES YES YES NO Knudson. actual and % predicted of FEF50 YES YES YES YES 127 12) Predicted. etc) 123 6) Predicted. actual and % predicted of MIF50 YES YES NO YES NO 130 15) Predicted. restrictive or mixed) YES YES YES YES YES 139 Severity of ventilatory defect YES YES YES YES YES 140 Resonse to bronchodilators YES YES YES YES YES 141 Need for additional test (LV. actual and % predicted of FVC YES YES YES YES YES 126 11) Predicted. kindly state the correction factor that your laboratory is using? PHC NO YES VMMC YES YES UPHDMC MDH NO YES YES YES YES YES NO NO YES NO NO NO NO NO YES YES YES YES YES YES NO NO NO NO NO YES YES YES YES YES YES NA NA NA NA NA YES YES YES YES YES YES NO NO NO NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO YES YES YES YES YES YES YES NO NO NO NO ATS. actual and % predicted of MIF50/MEF50 132 17) MVV (error code) YES YES YES YES YES 133 18) Tabulation of serial PTT (if with previous spirometry) NO NO NO NO YES 134 In the interpretation of results are the comments on the following included 135 Quality of test YES YES YES YES 136 Ventilatory pattern of flow volume loop YES YES YES YES YES 137 Parameters which are abnormal YES YES YES YES YES 138 Type of ventilatory defect (obstructive. actual and % predicted of FEF75 YES YES YES YES YES 128 13) Predicted. actual and % predicted of FEV1/FVC YES YES YES YES YES 124 7) Predicted. Crapo. GOLD NHANES. actual and % predicted of FEV1 YES YES YES YES YES 125 8) Predicted.Appendix D Tally of Responses to the Survey Questions 1 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry 2 SLMC CGH UST UP-PGH LCP 121 4) Graphical representation of MVV maneuver of best trial YES YES YES YES YES 122 5) Reference equation used in predicted values (ex.

7 YES 151 <80% of predicted 152 < percentile of the normal range 153 6) Aside from the FEV1. FEF75FEF25. FVC and FEV1/FVC. kindly explain.FEF25. does your laboratory YES test results interpreter use the "other parameters" routinely? 154 7) Is the criteria that your laboratory results interpreter uses for a positive response to a bronchodilator as follows: an increase in FEV1 or FVC >= 12% and 200 ml increase from baseline value 155 8) Does your laboratory test result interpreter routinely comment on the MVV? 156 8) Does your laboratory test result interpreter routinely comment on the MVV? 157 9) Is the criteria for the classification of ventilatory dysfunction suggested by the ATS/ERS followed by your laboratory test interpreter? 158 Quality Control 159 Laboratory Details 160 1) Name of laboratory 161 2) Address of laboratory 162 3) Phone number of laboratory 163 4) Name of techinican who conducted the test 164 5) Date of procedure YES YES (0. 85. 200-1200 FEF75 YES YES YES YES UPHDMC MDH NO NO YES YES YES YES NO NO YES YES YES NO YES YES YES YES YES NO NO NA NO NO NA YES YES YES NO NO NA NO NO NA YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO YES YES . FEF FEF50.FEF 25. 75. FEV1/FEV6 as abnormal? 150 <0.FEF 2575 75 75. 149 5) When does your laboratory results interpreter classify the FEV1/FVC.Appendix D Tally of Responses to the Survey Questions 1 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry 2 SLMC CGH UST UP-PGH NO NA NO YES 147 3) Was the decision of your laboratory interpreter in choosing your reference equation based on a local study that you had done in your institution? 148 4) Does your laboratory results interpreter use only one reference YES YES YES YES equation for all the measured parameters? If no.75) YES LCP NO PHC NO VMMC NO YES YES YES YES YES YES YES YES YES FEF25. PEF.

Appendix D Tally of Responses to the Survey Questions 1 2 165 166 167 168 169 170 171 172 173 174 175 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry SLMC CGH UST UP-PGH 6) Time of procedure YES YES YES YES 7) Room temperature at time of testing YES YES YES YES 8) Room atmospheric pressure at time of testing YES YES YES YES 10) Possible sequence for undertaking lung function tests YES YES YES 1) Who interprets the result Pulmonary fellow YES YES YES YES Pulmonary function laboratory director NA NO YES Pulmonary consultant on deck YES YES YES YES Patient's attending pulmonary consultant YES YES YES YES PFT Techniques and Procedures 2) Do you have a manual of procedure which contain the following 176 Calibration procedure 177 Test performance procedures 178 Calculations 179 Criteria 180 Reference values source 181 Action to be taken when "panic" values are observed 182 3) Do you have a record which documents the following 183 Schedule of instrument calibration 184 Problems encountered with the system 185 Correction action required 186 Systems hardware and software upgrades 187 Record of anomalous events involving either patients/subjects or technicians and result of subsequent evaluation and responses to event 188 Record of continuing eduction of personnel 189 Record of results of evaluation and feedback provided by medical director 190 Schedule and procedures for routine maintenance of all equipment in the facility 191 Record of contact phone numbers of appropriate maintenance of all equipment in the facility LCP YES NO NO YES PHC NO NO NO NO VMMC YES YES NA YES UPHDMC MDH YES YES YES YES NO YES YES NO YES NO YES YES NO YES NO YES YES YES YES YES NA YES YES YES YES YES NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO YES YES YES YES YES NO YES YES YES NO YES NO NO YES NO NO YES YES YES YES YES YES YES YES YES YES NO NO NO YES NO NO YES YES YES YES YES NO YES NO YES NA YES YES YES YES NO YES YES NO YES YES YES YES YES YES YES YES YES YES YES YES .

Appendix D Tally of Responses to the Survey Questions 1 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry 2 SLMC CGH UST UP-PGH 192 4) Is there a protocol and frequency for calibration? YES YES YES YES 193 5) Is there a protocol for testing standard subjects monthly to YES YES NO YES supplement spirometry. LV and diffusing capacity? 194 6) Is there a schedule for specific quality control procedures for YES YES NO YES each procedure done? 195 7) Are tolerance limits derived for quality control checks for each YES YES NO YES procedure? 196 8) Is there a plan for corrective action when tolerance limits are YES YES NO YES exceeded? 197 9) Are standard subjects tested monthly? YES NO YES YES 198 10) Is there evidence of review by medical director or head of NO YES NO YES pulmonary laboratory? 199 11) Are manuals available for 200 Equipments YES YES YES YES 201 Policies YES YES YES YES 202 Procedures YES YES YES YES 203 Safety YES YES YES YES 204 12) Are these manuals readily accessible? YES YES YES YES 205 Hygine and Infection Control 206 Do you perform the following precautions when performing spirometry? 207 1) Strict handwashing in between patients YES YES YES YES 208 2) Wearing gloves by the technician when handling body fluids and YES YES YES YES equipment 209 3) Require suspected potential active infection patients tested on an YES NO NO YES isolation room or negative pressure room 210 4) Prepare testing rooms with filtration or UV decontamination NO NO NO device 211 5) Require patients with suspected infectious airborne disease to YES NO NO YES wear barrier protection 212 6) Require technicians to wear barrier protection YES NO YES YES 213 7) Flushing of air in a volume displacement spirometer at least 5x in YES NO NO NO between subjects LCP YES YES PHC YES NA VMMC YES YES UPHDMC MDH NA YES NA YES YES NO YES NA YES YES YES NO NA YES YES YES NO NA YES NA YES NO NO YES YES NO NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NA NO NA YES YES NO NO NO NA YES YES YES NA NA YES YES YES YES YES YES NO YES NA YES YES .

YES YES YES YES 226 Do you calibrate machine with the filters? NO NO NO YES 227 Do you discard the filter after use on a single patient? YES YES YES NO 228 Do you still do regular cleaning and disinfection despite the YES YES YES YES filters? LCP YES PHC NA VMMC NA UPHDMC MDH NA YES YES YES YES NO NO YES YES NO YES NO YES YES YES YES YES NO YES YES NO YES YES YES NO YES YES YES YES YES YES YES YES NO YES NO YES YES YES YES YES YES NA YES YES YES YES YES YES YES YES YES YES YES YES NA NA YES YES YES YES YES YES .Appendix D Tally of Responses to the Survey Questions 1 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry 2 SLMC CGH UST UP-PGH 214 8) Require potentially infected patients with airborne disease to be YES NO YES YES tested at the end of the day or week 215 9) Require use of disposable mouthpiece of disinfection of tubing or YES YES YES YES any parts that come into direct contact with subjects 216 10) Do you use an open circuit technique? If yes. YES YES 217 Do you change the mouthpiece between patients? YES YES YES YES 218 Do you change the breathing tube between patients? NO NO YES NO 219 11) Do you use the closed circuit technique? If yes. YES YES 220 Do you dispose of or disinfect the mouthpiece between YES YES YES YES patients? 221 Do you dispose of or disinfect the breathing tube between NO NO NO NO patients? 222 12) Do you use a flow sensing system in which no breathing tube is YES NO YES interposed between subject and device? 223 Is the flow sensing element and interior tubing disinfected NO YES NO YES between patients? 224 Is inspiration from the device avoided? YES YES NO NO 225 13) Do you use in-line bacterial filters? If yes.

