SPIROMETRI

ANDREW SANTOSA
DEFINISI
• SPIROMETRI ADALAH SUATU METODE UNTUK MENILAI FUNGSI
PARU DENGAN CARA MENGUKUR VOLUME UDARA YANG DAPAT
DIKELUARKAN DARI PARU OLEH PASIEN SETELAH INSPIRASI
MAKSIMAL

The air flows into the thorax (inspiration) and the air

Ventilation move out to the atmosphere (expiration)

Diffusion Oxygen and Carbondioxide changing between alveoli

and blood (capillaries)

Perfusion Blood flows to tissue and organs.

VOLUME DAN KAPASITAS PARU

Source : Tortora 3
  The flow volume loop

FLOW VOLUME DIAGRAM  illustrates the relationship between flow &

volume
 Maximal effort
 maximal inspiration to maximal expiration
(positive) & maximal expiration to maximal
inspiration (negative)

VC RV
6
RV

VOLUME (LITER)
NORMAL

4 FEV 1FEV 1/FVC = 4/5 = 0,8 = 80 %

EKSPIRASI
FLOW

FVCTLC
6 4 2 VOLUME
0 2
INSPIRASI
TLC
TIME
1 6 12 (DETIK)
Graham BL, Steenbruggen I, et al. (2019) Standardization of Spirometry 2019 Update. American Journal of Respiratory and Critical Care Medicine. 200(8):e70-
e88.
 FLOW - VOLUME DIAGRAM

Add a Footer 5
INDIKASI & KONTRAINDIKASI

Graham BL, Steenbruggen I, et al. (2019) Standardization of Spirometry 2019 Update. American Journal of Respiratory and Critical Care Medicine. 200(8):e70-
e88.
 PERSIAPAN PASIEN
• MEMAKAI PAKAIAN YANG NYAMAN
• HINDARI LATIHAN BERAT SEBELUM
DILAKUKAN TES
• HINDARI MAKAN TERLALU KENYANG
SEBELUM TES
• POSISI SUBJEK DAPAT DUDUK ATAU BERDIRI
• HENTIKAN MEROKOK 1 JAM SEBELUM TES
• OBAT SEPERTI BRONKODILATOR DIHENTIKAN
SESUAI PETUNJUK DOKTER

Graham BL, Steenbruggen I, et al. (2019) Standardization of Spirometry 2019 Update. American Journal of Respiratory and Critical Care Medicine. 200(8):e70-
e88.
HOW IS SPIROMETRY PERFORMED

Jeffrey M. Haynes, Gregg L. Ruppel, Matthew J. O’Brien. (2020) Calibration Myths in the 2019 American Thoracic Society/European 8
Respiratory Society Spirometry Technical Standards. American Journal of Respiratory and Critical Care Medicine . 14-Jul-2020.
 HOW TO DO SPIROMETRY

1. With-holding Medications Before performing spirometry, withhold:

• Short acting β2 - agonists for 6 hours
• Ipratropium for 6 hours
• Long acting β2 - agonists for 12 hours
• Tiotropium for 24 hours

2. Preparation
• Explain the purpose of the test & demonstrate the procedure
• Record the patient’s age, height and gender
• Note when bronchodilator was last used
• The patient sits comfortably
• Loosen any tight clothing
• Empty the bladder
• Breath in until the lungs are full

9
American Thoracic Society/European Respiratory Society Spirometry Technical Standards. American Journal of Respiratory and Critical Care Medicine 202:2, 304-304. Online publication date: 14-Jul-2020.
 PREPARATION (CON’T)

• HOLD THE BREATH & SEAL THE LIPS TIGHTLY IN MOUTHPIECE

• BLAST THE AIR OUT AS FORCIBLY AND FAST AS POSSIBLE.
• CONTINUE BLOWING UNTIL THE LUNGS FEEL EMPTY
• WATCH THE PATIENT DURING THE BLOW
• CHECK TO DETERMINE IF AN ADEQUATE TRACE HAS BEEN
ACHIEVED
• REPEAT UNTIL 3 READINGS VALID DATA.

