Spirometry Effort Acceptability & Reproducibility

Inaccurate Results From Coughing

An acceptable effort is defined as free from error and Volume Time Curve Flow Volume Curve
Coughing
Coughing during the first second
artifacts. A reproducible effort is defined as being may affect the FEV1. Both volume
time and flow volume curves
show dips instead of smoothly
without excessive variability. Criteria for determining formed line.

whether efforts are acceptable and reproducible are

outlined below. Inaccurate Results From Glottis Closure
Volume Time Curve Flow Volume Curve
Glottis closure
The flow of air is temporarily
Normal Volume Time Curve Normal Flow Volume Curve completely cut off. Both curves
stop abruptly. An artificial plateau
is reached on volume time curves,
with a bend where the effort
stopped.

Inaccurate Results From Early Termination

Volume Time Curve Flow Volume Curve
Early termination (< 6 sec)
No obvious plateau is reached on
volume time curves and the
exhalation is less than 6 seconds.
Flow volume curves show a low
total volume with flow dropping
Flow volume curves exhibit a sharp initial peak flow close to the “Y” axis, then a sharply at the end of expiration.

relatively straight descent at 45° to the baseline. Volume time curves show an
Inaccurate Results From Leaks
obvious plateau of at least 1 sec after 6 seconds of exhalation.
Volume Time Curve Flow Volume Curve
Air leak can happen around the
flow transducer or from the nose.
Volume time curves drop instead of
Patient Preparation Patient Coaching reaching a plateau. Flow volume
curves backtrack at the end.

We recommend that you practice the • Place the flow transducer in your
procedure with the patient before mouth, on top of your tongue &
starting the test, but first, you should between your teeth.
prepare the patient for the procedure: Inaccurate Results From Variable Effort
• Close lips and teeth around the flow
Volume Time Curve Flow Volume Curve Variable effort
• Patient may sit or stand. transducer to create a tight seal, like if
The patient forced out the air at
you were blowing in a musical an inconsistent rate. Both curves
• Patient should loosen tight clothing. instrument. show dips similar to those for a
cough, making it difficult to
• Patient should elevate chin and extend • Keep your chin slightly elevated and distinguish between the two
the neck slightly. make sure that your tongue is out of conditions. Tracings are
the flow transducer. unacceptable if cough or variable
effort occurred during the first
• Patient should use a nose clip or pinch
second.
his/her nostrils with fingers. • Take a good deep breath.
Inaccurate Results From Hesitation
• Now BLAST into the flow transducer
Reproducibility Criteria as hard, fast and completely as Volume Time Curve Flow Volume Curve Hesitation, False Start or
possible. Excessive Extrapolated Volume
The patient did not exhale as
• Largest FVC should be within 5%
• Keep blowing, squeeze all the air out. forcefully as possible at the start
of the next largest FVC.
of the effort. Volume time curves
• Stop. start slowly instead of climbing
• Largest FEV1 should be within 5% sharply. The peak of the flow
of the next largest FEV1. volume curve is displaced to the
right, away from the vertical axis.
• Must meet criteria for acceptability.
Example of Non-Reproducible and Reproducible Spirometry Test

Volume Time Curve Flow Volume Curve Volume Time Curve Flow Volume Curve
Reproducible test Non reproducible test
This example shows a This example shows a non-
reproducible test with 3 reproducible test with 3
acceptable curves. The 3 FVC acceptable curves. Note the
efforts are within 5% of each obvious variability in the FVC size
other, which indicates that the of the curves, most likely due to an
patient inhaled completely incomplete inhalation. Coach the
before each expiration. subject to take a deeper breath in
before performing the FVC
maneuver.

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