to include Correct posture Inhale rapidly and maximally Position of the mouthpiece Exhale with maximal force 5) Maneuvers proper (closed-circuit method) Have subject assume the correct posture Attach nose clip.Appendix E Tally of Responses to the Survey Questions Rearranged 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 Parameter Do you perform the following for recording FVC 1) Check the spirometer calibration 2) Explain the test 3) Prepare the subject Ask about: Smoking history Recent illness Medication use Reason for test Measure weight and height without shoes 4) Instruct and demonstrate the test to the subject. No more than 8 trials SLMC CGH UST UP-PGH LCP PHC VMMC UPHDMC MDH YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NA NA NA NA NA NA NA NO NO NO NO NO NO NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES . No more than 8 trials Check for acceptability Check for reproducibility 6) Perform maneuver (open circuit method) Have subject assume the correct posture Attach nose clip Inhale completely and rapidly with a pause of <1sec at TLC Place mouthpiece in mouth and close lips around mouthpiece Repeat instructions as necessary Coach vigorously Repeat for a minimum of 3 trials. place mouthpiece in mouth and close lips around the mouthpiece Inhale completely and rapidly with a pause of <1sec at TLC Exhale maximally for <6secs until no more air can be expelled while maintaining an upright posture Repeat instructions as necessary Coach vigorously Repeat for a minimum of 3 trials.

do you apply the following? The 2 largest values of FVC must be within 0. continue testing until Both criteria are met OR A total of eight tests have been performed Subject can no longer continue d) Save.150L of each other The 2 largest values of FEV1 must be within 0.15L.Appendix E Tally of Responses to the Survey Questions Rearranged 1 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 Parameter Check for acceptability Check for reproducibility Do you check the following Acceptability Criteria a) Spirograms are free from artifacts Cough during 1st second of exhalation Glottis closure Early termination Submaximal effort Leaks Obstructive mouthpiece b) Test results have good starts Extrapolated volume <5% of FVC or 0. whichever is greater c) Test shows satisfactory exhalation Duration of >= 6 secs or a plateau in the volume-time curve or if the subject cannot continue to exhale Reproducibility Criteria a) After 3 acceptable spirograms have been obtained.150L of each other b) If both criteria are met. 3 satisfactory maneuvers 1) Who interprets the result Pulmonary fellow Pulmonary consultant on deck Pulmonary function laboratory director Do you perform the following for recording FVC SLMC CGH YES YES YES YES UST YES YES UP-PGH LCP YES NA YES NA PHC NO NO VMMC YES YES UPHDMC MDH YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NA NA YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES * YES NA YES YES YES NO NO YES YES YES YES YES YES YES YES YES YES YES NA YES YES NO YES YES YES YES YES YES YES NO YES YES NO YES YES YES YES YES NA YES YES YES . as a minimum. conclude test series c) If both criteria are not met.

Appendix E Tally of Responses to the Survey Questions Rearranged
1
65
66
67
68
69

Parameter
1) Check the spirometer calibration
3) Do you have a record which documents the following
Schedule of instrument calibration
Problems encountered with the system
Record of anomalous events involving either patients/subjects or
technicians and result of subsequent evaluation and responses to event

70

Record of results of evaluation and feedback provided by medical
director

71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91

Are the following data included in your report?
6) Predicted, actual and % predicted of FEV1/FVC
8) Predicted, actual and % predicted of FVC
7) Predicted, actual and % predicted of FEV1
13) Predicted, actual and % predicted of FEF25-75
Aside from FEV1, FVC and FEV1/FVC, do you routinely determine the
following
e) PEF
g) MVV
Are the following data included in your report?
11) Predicted, actual and % predicted of FEF50
12) Predicted, actual and % predicted of FEF75
Aside from FEV1, FVC and FEV1/FVC, do you routinely determine the
following
14) Predicted, actual and % predicted of MIF50
15) Predicted, actual and % predicted of MEF50
16) Predicted, actual and % predicted of MIF50/MEF50
a) FEV6
b) FEV1/FEV6

SLMC CGH UST
YES YES
YES

UP-PGH LCP
YES
YES

PHC
YES

VMMC
YES

UPHDMC MDH
YES
YES

YES
YES
YES

YES
YES
YES

YES
YES
NO

YES
YES
YES

YES
YES
NO

YES
YES
YES

NO
NO
NO

YES
YES
YES

YES
YES
YES

NO

YES

NO

YES

YES

NO

NO

NA

YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

YES

NO
NO

YES
YES

YES
YES

YES
YES

YES
YES

YES
YES

NO
NO

YES
NO

NO
NO

NO
NO

NO
NO

NO
NO

NO
NO

NO
NO
NO
NO
NO

NA
NA
NA
YES
YES

NO
NO

YES
NO

NO
NO
NO
YES
NO

NO
NO

Appendix E Tally of Responses to the Survey Questions Rearranged
1
92

93
94
95
96
97

Parameter
SLMC CGH
6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory test YES YES
results interpreter use the "other parameters" routinely?

Test Result Selection
Do you select (SELECT ONE ONLY)
The largest FVC and the largest FEV1 of the same curve
The average of FVC and FEV1 even if they don't come from the
same curve
The maneuver with the largest sum of FVC and FEV1

UST
NO

UP-PGH LCP
PHC
VMMC
FEF25- FEF 25- FEF25- FEF 2575
75,
75, PEF, 75
FEF75FEF25,
85, FEF
FEF50,
200-1200
FEF75

UPHDMC MDH
NO
NO

YES

YES
YES

YES
YES

NO
NO

YES
YES

YES
YES

YES
NO

NO
YES

98
YES
99
100 6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory test YES
results interpreter use the "other parameters" routinely?

YES

YES

YES

NA

NO

NO

YES

NO

FEF25- FEF 2575, PEF, 75
FEF25,
FEF50,
FEF75

FEF25- FEF 2575
75,
FEF7585, FEF
200-1200

NO

NO

YES

YES

YES

YES

YES

NO

YES

YES

YES

YES
YES

YES
NO

YES
YES

YES
YES

YES
NO

YES
NO

YES
YES

YES
NO

YES
YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

101
102 In the interpretation of results are the comments on the following
included
103
Ventilatory pattern of flow volume loop
104
105 Are the following data included in your report?
106 1) Graphical representation of the best trial flow volume loop
107 2) Graphical representation of all trials flow volume loop
108
109 In the interpretation of results are the comments on the following
included
110 9) Is the criteria for the classification of ventilatory dysfunction
suggested by the ATS/ERS followed by your laboratory test interpreter?
111

YES
YES
YES

Appendix E Tally of Responses to the Survey Questions Rearranged
1
Parameter
112 5) When does your laboratory results interpreter classify the
FEV1/FVC, FEV1/FEV6 as abnormal?
113
<0.7
114
<80% of predicted
115
< percentile of the normal range
116
117 7) Is the criteria that your laboratory results interpreter uses for a
positive response to a bronchodilator as follows: an increase in FEV1 or
FVC >= 12% and 200 ml increase from baseline value
118
119 In the interpretation of results are the comments on the following
included
120
Need for additional test (LV, DLCO, postbronchodilator test serial
testing)
121
122 2) What reference equation is your laboratory test result interpreter
using for classifying the normality or abnormality of the measured
parameters? If using a foreign equation, kindly state the correction
factor that your laboratory is using?
123 3) Was the decision of your laboratory interpreter in choosing your
reference equation based on a local study that you had done in your
institution?
124
125 In the interpretation of results are the comments on the following
included
126
Quality of test
127
128 Do you include the following details in your report (Are information
about the following noted?)
129 Patient Details
130 1) Name of patient
131 2) Patient identifier
132 3) Gender of patient
133 4) Age of patient

