Spirometry

Indications
 Assisting with diagnostic evaluations
 Monitoring of pulmonary function
 Evaluating disability or impairment
 Providing public health information

Contraindications
 Unstable cardiovascular status, unstable angina, recent MI <1/12, PE
 Haemoptysis of unknown origin
 Recent PTX
 Thoracic abdominal or cerebral aneurysms
 Recent thoracic, abdominal or eye surgery
 Acute disorders such as nausea or vomiting
 Severe respiratory distress
 Physical limitations
 Cognitive impairment, dementia

Preparation
 Carry out infection control measures – hand washing
 Document if the patient has withheld bronchodilator
 Ceased smoking > 1 hour prior, no alcohol > 4 hours prior, no vigorous exercise > 30 mins prior, no
large meal > 2 hours prior
 Measure height and weight

Technique
 Perform FVC and FEV1 manoeuvre – repeat x 3
o Correct use of mouthpiece and nose clip
o Correct posture with head slightly elevated
o Position of mouthpiece, including tight mouth seal over the mouthpiece
o Complete inhalation prior to FVC and FEV1
o Rapid and complete exhalation with maximal force
 If flow-volume loop is being preformed (to measure forced inspiratory vital capacity)
o The patient will exhale rapidly and forcefully until end of test criteria are achieved aadn then
inhale as rapidly as possible back to TLC
 Performing the VC testing
o Slow, complete and relatively constant flow inhalation for VC
o Slow, complete and relatively constant flow exhalation for VC
o Emphasis on complete filling and emptying of the lungs

Post bronchodilatory therapy

 4 puffs (4 x 100mcg) salbutamol via spacer, perform 15 mins post
 An increase in FEV1 and/or FVC of ≥ 12% compared with pre-bronchodilator spirometer and ≥200ml
increase in FEV1 and FVC compared with a pre-bronchodilator spirometry
= Tweet
Lung volumes

FLOW VOLUME LOOP

PARAMETERS
• VC = 70mL/kg
= IRV + TV + ERV
• IRV = 45mL/kg
• TV = 10mL/kg – volume breathed in & out during a normal
breath (without extra effort)
• ERV = 15mL/kg – extra volume beyond normal expiration
• RV = 15mL\kg (not measured by spirometer)
• TLC = 85L\kg
• FRC = 30mL\kg
• FEV1 = forced expiratory volume in 1 second (normally 4L)
• FVC = forced vital capacity (a little lower than VC because of
dynamic airway closure; normally ~5L)
• PEFR = peak flow rate over an expiration (normally 500L/min)
• FEV1/FVC (normal = 80%)
Obstructive disease = FEV1 reduced more than FVC, low
FEV1/FVC
Restrictive disease = FEV1 & FVC reduced but FEV1/FVC normal or increased

After a relatively small amount of gas has been exhaled -> flow is limited by airway compression
determined by (1) elastic recoil force of lung & (2) resistance of airways upstream of the collapse
point.

• FEF50%
• FIF50%
• FEF/FIF50 = if > 1 -> inspiratory flow is affected more than expiratory -> extrathoracic site of obstruction
OBSTRUCTIVE DISEASE
 flow rate very low in relation to lung volume (c/o resistance to flow – scooped out appearance often
seen following the point of maximum flow)
 total lung capacity is large, but expiration ends prematurely c/o early airway closure from increased
smooth muscle tone of bronchi (asthma) or loss of radial traction from surrounding parenchyma
(emphysema).
 equal pressure point is close to the alveolus and the transmural pressure gradient can become
negative quickly -> collapse.
 encroachment of VC by an increased RV caused by hyperinflation (‘air trapping’)

Severity Features Respiratory funciton

Mild Exertional symptoms FEV1 and PEFR >60% predicted
Able to speak normally
Good response to usual therapy
Moderate Dyspnoeic at rest FEV1 and PEFR 40 – 60% predicted
Able to speak in short sentences PEFR 200 – 300L/min
Chest tightness
Wheeze
Partial or short-term relief with usual therapy
Nocturnal symptoms
Severe Laboured respiration FEV1 and PEFR unable or <40% predicted
Sweating, restless SPO2 <90% on RA
Tachycardia, HR >120bpm PEFR <200L/min
Tachypnoea, RR >25/minute
Difficulty speaking – words or short sentences
Near death Exhaustion FEV1 and PEFR in appropriate
Confusion, coma SPO2 <90% despite supplemental O2
Cyanosis
Sweating
Silent chest
Inabilty to speak
Reduced respiratory effort
Dysrhythmia, bradycardia
Hypotension

RESTRICTIVE DISEASE
 total volume exhaled and flow rate reduced
 inspiration limited by reduced compliance of lung/chest wall or weakness of inspiratory muscles