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SPIROMETRY

What is Spirometry?
Spirometry assesses lung function.
Effective for differentiating obstructive from non-respiratory
disease.

Devices used in practice have many advantages Cheap,


small, portable, readily available (calibration important).

Health professionals involved in care of people with


obstructive airway disease => access + competent in
interpretation (NICE Guidelines 2004).

Ref: https://www.nice.org.uk/guidance/cg101/chapter/1-
guidance#diagnosing-copd
Why Spirometry?
Measure airflow obstruction, helps definitive diagnosis.
Grades severity.
Detect airflow obstruction in smokers.
Monitor disease progression + prognosis in COPD.
Pre-operative assessment.
Indications for Spirometry
Patients with undiagnosed respiratory symptoms.
Patients with suspected COPD (smokers).
Monitoring Txt.
NICE 2004: > 35yrs, smoking status, cough, chronic bronchitis.
Ref: http://www.thepcrj.org/journ/vol18/18_3_130_147.pdf
Contraindications
Haemoptysis.
Pneumothorax.
Unstable cardiovascular status.
Myocardial Infarction.
Thoracic, abdominal or cerebral aneurysms.
Spirometry Testing
Biometric Measurments.
Attach device.
Instruction to patient.
Set at current repeatability standards.
Ref: http://www.spirxpert.com/performing2.htm
Standard Spirometric
Indices
FEV1 - Forced expiratory volume in one second.
FVC - Forced vital capacity.
FEV1/FVC ratio.
Normal values depend on height, age.
Ref: http://vitalograph.co.uk/resources/spirometry-normal-
values.
COPD Diagnosis
NICE recommendations =>
https://www.nice.org.uk/guidance/cg101/chapter/1-
guidance#diagnosing-copd

FEV1 80% predicted normal + Resp sxs = COPD.


COPD confirmed by postbronchodilator FEV1/FVC < 0.7
Post-bronchodilator FEV1/FVC measured 15 minutes after
400g salbutamol or equivalent.

Consider alternatives in:


a) Elderly without COPD Sxs + FEV1/FVC ratio < 0.7

b) Younger people with COPD Sxs + FEV1/FVC ratio 0.7


Spirometric Classification of COPD Severity Based on Post-bronchodilator FEV1

Ref: http://www.goldcopd.com/Guidelineitem.asp?l1=2&l2=
1&intId=989
Asthma Diagnosis
Spirometry-based diagnosis (may be falsely negative in a
patient who is well at time of assessment).

>400 ml increase in FEV1 post-bronchodilator.


FEV1/FVC < 70% = an obstructive picture (Asthma or COPD) but
in asthma there is reversibility in the lung function.

Ref: https://www.brit-thoracic.org.uk/document-
library/clinical-information/asthma/btssign-guideline-on-the-
management-of-asthma/
Thank You