SLMC CGH

UST

PHC

VMMC

UPHDMC MDH

YES

YES
YES

YES (0.75) YES

YES
YES
YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

Morris Morris Morris
Polgar Polgar Polgar

ECCS

Morris
Polgar

ATS,
GOLD

NO

NO

YES
YES
YES
YES

UP-PGH LCP

NA

NO

YES

NO

NO

NHANES, ATS
0.88 OF
ABS
VALUE
NO
NO

YES

YES

YES

YES

NO

YES

YES

YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES
YES
YES

YES
YES

Morris
Polgar

CR. RR) prior to test Patient Considerations 1) Symptoms of the patient 2) Smoking history Duration of smoking (# of pack years) Smoking status (current or former) # of years stopped 3) Medicines taken by patient Short acting B agonist Inhaled long acting B agonist Oral bronchodilator Inhaled steroids Oral corticosteroids Antileukotrienes Anti-IgE antagonist 4) Time the above medications were last taken 5) History of the following particular symptoms Chest or abdominal pain of any cause Oral or facial pain exacerbated by mouthpiece Stress incontinence Dementia or confusional status 6) Position of the patient while performing the test 7) Use of restrictive clothing during the test 8) History of doing particular activities immediately prior to test Smoking within 1 hour Alcohol intake within 4 hours Performing vigourous exercise within 30 mins Eating large meals within 2 hours SLMC YES YES YES YES YES NO CGH YES YES YES YES YES NO UST YES YES YES YES YES NO UP-PGH YES YES YES YES YES NO LCP YES YES YES YES YES NA PHC YES NO YES YES YES NO VMMC YES YES YES YES YES YES UPHDMC YES YES YES YES YES YES MDH YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO YES YES YES NO YES NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NA YES YES YES YES YES NO NO NO YES YES YES NO NO NO NO YES YES YES YES YES YES YES NO YES YES YES YES YES YES YES YES NO NA NA NA NA NA NA NA YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO NA YES NA YES YES YES NO NO NO NO YES NO YES NO NO NO NO YES YES NO NO NO YES NO NO NO NO NO NO NO YES NO NO NO NO NO YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES NO NO YES YES YES YES NO NO NO NO YES YES YES YES NO NO YES NO NO NO NO NO NO NO NO NO YES YES YES YES YES YES YES YES YES YES YES YES .Appendix E Tally of Responses to the Survey Questions Rearranged 1 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 Parameter 5) Measured height 6) Estimated Height of a patient with limb deformity 7) Measured weight 8) Race of patient 9) Name of referring physician 10) Vitas signs of patient (BP.

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

Appendix F: Sample PFT reports from PCCP PFTI .

– 1 neb of ventolin was given for post bronchodilator test  Interpretation – Normal FEV1/FVC and FEV1. – Nebulization of 5 cc distilled water was given for modified bronchoprovocation test  Interpretation – Normal spirometry study – Bronchoprovocation showed no reduction in post FEV1 values  Probable Restrictive Ventilatory Defect  Comments – Patient performed the test maximally on standing position.APPENDIX G Terms Used by PCCP-PFTI in the Interpretation of Spirometry Results 1 Chinese General Hospital  Normal  Comments: – Patient performed the test maximally on standing position. – Please correlate clinically. Suggest lung volume studies if clinically indicated. – There is no significant response to bronchodilator. FEV1/ FVC ratio is normal – There is no acute bronchodilator response – Able to do 6 seconds test. Manila Doctors Medical Center  Normal  Comments: – FVC and FV1 are normal. – 1 neb of ventolin was given for post bronchodilator test  Interpretation – There is moderate obstructive lung defect with significant response to bronchodilator. Suggest lung volume studies if clinically indicated.  Interpretation: – PFT suggest normal ventilatory pattern – There is no significant bronchodilator response 3 . MVV is normal. – FVC is reduced probably due to obstructive defect and/ or restrictive lung defect.  Obstructive with probable Restrictive Ventilatory Defect  Comments and Interpretation – Spirometry shows severe obstructive ventilatory pattern with significant bronchodilator response with moderate restrictive ventilatory pattern. – Decreased FVC.  Suggest post bronchodilator and lung volume studies. 2 Lung Center of the Philippines  Normal  Comments and Interpretation – Normal spirometry  Obstructive Ventilatory Defect  Comments and Interpretation – Spirometry shows a severe obstructive ventilatory pattern with significant response to bronchodilator  Probable Restrictive Ventilatory Defect  Comments and Interpretation – Spirometry shows a mild restrictive ventilatory pattern.  Obstructive with probable Restrictive Ventilatory Defect  Comments – Patient performed the test maximally on standing position. – There is probable restriction.

– Post-bronchodilator study showed a 22% improvement in the FEF25-75 – Please correlate clinically  Obstructive with probable Restrictive Ventilatory Defect  Comments and Interpretation – There is moderate obstructive lung defect with significant response to bronchodilator. FEV1. – There is no significant acute bronchodilator response noted.  Interpretation – PFT showed severe obstructive ventilatory pattern with significant bronchodilator response. FEV1 and FEV1/FVC ratio are decreased. FEV1. – FVC is reduced probably due to underlying obstructive lung defect and or concomitant restrictive defect. University of Philippines. Luke’s Medical Center Quezon City  Normal  Comments & Interpretation – Normal Spirometric Study  Obstructive Ventilatory Defect  Comments & Interpretation – There is a mild obstructive lung defect – Suggest post-bronchodilator study if clinically indicated.  Interpretation – PFY is consistent with moderate restrictive ventilatory pattern with normal DLCO. St. Normal MVV – No airway resistance exam done. DLCO is decreased – There is significant bronchodilator response. FVC. – There is no acute bronchodilator response  Interpretation & Recommendation – Normal Spirometry Findings  Obstructive Ventilatory Defect  Comments and Findings – The FEV1/FVC. MVV and flow rates are within normal range.Philippine General Hospital  Normal  Comments and Findings – The FEV1/FVC. – In view of the smoking history of the patient.  Probable Restrictive Ventilatory Defect  Comments – Spirometry shows low FEB1 and FVC while FEV1/FVC ratio. – There is scooping of the expiratory curve – There is an acute bronchodilator response  Interpretation & Recommendation – Spirometric findings are consistent with a severe obstructive ventilatory defect with acute bronchodilator response. – Lung volume shows low TLC and RV. . DLCO is normal.  Probable Restrictive Ventilatory Defect  Comments & Interpretation – There is no obstructive lung defect. he maybe labeled at risk for COPD. – There is mild diffusion limitation to CO. – Please correlate clinically. – Suggest lung volume study if clinically indicated. FEF 25-75.APPENDIX G 4 5  Obstructive Ventilatory Defect  Comments – FVC. FEF 25-75 values are within normal limits. FVC values are low. – There is no scooping of the expiratory curve. Suggest lung volume study if clinically indicated.

– Post-bronchodilator study showed no significant reversibility. – There is no scooping in the expiratory curve. FVC has no significant improvement after bronchodilator administration. FEV1 and FVC are low indicative of severe obstructive lung defect. – FVC is reduced probably due to underlying obstructive defect and/ or concomitant restrictive lung defect. FVC is normal. – Please correlate clinically. – There is no significant acute bronchodilator effect. FEV1 and FVC are reduced indicative of mild restriction of the volume excursion of the lung. Philippine Heart Center  Normal  Comments & Interpretation – Normal spirometry study  Obstructive Ventilatory Defect (To be submitted)  Probable Restrictive Ventilatory Defect  Comments & Interpretation – FEV1/FVC ratio is normal. Suggest lung volume studies if clinical indicated.  Interpretation & Recommendation – Spirometric findings are consistent with a moderate restriction in the volume expansion of the lungs.APPENDIX G 6 7 8  Probable Restrictive Ventilatory Defect  Comments and Findings – The FEV1/FVC is normal – FEV1& FVC values are low. University of Perpetual Health Medical Center  Normal  Interpretation – Normal Spirometry  Obstructive Ventilatory Defect  Interpretation – Severe obstructive ventilatory pattern with significant post bronchodilator response.  Obstructive with probable Restrictive Ventilatory Defect  Comments & Interpretation – FEV1/FVC ratio. FEV1 is normal. – FEV1 has no significant improvement after bronchodilator administration.  Probable Restrictive Ventilatory Defect  Interpretation – Restrictive Ventilatory Pattern – Please Correlate Clinically – Suggest Body Phlethysmography  Obstructive with probable Restrictive Ventilatory Defect  Interpretation – Combined restrictive and obstructive ventilatory pattern due to low FVC and FEF25-75 in the background of inadequate of expiratory maneuver – Suggest body phlethysmography. – Suggest total lung volume studies with DLCO and or clinical correlation for further evaluation especially if a restrictive lung disease secondary to ILD is considered. Veterans Memorial Medical Center  Normal  Comments & Interpretation – FEV1/FVC is normal. – Normal Spirometric Studies .

Based on the 12% (120ml) change in FEV1.  Obstructive with probable Restrictive Ventilatory Defect – Based on the low FEV1/FVC and FEV1. FVC has no significant improvement after bronchodilator administration. FVC is low. FVC there is no ventilatory defect – The predicted values are based on Morris and Polgar. Kindly correlate clinically. FEV1 has significant improvement after bronchodilator administration. – These findings are suggestive of a restrictive ventilatory impairment – For lung volume studies if clinically indicated University of Santo Tomas Hospital  Normal  Interpretation – Based on FEV1/FVC.  Obstructive Ventilatory Defect  Interpretation – Based on a low FEV1/FVC and FEV1. FVC has no significant improvement after post bronchodilator studies. Kindly correlate with clinical data. Kindly correlate with clinical data.  Probable Restrictive Ventilatory Defect  Comments & Interpretation – FEV/FVC is normal. there is a poor response to bronchodilator. – Based on a 51% change in FEV1. – The predicted values are based on Morris Polgar. there is a severe obstructive ventilatory defect. FEV1 is low and there is an exaggerated concavity in the distal portion of the expiratory limb.APPENDIX G 9  Obstructive Ventilatory Defect  Comments & Interpretation – FEV1/FVC is low. For verification. FEV1 has no significant improvement after bronchodilator administration. FEV1 is normal. Post bronchodilator study showed a significant degree of reversibility.  Probable Restrictive Ventilatory Defect  Interpretations – Based on the FEV1/FVC ratio there is no obstructive ventilatory defect. Kindly correlate clinically. These findings are suggestive of Moderately Obstructive Ventilatory Defect. . – FVC is low. The predicted values are based on Morris Polgar. there is a good response to bronchodilator – The predicted values are based on Morris and Polgar. The FVC is low which maybe due to a concomitant restrictive ventilatory defect or RV hyperinflation. To verify the cause of the low FVC we suggest a lung volume study. – The FVC is low which maybe due to a restrictive ventilatory defect. we suggest lung volume studies. there is a moderately severe obstructive ventilatory defect. FEV1.

