Running head: SPIROMETRY 1

The Principles of Spirometry and Related Tests

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The Principles of Spirometry and Related Tests

Introduction

Spirometry is a non-invasive technique that respiratory therapists and other health

care professionals use for diagnosis and treatment of respiratory disorders. As the name

suggests, the instrument used for this purpose is called a spirometer. The technique offers

insight into the type and extent of lung function impairment or progress of treatment. Seeing

as to how they are non-invasive, these instruments are not only cheap to administer but also

effective across a variety of patient groups. In light of the ever-increasing pulmonary

conditions in the contemporary world, spirometry is steadily growing to be a diagnostic and

management tool for pulmonary care professionals around the world. As mentioned,

pulmonary diseases are now more than ever, and this has led to the use of spirometry for two

essential applications; to determine the size of lung volume during respiration and to

determine the time that a patient takes to complete full breath. These two essential functions

form the basis of spirometry tests and principles. To this end, a Spirometer measures the flow

rates and volumes of a patient’s lungs through a sensor attached to the mouthpiece which a

subject blows air through. At the end of the mouthpiece is a calibrated container that contains

some balls of various weights to measure the volume of air and the speed of respiration.

Principles of Spirometry

Spirometry, as a diagnostic and management procedure, has a long history spanning

more than two decades. As such, many scholars, researchers and healthcare professionals

have discovered multiple forms of the Spirometer. The principle behind the functioning of a

Spirometer, however, remains the same. The device measures the volume of air inhaled or

exhaled and the speed of the respiratory process. A simple spirometer consists of a jar, a

mouthpiece and some form of resistance which may be a set of balls, water or air trapped
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within it. The simple working of a spirometer is that a patient or the subject under

observation blows air into or out of the device using the mouthpiece. The healthcare

professional then takes a reading depending on what the either Spirometer was measuring

either lung volumes or respiratory speed (Cairo, 2013).

Pulmonary Function Tests

Pulmonary function tests provide a quantitative assessment of lung function after

encompassing a myriad of specific measurements that range in complexity. Some tests are

easily completed at the bedside whereas others require more specialized conditions and

environments to ensure validity and reliability of the results. Spirometry in normal ambient

conditions like the office can be utilized to screen for abnormalities of airflow or lung

volume, to test for the responsiveness of a patient to bronchodilator medication, assess for

responsiveness to treatment of other pertinent respiratory conditions like asthma and chronic

obstructive pulmonary diseases. Scholars and other healthcare research scientists recommend

the use of Spirometry as an early screening tool for pulmonary obstruction in at-risk patient

groups like tobacco smokers and other drug users (Peters, Kaminsky & Maksym, 2019).

Testing in the laboratory or designated stations allow for a respiratory therapist to further

classify and quantify lung conditions by adding data gleaned from more sophisticated

instruments.

The most common measurement that a Spirometer produces is the lung capacities of a

patient. Lung capacities are several and depending on the aim of the test, and they can be;

forced vital capacity (FVC), forced expired volume (FEV), tidal volumes (VT), inspiratory

capacity (IC), and expiratory reserve volume (ERV), among other subdivisions. The basis of

all pulmonary function tests lies in recording air flow rates against the time that a patient

spends for total respiration. Vital capacity (VC), is one of the most important measurements
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that a Respiratory Therapist focuses on in a patient. Simply put, VC is the total amount of air

that a person can retain in the lungs after a maximal inhalation and a forced maximal

exhalation. The Respiratory Therapist attains the result by getting the patient to inhale as

much volume of air as they can and then asking them to exhale forcefully as much as they

can. The final reading after this process is the VC. In measuring the VC, the forced vital

capacity (FVC), total lung capacity (TLC) and residual volume (RV) can also be measured.

RV is the amount of air that remains in the lungs after a standard inspiratory and expiratory

maneuver. Total lung capacity, on the other hand, is the maximum amount of air that one can

contain after a forced inhalation (Landsberg, 2018). Additionally, in measuring the VC,

specific changes take place in the thoracic cavity. These changes in pressure cause an

exertion on the surrounding tissues, and this becomes the measurement of the lung recoil

pressure; the ability of the lungs to withstand compression from within and without.

A pulmonary function laboratory has advanced Spirometry equipment which has a

range of diagnostic capabilities. This equipment can measure lung volumes, assess gas

exchange in the alveoli, test for gas distribution and estimate the diffusing capacity of various

gases in the lungs. The other tests of pulmonary function come in the form of prethoracotomy

evaluation, assessment of upper airway obstruction, cardiopulmonary exercise response, and

bronchoprovocation challenge testing. These tests measure various diseases and disorders of

the respiratory system through the use of more advanced Spirometers fitted with sophisticated

sensors (Merghani, 2017).

The pulmonary tests mentioned above can also be adapted to be interventional. The

implication of this is that patients diagnosed with pulmonary conditions have reduced lung

capacities and thus, need exercise to return their lung capacities to the optimum level. Thus

comes in the incentive spirometer which is a variant of the diagnostic spirometer which is

used by the patient and sometimes in conjunction with the Respiratory Therapist to increase
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the lung capacity by blowing through the mouthpiece. Some Spirometers allow for bi-

directional flow (Cairo, 2013). Hence, the patient can blow in and out through the device and

at the end, measure their inspiratory and expiratory capacities.

Conclusion

Spirometry is a simple test of lung function which is not only easy to use but also

relevant in the diagnosis of pulmonary disorders. The ease of use of the device makes it a

favorite tool for Respiratory Therapists around the world; it is both cheap and portable and

hence, doubles as a convenient diagnostic and interventional device. With the contemporary

discoveries advanced in the field of Respiratory Care, advancements in the technique of use

and design of Spirometers is bound to take place. These advances are indeed the way forward

as it ensures that respiratory conditions are caught at an early stage and consequently, their

management becomes more accessible and less costly.

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References

Cairo, J. M. (2013). Mosby's Respiratory Care Equipment. St. Louis, MO: Elsevier Health

Sciences.

Landsberg, J. W. (2018). Pulmonary function testing. Clinical Practice Manual for

Pulmonary and Critical Care Medicine, 22-35. doi:10.1016/b978-0-323-39952-

4.00003-2

Merghani, T. (2017). Patterns of spirometry in asthmatic patients presenting with respiratory

symptoms. International Journal of Medical Science and Public Health, 6(2), 1.

doi:10.5455/ijmsph.2017.27082016618

Peters, U., Kaminsky, D. A., & Maksym, G. N. (2019). Standardized Pulmonary Function

Testing. Lung Function Testing in the 21st Century, 5-23. doi:10.1016/b978-0-12-

814612-5.00002-6