Most Reliable Spirometry Parameters (MRSP): refers to the spirometry parameters used in the American Thoracic Society – European Respiratory Society Task Force on Lung Function Testing suggested algorithm for the interpretation of lung function testing. These parameters are FEV1/FVC. These parameters are FEV1/FVC.APPENDIX H Definition of Terms/ Abbreviations Definition of Terms       Closed Circuit Method Spirometry Testing: method of conducting spirometry wherein the volume is measured indirectly by a device which either measure a pressure drop across a fixed resistance or flow via means of a propeller. FEV1 and FVC. bell. Spirometry with post-bronchodilator study: a type of spirometry testing wherein a pre-bronchodilator and post bronchodilator study is done. Open Circuit Method Spirometry Testing: method of conducting spirometry wherein the volume is measured by a wedge bellows. water seal or rolling seal cylinder/ piston. Simple spirometry: a type spirometry testing wherein only a prebronchodilator study is done. Abbreviations                   ATS-ERS-TFLFT: American Thoracic Society Task Force on Lung Function Testing CAO: Central airway obstruction DATS: Philippine College of Chest Physician Council on Diagnostics and Therapeutic FEV1: Forced expiratory volume in one second FEF 25-75: Mean forced expiratory flow between 25% and 75% of FVC FEF50: Instantaneous expiratory flow when 50% of the FVC has been expired FEF75: Instantaneous expiratory flow when 75% of the FVC has been expired FVC: Forced vital capacity FVC6: Forced expiratory volume in 6 seconds MIF50: Maximum inspiratory flow at 50% of the FVC MEF50: Maximum expiratory flow at 50% of the FVC MRSP: Most reliable spirometry parameters MVV: Maximum voluntary ventilation OSP: Other spirometry parameters PCCP PFTI: Philippine College of Chest Physicians Pulmonary Fellowship Training Institution PEF: Peak expiratory flow PEFR: Peak expiratory flow rate UAO: Upper airway obstruction . Other Spirometry Parameters (OSP): refers the spirometry parameters not used in the American Thoracic Society – European Respiratory Society Task Force on Lung Function Testing suggested algorithm for the interpretation of lung function testing. FEV1 and FVC.

15 L.150 L of each other  The two largest values of FEV1 are within 0. this includes  Proper posture  Rapid and complete inhalation  Proper use of mouthpiece  Rapid and maximally forceful expiration Perform maneuver  Assist the to assume the correct posture  Attach the nose clip  Place the mouthpiece and ask patient to close lips around the mouthpiece  Ask the patient to inhale completely and rapidly with a pause of 0.Appendix I Procedural Steps for Spirometry testing (using closed circuit method) o o o o o o o o o o o Calibrate the spirometer and record Explain the test Secure a written consent Answer the PCCP Spirometry Testing Information Sheet (Appendix J) Measure weight and height without shoes Wash hands Instruct and demonstrate the test to the subject.150 L of each other Spirogram Acceptability Criteria o It is free from artifacts  Cough during the first second of exhalation  Glottis closure that influences the measurement  Early termination or cut-off  Effort that is not maximal throughout  Leak  Obstructed mouthpiece o It shows a good start  Extrapolated volume 0. coaching vigorously  Repeat the test until any of the following  The reproducibility criteria is met (see below)  The patient cannot continue  A maximum of 8 maneuvers is obtained  Save at least the best 3 spirograms Completes the answering of the PCCP Spirometry Testing information sheet Spirogram Reproducibility Criteria  There is at least 3 acceptable spirogram  The two largest values of FVC are within 0.1 s at TLC  Instruct the patient to exhale maximally until no more air can be expelled while maintaining an upright posture  Repeat instructions as necessary. whichever is greater o It shows satisfactory exhalation  Duration of 6 seconds  A plateau in the volume–time curve .5% of FVC or 0.

Room temperature: __________Atmospheric pressure: _________ 6. Conditions that may influence the results (Place a check if present or x if absent)       Chest or abdominal pain of any cause Oral or facial pain exacerbated by mouthpiece Stress incontinence Dementia or confusional status Non standing position of the patient while performing the test    Use of restrictive clothing during the test Alcohol/ Caffeinated drink intake within 4 hours prior to testing Vigorous exercise within 30 mins prior to testing Eating large meals within 2 hours prior to testing 11. Working Diagnosis/ Reason for Testing: ____________________ 9. Name of referring physician: __________________________ 7. Smoking History: Status (Never. Date of procedure: _________________Time of procedure: ___________ 5. Current or Previous): __________________ Pack years: __________________ Last Intake: __________________ 8. Were the ATS/ERS reproducible criteria satisfied? _________________________ _____________________________________________________________________ . Intake of the following respiratory drugs prior to testing Medicine Trade Name Dosage Last Intake (Hours prior to testing) Salbutamol Terbutaline Formoterol Indacaterol Salmeterol Ipratropium Bromide Tioptropium Methylxanthines Formoterol/ Budesonide Salmeterol/ Fluticasone Oral Steroid Roflumilast  Please use the back page for additional listing of medicines if needed 12. Date of Previous Spirometry Testing: _________________ 10. Gender: _________ Height: ____________ Weight: ______________ 3.APPENDIX J PCCP Council of Diagnostic & Therapeutic Spirometry Testing Information Sheet 1. Name: __________________________________Age: _________ 2. Race of patient: ___________________ 4.

MVV. and we will institute measures to implement this. We agree with recommendation and are. C. _____ 1 (R1-1) Spirometry testing using the closed circuit technique should be performed based on the standards set by the ATS-ERS-TFLFT (1). spirometry with post bronchodilator study and simple spirometry study with possible post bronchodilator study if initial result is abnormal _____ 3 (R1-3) In a situation wherein the referring physician requested only a simple spirometry and it showed abnormal results. FEV1/FV6. FVC and FEV1. MIF50/ MEF50. MEF 50. B. FEF 25-75. _____ 8 (R3-2) If the spirometry machine is capable. the following should be measured and reported (in order of decreasing importance): PEFR. D. _____ 4 (R2-1) Daily instrument calibration should be done. FEF 25 and FEF 50 _____ 9 (R4-1) Test result selection should be based on the recommendations set by the ATS-ERS-TFLFT (1). Kindly see appendix I & J. _____ 2 (R1-2) A referring physician can either request any of the following types of spirometry testing: simple spirometry. _____ 11 (R5-2) There is no need to give a clinical correlation. _____ 5 (R2-2) The interpreter (lab medical director or pulmonary consultant on deck) should give a feedback to the technician with regards the quality of the test.1 Name of Institution/ Chapter/ Key Opinion Leader: ____________________________ Name of Person Answering in behalf of Institution/ Chapter: ____________________ For each of the 51 recommendations. there should be 3 sections for the interpretation of the results: technician’s comments. We disagree with the recommendation. MIF 50.Appendix K: Forms Used for Voting of the Statements/ Recommendations . FEV6. interpreter’s comments and final interpretation. already instituting this. We agree with the recommendation. The choices are A. We agree with the recommendation but will have a hard time implementing this in the near future. the technician in coordination with doctor (interpreter of the results) should try to ask permission from the referring physician to proceed in performing a post bronchodilator study while the patient is still in the test site. _____ 6 (R2-3) A log book should be maintained. It should contain the following: daily calibration results. _____ 7 (R3-1) The following should be measured and reported FEV1/ FVC. . Part of the procedure includes the answering of the “PCCP DATS Spirometry Testing Information Sheet”. in fact. kindly write the letter corresponding to your answer/ vote. FEF 75. anomalous events or problems encountered with the system and feedback of the interpreter to the technician. _____ 10 (R5-1) In the spirometry report.

Use of the term “compatible” is discouraged. already instituting this. We agree with the recommendation. room atmospheric pressure at time of testing. If not. the report should use the phrase “ventilatory defect” (not lung defect or ventilatory pattern). name of the laboratory and phone number of laboratory _____ 13 (R7-1) The report should contain a section for technician comments. measured height. measured weight. it should state which of the criteria was not satisfied. race of patient. B. name of referring physician. FEF25-75 and “other spirometry parameters”. _____ 15 (R7-3) The technician comments should state if conditions that may alter the results are present or not. _____ 14 (R7-2) The technician comments should state if the test done satisfies the ATS-ERS-TFLFT (1) reproducibility criteria. and we will institute measures to implement this. Use of the term “scooping” is discouraged. in fact. _____ 19 (R9-1) Spirometry results should be interpreted based on the ATS-ERS-TFLFT suggested algorithm. _____ 22 (R10-3) Slowing down of the terminal portion of spirogram should be described as “exaggerated concavity in the distal portion of the expiratory limb of the flow volume loop”. _____ 18 (R8-1) In the interpretation of the results. The choices are A. all trials flow volume loop should be reported. date of procedure. _____ 23 (R10-4) In cases wherein the interpretation uses any of the following: flow volume loop’s configuration. _____ 20 (R10-1) The best trial flow volume (pre and post-bronchodilator if done) should be part of the spirometry report. age of patient. _____ 12 (R6-1) The spirometry report should contain a section on general data which contains the following information: name of patient. _____ 16 (R7-4) Technician comments should state if the patient is on respiratory drug and if so when was the last intake. _____ 21 (R10-2) In cases of possible upper airway obstruction interpretation. We agree with recommendation and are. We disagree with the recommendation. kindly write the letter corresponding to your answer/ vote.Appendix K: Forms Used for Voting of the Statements/ Recommendations .2 - For each of the 51 recommendations. gender of patient. room temperature at time of testing. time of procedure. C. . it should be stated that these parameters are suggestive but not definitive. _____ 17 (R7-5) Technician comments should state the patients smoking history particular the pack years and the last time when the patient smoked cigarettes. If the spirometry software is not capable. reproducibility of the flow volume loop should be mentioned in the interpreter’s comments. We agree with the recommendation but will have a hard time implementing this in the near future. D.

in fact. . The choices are A. and we will institute measures to implement this. Uses of other terms such as “poor or good response to bronchodilator” are discouraged. _____ 30 (R12-5) Cut off value for the lower limit of normality should be stated in the interpreter’s comments. Statement on the need to correlate clinically should be written in the final interpretation. We agree with the recommendation but will have a hard time implementing this in the near future.3 For each of the 51 recommendations. _____ 34 (R13-4) To standardize the semantics. _____ 28 (R12-3) If the spirometer software is capable (optional).com/dataform3. all parameters should have corresponding actual value (in BTPS).html.Appendix K: Forms Used for Voting of the Statements/ Recommendations . We agree with the recommendation. If not available. D. the value corresponding to the 95% CI of the predicted value should be written in the report. C. _____ 33 (R13-3) FEF 25-75 should not be used in the interpretation of the post bronchodilator response. kindly write the letter corresponding to your answer/ vote. it should stated in the interpreter’s comments what cut off value was used for the lower limit of normality.dynamicmt. _____ 31 (R13-1) Performance of a post-bronchodilator study should be done based on the recommendations of ATS-ERS-TFLFT (2). it is encouraged that the technician or interpreter derived this value by manual computation or use an online calculator at http://www. _____ 29 (R12-4) The cut-off value for the FEV1/FVC ratio should be <5th percentile of predicted value. _____ 35 (R14-1) Interpretation should include suggestion/s on need for additional test if warranted. already instituting this. _____ 25 (R11-2) FEV1% predicted (post bronchodilator value if available) is used both for obstructive and restrictive ventilatory defect. _____ 24 (R11-1) Grading of severity should be based on the criteria set by ATS-ERSTFLFT (2). _____ 36 (R15-1) In the section on “Interpreter’s Comments” the report should state what reference equation was used in the interpretation of the results. predicted value and % predicted. _____ 27 (R12-2) If the spirometer software is capable (optional). _____ 32 (R13-2) Interpretation of response to bronchodilator should be based on the criteria set by the ATS-ERS-TFLFT (2). response to bronchodilator will either be labeled as “significant or no significant response to bronchodilator” {as used by the ATS-ERS-TFLFT (2)}. B. _____ 26 (R12-1) In the spirometry report. If the spirometer software is not capable. values < 5th percentile of the predicted should be flagged down (either a change of color or marked). We disagree with the recommendation. We agree with recommendation and are.

FEV6. _____ 40 (R17-1) The spirometry report should contain at least. FVC and FEV1. _____ 46 (R18-5) In the tabular graph (if the spirometry software is capable). C. it should be stated if the test satisfies the reproducibility criteria set by the ATS-ERS-TFLFT (1) or not. FEV1/FV6. FEF 25 and FEF 50 _____ 45 (R18-4) In the tabular graph. 95% confidence interval limit (if the spirometry software is capable). predicted. % predicted (pre & post if done) and % change from baseline of post-bronchodilator measurement. _____ 49 (R19-3) The section should contain the basis for the interpretation. MVV. it should state the consequences of this deficiency in the parameters. We disagree with the recommendation. _____ 48 (R19-2) The IC section should state if the test satisfied the ATS-ERS-TFLFT (1) reproducibility criteria. in fact. We agree with the recommendation. criteria for severity and response to bronchodilator . the reproducibility of the flow volume loop should be stated in the section on “Interpreter’s Comments”. _____ 47 (R19-1) The report should contain a section for the interpreter’s comments (IC) of the results. B. FEF 75. each parameter should have its corresponding actual values (pre & post if done). If the spirometry software is not capable. _____ 39 (R16-2) It the test does not satisfy one of the acceptability or reproducibility criteria. MIF 50. If the test did not satisfy the criteria. the pre (and postbronchodilator if done) best trial flow volume loop/s _____ 41 (R17-2) The spirometry report should contain all trials flow volume loops if an interpretation of CAO or UAO made.Appendix K: Forms Used for Voting of the Statements/ Recommendations . _____ 42 (R18-1) The spirometry report should contain the measured parameters tabular graph. _____ 38 (R16-1) In the reports section on “Interpreter’s Comments”. _____ 43 (R18-2) The first 3 rows of should be allotted for the MRSP in the following order: FEV1/FVC. the interpreter should state the consequences of this deficiency. the ATS-ERS-TFLFT (2) interpretation algorithm. The choices are A. _____ 44 (R18-3) The succeeding rows maybe be allotted for the “other parameters” in the following order of priority: PEFR. We agree with the recommendation but will have a hard time implementing this in the near future.4 For each of the 51 recommendations. D. FEF 25-75. Specifically it should apply. MEF 50. _____ 37 (R15-2) A research study will be conducted by the Council of Diagnostics & Therapeutics to determine which reference equation is best fitted for the local Filipino population. MIF50/ MEF50. and we will institute measures to implement this. kindly write the letter corresponding to your answer/ vote. We agree with recommendation and are. each parameter below the 5th percentile should be flagged down. already instituting this.

The choices are A. suggestion for specific additional test if indicated. We agree with the recommendation but will have a hard time implementing this in the near future. positive or negative response to bronchodilator if done. _____ 50 (R20-1) The spirometry report should contain a section for the final interpretation (FI) of the results.Appendix K: Forms Used for Voting of the Statements/ Recommendations . and we will institute measures to implement this. We disagree with the recommendation. in fact. We agree with recommendation and are.” and printed name plus signature of the interpreter/s . D. a generic sentence “Please correlate results with patient’s clinical data. We agree with the recommendation. kindly write the letter corresponding to your answer/ vote. presence or absence of probable restrictive ventilatory defect and severity if present.5 For each of the 51 recommendations. _____ 51 (R20-2) The FI should contain the following information: presence or absence of obstructive ventilatory defect and severity if present. already instituting this. B. C.

Manila Doctors Hospital (MDH) 6.Appendix L List of Voters Philippine College of Chest Physicians Accredited Training Institutions 1. Camilo Roa 2.Philippine General Hospital (UP-PGH) 10. Dr. Lung Center of the Philippines (LCP) 4. Philippine Heart Center (PHC) 7. Dr. University of the Philippines . Makati Medical Center (MMC) 5. Veterans Memorial Medical Center (VMMC) Philippine College of Chest Physicians Chapters 1. University of Santo Tomas Hospital (UST) 11. 4. Luke’s Medical Center (SLMC) 8. 3. Chinese General Hospital and Medical Center (CGH) 2. Ric Zotomayor . Dr. Chong Hua Hospital (CHH) 3. Southern Tagalog Northern Mindanao Negros Mindanao Key Opinion Leaders 1. University of Perpetual Help Dalta Medical Center (UPHM) 9. Jennifer Wi 3. St. 2.

Mindanao Negros C B B B B B B B B D B B B B B C B B B B C B .Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC CHH MDH (R1-1) Spirometry testing using the closed circuit technique should be performed based on the standards set by the ATSERS-TFLFT (very good consensus) B B B B B C B (R1-2) A referring physician can either request any of the following types of spirometry testing: simple spirometry. Roa Dr. Tagalog N. Zotomayor Dr. spirometry with post bronchodilator study and simple spirometry study with possible post bronchodilator study if initial result is abnormal. Wi Mindanao S. (perfect consensus) B B B B C B B UST PHC UPHM Dr.

Mindanao Negros B B C B C B B C A C B B B B B D B B B A B D B B B B C B B B B C B B C . Tagalog N. Zotomayor Dr. Wi (R1-3) In a situation wherein the referring physician requested only a simple spirometry and it showed abnormal results. (very good consensus) B B C B B B (R2-2) The interpreter (lab medical director or pulmonary consultant on deck) should give a feedback to the technician with regards the quality of the test. the technician in coordination with doctor (interpreter of the results) should try to ask permission from the referring physician to proceed in performing a post bronchodilator study while the patient is still in the test site. (perfect consensus) B B B B B B Mindanao S. Roa Dr. (very good consensus) C B B B C C B (R2-1) Daily instrument calibration should be done.Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC CHH MDH UST PHC UPHM Dr.

It should contain the following: daily calibration results. (perfect consensus) B B B B B B (R3-2) If the spirometry machine is capable. Roa Dr. FEV1/FV6. FVC and FEV1. Mindanao Negros C B C D C B B C B C B B B B B B B B B B B B B B C B C B B B B B B B B .Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC CHH MDH UST PHC UPHM Dr. FEF 2575. the following should be measured and reported (in order of decreasing importance): PEFR. MEF 50. MIF 50. Tagalog N. (very good consensus) B B C B B B B (R3-1) The following should be measured and reported FEV1/ FVC. Zotomayor Dr. MIF50/ MEF50. FEF 75. Wi (R2-3) A log book should be maintained. FEV6. FEF 25 and FEF 50 (very good consensus) B O ANSW C C B C Mindanao S. MVV. anomalous events or problems encountered with the system and feedback of the interpreter to the technician.

interpreter’s comments and final interpretation. (good consensus) B B B B A O ANSW CHH MDH UST PHC UPHM Dr.Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC (R4-1) Test result selection should be based on the recommendations set by the ATS-ERS-TFLFT (1). there should be 3 sections for the interpretation of the results: technician’s comments. Tagalog N. Zotomayor Dr. (perfect consensus) C C C B B C (R5-2) There is no need to give a clinical correlation. Mindanao Negros B B C B B B B B B B B C C C C B C B B B B C C B B B A B A B B B A A A . Wi Mindanao S. (perfect consensus) B B B B B B B (R5-1) In the spirometry report. Roa Dr.

(very good consensus) C C D B B B C UST PHC B B B C C C UPHM B Dr. time of procedure. race of patient. measured weight. name of the laboratory and phone number of laboratory (very good consensus) B B C C C C B (R7-1) The report should contain a section for technician’s comments. measured height.Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC CHH MDH (R6-1) The spirometry report should contain a section on general data which contains the following information: name of patient. Wi Mindanao S. name of referring physician. Tagalog N. Roa Dr. room temperature at time of testing. It should state the indication for doing the test and the information about previous spirometry testing. date of procedure. Zotomayor Dr. age of patient. Mindanao Negros C B C C B C C C B C B B C C . room atmospheric pressure at time of testing. gender of patient.

Appendix M: Tally of Votes (R7-2) The technician comments should state if the test done satisfies the ATS-ERS-TFLFT (1) reproducibility criteria. Mindanao Negros C B C B C B C C C C C B C B C B C B C C C C C B B C B C B B B B B B C B B B C B C B C B B C B C C . (perfect consensus) (R7-5) Technician’s comments should state the patients smoking history particularly the pack years and the last time when the patient smoked cigarettes. (perfect consensus) SLMC CGH VMMC LCP UP-PGH MMC CHH MDH UST PHC UPHM Dr. (perfect consensus) (R7-3) The technician’s comments should state if conditions that may alter the results are present or not. Roa Dr. (perfect consensus) (R7-4) Technician’s comments should state if the patient is on respiratory drug and if so when was the last intake. Wi C B B B C C B C C B B B C C C C B B C B C B C Mindanao S. If not. it should state which of the criteria was not satisfied. Zotomayor Dr. Tagalog N.

(very good consensus) B B B B B (R10-1) The best trial flow volume (pre and postbronchodilator if done) should be part of the spirometry report. If the spirometry software is not capable. (perfect consensus) B B B B B (R10-2) In cases of possible upper airway obstruction interpretation. (very good consensus) C B C C C CHH MDH UST PHC UPHM Dr. Mindanao Negros B C B C B B B C B A B C B C B C B B B D B B C B B B B B B B B B B B B C B B C C C C B B B C B B D C . Roa Dr. (very good consensus) B C B C B B (R9-1) Spirometry results should be interpreted based on the ATS-ERS-TFLFT suggested algorithm.Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC (R8-1) In the interpretation of the results. all of the trials flow volume loop should be reported. Wi Mindanao S. Zotomayor Dr. reproducibility of the flow volume loop should be mentioned in the interpreter’s comments. Tagalog N. the report should use the phrase “ventilatory defect” (not lung defect or ventilatory pattern).

Mindanao Negros C C C B C B C C C C C B C C C B B B D B B C B B B B B B B B B B B C B .Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC CHH MDH UST PHC UPHM Dr. Zotomayor Dr. (perfect consensus) C B B C C C B (R10-4) In cases wherein the interpretation uses any of the following: flow volume loop’s configuration. Roa Dr. Use of the term “compatible” is discouraged. Use of the term “scooping” is discouraged. (very good consensus) B B C C C C (R11-1) Grading of severity should be based on the criteria set by ATS-ERSTFLFT. FEF25-75 and “other spirometry parameters”. Tagalog N. it should be stated that these parameters are suggestive but not definitive. (perfect consensus) B B B B B B Mindanao S. Wi (R10-3) Slowing down of the terminal portion of spirogram should be described as “exaggerated concavity in the distal portion of the expiratory limb of the flow volume loop”.

Zotomayor Dr. Mindanao Negros B B B B B B B B B B B B B B B B B B B B B B C C B B B C C C C B C B C B C C/B B D C . Wi Mindanao S. (very good consensus) B B B C UP-PGH MMC CHH MDH UST PHC UPHM Dr. (perfect consensus) B B B B (R12-2) If the spirometer software is capable (optional).Appendix M: Tally of Votes SLMC CGH VMMC LCP (R11-2) FEV1% predicted (post bronchodilator value if available) is used both for obstructive and restrictive ventilatory defect. Roa Dr. all parameters should have corresponding actual value (in BTPS). predicted value and % predicted. (perfect consensus) B B B B (R12-1) In the spirometry report. Tagalog N. the value corresponding to the 95% CI of the predicted value should be written in the report.

(good consensus) B B D D D A D (R12-4) The cut-off value for the FEV1/FVC ratio should be <5th percentile of predicted value. If not available. (good consensus) B C C C D A C UST PHC UPHM Dr. Wi Mindanao S.html. Zotomayor Dr. Mindanao Negros D B C D C B C C D D C D C C B C B C C/B D D C .dynamicmt. Roa Dr. If the spirometer software is not capable. Tagalog N.Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC CHH MDH (R12-3) If the spirometer software is capable (optional). it is encouraged that the technician or interpreter derives this value by manual computation or uses an online calculator at http://www. it should be stated in the interpreter’s comments what cut off value was used for the lower limit of normality.com/ dataform3. values < 5th percentile of the predicted should be flagged down (either a change of color or marked).

Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC B C C C D A C B B B B B B (R13-2) Interpretation of response to bronchodilator should be based on the criteria set by the ATS-ERSTFLFT. (very good consensus) (R13-1) Performance of a post-bronchodilator study should be done based on the recommendations of ATS-ERS-TFLFT (2). Tagalog N. (perfect consensus) CHH MDH UST PHC UPHM Dr. Mindanao Negros C C C B C B C B/C D C C B B B C B B B B B B C B B B ANSW B C B B B B B B C B C B B B C B B B C B B C C . Zotomayor Dr. Roa Dr. (perfect consensus) B B B B B (R13-3) FEF 25-75 should not be used in the interpretation of the post bronchodilator response. Wi Mindanao S. (perfect consensus) C B B B B (R12-5) Cut off value for the lower limit of normality should be stated in the interpreter’s comments.

Mindanao Negros B C B B B B C C/B B B B B B B B B B B D C/B B B B B C B C B C B D A/B A C C . Statement on the need to correlate clinically should be written in the final interpretation (very good consensus). Uses of other terms such as “poor or good response to bronchodilator” are discouraged. response to bronchodilator will either be labeled as “significant or no significant response to bronchodilator” {as used by the ATS-ERS-TFLFT (2)}. Tagalog N. Roa Dr.Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC CHH MDH UST PHC UPHM Dr. C C C C C A Mindanao S. Wi (R13-4) To standardize the semantics. (very good consensus) B B B B B B (R15-1) In the section on “Interpreter’s Comments” the report should state what reference equation was used in the interpretation of the results. Zotomayor Dr. (perfect consensus) B B B B B B B (R14-1) Interpretation should include suggestion/s on need for additional test if warranted.

(For this item. Roa Dr. (very good consensus) Mindanao S.Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC CHH MDH UST PHC UPHM Dr. Tagalog N. kindly just state of your agree or disagree) (very good consensus) (R16-1) In the reports section on “Interpreter’s Comments”. Mindanao Negros Y/A Y/A Y/A A B C C B B C C . Wi Y/A Y/A Y/A Y/A N/D Y/A Y/A Y/A Y/A Y/A Y/A Y/A Y/A C C C C C C B C B C B B B B C B C C D C B C B C B B B D (R15-2) A research study will be conducted by the Council of Diagnostics & Therapeutics to determine which reference equation is Y/A best fitted for the local Filipino population. it should be stated if the test satisfies the reproducibility criteria set by the ATS-ERS-TFLFT (1) or not. (very good consensus) (R16-2) It the test does not satisfy one of the acceptability or reproducibility criteria. Zotomayor Dr. it should state the consequences of this deficiency in the parameters.

FVC and FEV1. Mindanao Negros B B B B B B B B B C B D B B C B B B C A/C C D D C B B B B B B B B B B D B C B C C C B C B B B C B C . Wi B B B B B B B C B C C B C B B D B B B C D C B Mindanao S. (very good consensus) (R18-2) The first 3 rows of the tabular graph should be allotted for the MRSP in the following order: FEV1/FVC.Appendix M: Tally of Votes (R17-1) The spirometry report should contain at least. (very good consensus) SLMC CGH VMMC LCP UP-PGH MMC CHH MDH UST PHC UPHM Dr. if an interpretation of CAO or UAO made. (very good consensus) (R18-1) The spirometry report should contain the measured parameters tabular graph. Tagalog N. If the spirometry software is not capable. Roa Dr. the reproducibility of the flow volume loop should be stated in the section on “Interpreter’s Comments”. Zotomayor Dr. (perfect consensus) (R17-2) The spirometry report should contain the flow volume loops of all trials. the pre (and postbronchodilator if done) best trial flow volume loop/s.

Mindanao Negros C C C B C B B B C B C B C B B B B B B B B B B C C B B D D B B C B C . FEV6. MVV. FEF 25-75. MIF 50. (very good consensus) (R18-4) In the tabular graph. Wi B C D C B B B B B B B B B B B D C D C Mindanao S. FEV1/FV6. FEF 25 and FEF 50. predicted. MIF50/ MEF50. MEF 50. Roa Dr. Zotomayor Dr.Appendix M: Tally of Votes (R18-3) The succeeding rows maybe be allotted for the “other parameters” in the following order of priority: PEFR. each parameter below the 5th percentile should be flagged down. (perfect consensus) (R18-5) In the tabular graph (if the spirometry software is capable). 95% confidence interval limit (if the spirometry software is capable). (good consensus) SLMC CGH VMMC LCP UP-PGH MMC CHH MDH UST PHC UPHM Dr. Tagalog N. % predicted (pre & post if done) and % change from baseline of post-bronchodilator measurement. each parameter should have its corresponding actual values (pre & post if done). FEF 75.

Appendix M: Tally of Votes SLMC CGH VMMC LCP UP-PGH MMC B C B C B B B C C C C D C (R19-3) The IC section should also contain the basis for the interpretation.(very good consensus) CHH MDH UST PHC UPHM Dr. Specifically it should apply. (perfect consensus) (R19-2) The IC section should state if the test satisfied the ATS-ERSTFLFT (1) reproducibility criteria. the interpreter should state the consequences of this deficiency. Mindanao Negros C B B B B B B B B B B C C B C B B D B C C B B B C C C C B B D B C B B B B B B B B B B B B B B B B . (perfect consensus) B B B B B (R19-1) The report should contain a section for the interpreter’s comments (IC) of the results. Wi Mindanao S. criteria for severity and response to bronchodilator. (very good consensus) C C B C B (R20-1) The spirometry report should contain a section for the final interpretation (FI) of the results. Roa Dr. Tagalog N. Zotomayor Dr. If the test did not satisfy the criteria. the ATS-ERS-TFLFT (2) interpretation algorithm.

” and printed name plus signature of the interpreter/s. Mindanao Negros B B B B . presence or absence of probable restrictive ventilatory defect and severity if present. Zotomayor B C B B B Dr. (very good consensus) SLMC CGH VMMC LCP UP-PGH MMC B B B B B B CHH MDH B C UST PHC UPHM Dr. Wi Mindanao S. significant or no significant response to bronchodilator if done.Appendix M: Tally of Votes (R20-2) The FI should contain the following information: presence or absence of obstructive ventilatory defect and severity if present. Tagalog N. a generic sentence “Please correlate results with patient’s clinical data. suggestion for specific additional test if indicated. Roa Dr.

0 P 15 3 100. there should be 3 sections for the interpretation of the results: technician’s comments.0 G 4 5 8 94.7 0. (good consensus) (R18-5) In the tabular graph (if the spirometry software is capable).5 G 7 6 4 100. (perfect consensus) (R2-2) The interpreter (lab medical director or pulmonary consultant on deck) should give a feedback to the technician with regards the quality of the test.0 P . (perfect consensus) (R5-1) In the spirometry report. (good consensus) (R12-4) The cut-off value for the FEV1/FVC ratio should be <5th percentile of predicted value.0 0.0 23. (good consensus) (R1-2) A referring physician can either request any of the following types of spirometry testing: simple spirometry. spirometry with post bronchodilator study and simple spirometry study with possible post bronchodilator study if initial result is abnormal. (perfect consensus) (R4-1) Test result selection should be based on the recommendations set by the ATS-ERS-TFLFT (1).0 0.1 G 3 10 4 94.0 P 18 17 1 100.com/dataform3. each parameter below the 5th percentile should be flagged down.dynamicmt. (perfect consensus) (R3-1) The following should be measured and reported FEV1/ FVC. If the spirometer software is not capable. If not available.0 0. values < 5th percentile of the predicted should be flagged down (either a change of color or marked). it is 1 encouraged that the technician or interpreter derives this value by manual computation or uses an online calculator at http://www. interpreter’s comments and final interpretation. FVC and FEV1.Appendix N: Computation of the Parameters Needed for the Level of Consensus Classification (R5-2) There is no need to give a clinical correlation.0 0.4 23.0 0. (perfect consensus) C D % of those who Agreed % of those who answered D Level of Consensus 64.0 P 7 11 100. (good consensus) A B 6 11 (R12-3) If the spirometer software is capable (optional).5 G 15 3 100.0 P 100.4 47.html. it should be stated in 1 the interpreter’s comments what cut off value was used for the lower limit of normality.

0 P 12 6 100.0 P . (perfect consensus) (R7-3) The technician’s comments should state if conditions that may alter the results are present or not.0 0.0 P 7 11 100.0 0.0 P 9 9 100. (perfect consensus) (R7-5) Technician’s comments should state the patients smoking history particularly the pack years and the last time when the patient smoked cigarettes.0 P 17 D 16 2 100. (perfect consensus) B C 7 % of those who Agreed % of those who answered D Level of Consensus 11 100.Appendix N: Computation of the Parameters Needed for the Level of Consensus Classification A (R7-2) The technician comments should state if the test done satisfies the ATS-ERS-TFLFT (1) reproducibility criteria.0 P 16 2 100.0 P 5 13 100.0 P 17 1 100. (perfect consensus) (R7-4) Technician’s comments should state if the patient is on respiratory drug and if so when was the last intake.0 0. predicted value and % predicted. (perfect consensus) (R13-1) Performance of a post-bronchodilator study should be done based on the recommendations of ATS-ERS-TFLFT (2). it should state which of the criteria was not satisfied. Use of the term “scooping” is discouraged.0 0.0 P 100. (perfect consensus) (R11-1) Grading of severity should be based on the criteria set by ATS-ERS-TFLFT. (perfect consensus) (R12-1) In the spirometry report.0 0.0 0.0 0. (perfect consensus) (R10-1) The best trial flow volume (pre and post-bronchodilator if done) should be part of the spirometry report.0 0. If not.0 0.0 0. (perfect consensus) (R11-2) FEV1% predicted (post bronchodilator value if available) is used both for obstructive and restrictive ventilatory defect. (perfect consensus) (R10-3) Slowing down of the terminal portion of spirogram should be described as “exaggerated concavity in the distal portion of the expiratory limb of the flow volume loop”.0 P 17 1 100. all parameters should have corresponding actual value (in BTPS).

the pre (and post-bronchodilator if done) best trial flow volume loop/s.0 0.0 P 15 3 100.0 P 17 1 100.4 0.0 0. Uses of other terms such as “poor or good response to bronchodilator” are discouraged.0 0.6 VG 94.0 VG 18 15 2 10 7 1 .Appendix N: Computation of the Parameters Needed for the Level of Consensus Classification A (R13-2) Interpretation of response to bronchodilator should be based on the criteria set by the ATS-ERS-TFLFT. each parameter should have its corresponding actual values (pre & post if done).0 0. (perfect consensus) (R20-1) The spirometry report should contain a section for the final interpretation (FI) of the results. response to bronchodilator will either be labeled as “significant or no significant response to bronchodilator” {as used by the ATS-ERS-TFLFT (2)}.0 0. (perfect consensus) (R13-4) To standardize the semantics. (perfect consensus) (R13-3) FEF 25-75 should not be used in the interpretation of the post bronchodilator response. predicted. (perfect consensus) (R18-4) In the tabular graph. (perfect consensus) (R1-1) Spirometry testing using the closed circuit technique should be performed based on the standards set by the ATS-ERS-TFLFT (very good consensus) (R1-3) In a situation wherein the referring physician requested only a simple spirometry and it showed abnormal results.0 P 100.0 0. % predicted (pre & post if done) and % change from baseline of postbronchodilator measurement.0 0. (very good consensus) B C 15 D % of those who Agreed % of those who answered D Level of Consensus 2 100.0 P 12 6 100. (perfect consensus) (R17-1) The spirometry report should contain at least.0 P 15 3 100. 95% confidence interval limit (if the spirometry software is capable).0 5. the technician in coordination with doctor (interpreter of the results) should try to ask 1 permission from the referring physician to proceed in performing a post bronchodilator study while the patient is still in the test site.0 P 100.0 P 17 1 100. (perfect consensus) (R19-1) The report should contain a section for the interpreter’s comments (IC) of the results.

4 11. time of procedure. (very good consensus) (R10-2) In cases of possible upper airway obstruction interpretation.4 0. room atmospheric pressure at time of testing. (very good consensus) (R3-2) If the spirometry machine is capable. race of patient.4 0. MIF 50.9 VG 7 10 1 100. MVV. name of the laboratory and phone number of laboratory (very good consensus) (R7-1) The report should contain a section for technician’s comments. anomalous events or problems encountered with the system and feedback of the interpreter to the technician. It should state the indication for doing the test and the information 1 about previous spirometry testing.6 VG 11 6 94.6 VG (R6-1) The spirometry report should contain a section on general data which contains the following information: name of patient.8 VG 11 6 1 100. the following should be measured and reported (in order of decreasing importance): PEFR. all of the trials flow volume loop should be reported. If the spirometry software is not capable.0 VG 7 10 100.6 VG 12 5 94.0 5. MEF 50.0 5. (very good consensus) (R9-1) Spirometry results should be interpreted based on the ATSERS-TFLFT suggested algorithm. FEV1/FV6. (very good consensus) (R2-3) A log book should be maintained. FEF 25 and FEF 50 (very good consensus) A B C D % of those who Agreed % of those who answered D Level of Consensus 1 14 1 2 94. gender of patient. date of procedure. It should contain the following: daily calibration results. measured height. (very good consensus) (R8-1) In the interpretation of the results. reproducibility of the flow volume loop should be mentioned in the interpreter’s comments.0 5. FEF 75.0 5. measured weight. the report should use the 1 phrase “ventilatory defect” (not lung defect or ventilatory pattern). (very good consensus) . MIF50/ MEF50.4 0. room temperature at time of testing. FEF 25-75.0 VG 8 9 94. name of referring physician. FEV6. age of patient.Appendix N: Computation of the Parameters Needed for the Level of Consensus Classification (R2-1) Daily instrument calibration should be done.0 VG 13 3 1 100.

6 VG 4 10 1 88.0 5. Statement on the need to correlate clinically should be written in the final interpretation (very good consensus). (very good consensus) (R14-1) Interpretation should include suggestion/s on need for additional test if warranted.4 11.0 11.2 6.0 5.0 VG 94.1 VG 16 1 1 100. kindly just state of your agree or disagree) (very good consensus) (R16-1) In the reports section on “Interpreter’s Comments”.Appendix N: Computation of the Parameters Needed for the Level of Consensus Classification A (R10-4) In cases wherein the interpretation uses any of the following: flow volume loop’s configuration.7 VG 0. (very good consensus) (R12-2) If the spirometer software is capable (optional).6 VG 7 10 1 100. (very good consensus) (R15-1) In the section on “Interpreter’s Comments” the report should state what reference equation was used in the interpretation of the 2 results. (very good consensus) 1 B C D % of those who Agreed % of those who answered D Level of Consensus 9 8 1 100. (very good consensus) (R16-2) It the test does not satisfy one of the acceptability or reproducibility criteria. the value corresponding to the 95% CI of the predicted value should be written in the report. FEF25-75 and “other spirometry parameters”. (R15-2) A research study will be conducted by the Council of Diagnostics & Therapeutics to determine which reference equation is best fitted for the local Filipino population. it should be stated that these parameters are suggestive but not definitive.0 0.0 VG 100.0 5. it should be stated if the test satisfies the reproducibility criteria set by the ATS-ERS-TFLFT (1) or not. (For this item. it should state the consequences of this deficiency in the parameters. (very good consensus) (R12-5) Cut off value for the lower limit of normality should be stated 1 in the interpreter’s comments.6 VG 4 11 2 94. Use of the term “compatible” is discouraged.1 VG 7 10 8 8 2 .4 0.

if an interpretation of CAO or UAO made.1 VG 8 9 1 100. MIF50/ MEF50. MEF 50.0 5. presence or absence of probable restrictive ventilatory defect and severity if present.(very good consensus) (R19-3) The IC section should also contain the basis for the interpretation. MIF 50. MVV. FVC and FEV1. FEF 25-75. (very good consensus) (R19-2) The IC section should state if the test satisfied the ATSERS-TFLFT (1) reproducibility criteria. suggestion for specific additional test if indicated. (very good consensus) B C 7 D 7 3 % of those who Agreed % of those who answered D 100. (very good consensus) (R18-1) The spirometry report should contain the measured parameters tabular graph. FEV1/FV6. the ATS-ERS-TFLFT (2) interpretation algorithm. FEF 25 and FEF 50.6 VG . FEV6.1 VG 9 8 1 100.0 17. If the test did not satisfy the criteria. criteria for severity and response to bronchodilator.6 VG 15 2 1 100.0 5.6 Level of Consensus VG 15 1 2 100.6 VG 6 10 2 100.0 5. (very good consensus) (R18-2) The first 3 rows of the tabular graph should be allotted for the MRSP in the following order: FEV1/FVC. the interpreter should state the consequences of this deficiency. a generic sentence “Please correlate results with patient’s clinical data. (very good consensus) (R20-2) The FI should contain the following information: presence or absence of obstructive ventilatory defect and severity if present. If the spirometry software is not capable. significant or no significant response to bronchodilator if done. (very good consensus) (R18-3) The succeeding rows maybe be allotted for the “other parameters” in the following order of priority: PEFR. the reproducibility of the flow volume loop should be stated in the section on “Interpreter’s Comments”.0 11.0 5.0 11.” and printed name plus signature of the interpreter/s. FEF 75.Appendix N: Computation of the Parameters Needed for the Level of Consensus Classification A (R17-2) The spirometry report should contain the flow volume loops of all trials.6 VG 9 8 1 100. Specifically it should apply.

Celeste Mae L. FPCCP . Janeth T. FPCCP Valenzuela. Tim S. Helarose M. FPCCP Villanueva. FPCCP Villanueva.. Czarina J.. MD... MD. Peachy Lara. MD. FPCCP Samson. Edwin I. FPCCP Reside. Flordeliza. FPCCP Divinagracia. MD. FPCCP Dalupang. Shirley Jane. Geraldine.FPCCP Zantua.Appendix O PCCP-DATS Committee on Spirometry Consensus Chair: Ma. Ma. FPCCP Claveria.MD. MD. FPCCP Santos.. FPCCP Chavez. Eloise Arabelle. Angelica. Andrew S. Alfredo Romeo Q.Aquino. FPCCP Mapanao. MD. MD.MD. FPCCP Ogbac. FPCCP Micu. Daisy. MD. Piedad R.. FPCP Chua-Panganiban. MD. MD. FPCCP Trinidad.. MD. FPCCP Elisterio. FPCCP Tan. Alvin..A. MD. MD. Raphael Ryan R. FPCCP Campomanes. MD. Jr. MD. Ma.. Lyndon H. Lolita Brigida. Christine L. MD.FPCP Mora. FPCCP Villasanta. MD.. Rosauro Vicente H. Julius. Marites. MD. FPCP Llanes-Gracia. Charissa. MD. Liza.. Arnold G. FPCCP Natividad. MD. Rachel. Anna Tessa. MD. MD. William George. Samson. FPCCP Gonzales.MD. MD. FPCCP Reyes. MD.FPCP Peñafiel. MD.. Mary Jane. Ma. Evelyn Victoria E. MD. FPCCP Tan. Florita... MD. FPCCP Lee-Chua. FPCCP Germar. MD. MD. FPCCP Cristobal. FPCCP Council of Diagnostics and Therapeutics Members Caburnay. MD. FPCCP Garcia.