Add a Footer 10
American Thoracic Society/European Respiratory Society Spirometry Technical Standards. American Journal of Respiratory and Critical Care Medicine 202:2, 304-304. Online publication date: 14-Jul-2020.
 KELAINAN PARU OBSTRUKSI / RESTRIKSI

• GANGGUAN VENTILASI TERDIRI ATAS GANGGUAN RESTRIKSI DAN

OBSTRUKSI
• KELAINAN RESTRIKSI DAPAT BERUPA KELAINAN PADA: PARENKIM
PARU (TUMOR PARU, PNEUMONIA, ABSES PARU, EDEMA PARU,
ATELEKTASIS, FIBROSIS PARU), PLEURA (EFUSI PLEURA,
PNEUMOTORAKS, TUMOR PLEURA), DINDING/TULANG DADA
(FRAKTUR IGA, OBESITAS, PEKTUS EKSKAVATUS, SKOLIOSIS, KIFOSIS,
GIBBUS)
• KELAINAN OBSTRUKSI BERUPA ASMA, BRONKITIS KRONIK, DAN
EMFISEMA
Bakhtiar A, Amran WS (2016) Faal Paru Statis. Jurnal Respirasi (JR). 2(3):91-98.
KELAINAN PARU OBSTRUKSI / RESTRIKSI

Bakhtiar A, Amran WS (2016) Faal Paru Statis. Jurnal Respirasi (JR). 2(3):91-98.
 SPIROGRAM PATTERN

Add a Footer 13
Deborah Leader, RN . An Overview of Obstructive vs. Restrictive Lung Diseases. 2020.
RESTRICTIVE & OBSTRUCTION

141127.
Ming-Lung Chuang. (2020) Combining Dynamic Hyperinflation with Dead Space Volume during Maximal Exercise in Patients with Chronic Obstructive Pulmonary Disease. Journal of Clinical Medicine 9:4,
 PENILAIAN HASIL SPIROMETRI

• AKSEPTIBILITAS/ACCEPTABILITY
PEMERIKSAAN YANG DAPAT DITERIMA APABILA: TES DILAKUKAN
SAMPAI SELESAI, WAKTU EKSPIRASI MINIMAL 6 DETIK, PERMULAAN
TES HARUS CUKUP BAIK, KURVANYA JUGA DILIHAT.
• REPRODUKSIBILITAS/REPRODUCIBILITY
DITENTUKAN SETELAH DIDAPATKAN 3 MANUVER YANG DAPAT
DITERIMA. KVP REPRODUKSIBEL BILA ANTARA 2 NILAI TERBESAR
TERDAPAT PERBEDAAN KURANG DARI 5% KVP TERBESAR / KURANG
DARI 100 CC DAN PERBEDAAN 2 NILAI VEP1 TERBESAR KURANG DARI
5% VEP1 PALING BESAR / KURANG DARI 100 CC

Bakhtiar A, Amran WS (2016) Faal Paru Statis. Jurnal Respirasi (JR). 2(3):91-98.
 ABNORMAL RESULT (ACCEPTABLE &
UNACCEPTABLE)

16
Brendan G Cooper, James H Hull, Julie K Lloyd. (2020) ARTP statement on pulmonary function testing. BMJ Open Respiratory Research 7:1, e000664. Online publication date: 5-Jul-2020.
 REPRODUCIBILITY CRITERIA
(BETWEEN MANEUVER CRITERIA)

• AFTER 3 ACCEPTABLE SPIROGRAMS HAVE BEEN OBTAINED,

APPLY THE FOLLOWING TESTS:
• ARE THE TWO LARGEST FVC WITHIN 0.2 L OF EACH OTHER?
• ARE THE TWO LARGEST FEV1 WITHIN 0.2 L OF EACH OTHER?

• IF THESE CRITERIA ARE NOT MET, CONTINUE TESTING UNTIL:

• THE CRITERIA ARE MET WITH ANALYSIS OF ADDITIONAL
ACCEPTABLE SPIROGRAMS, OR
• A TOTAL OF 8 TESTS HAVE BEEN PERFORMED, OR
• THE PATIENT CANNOT OR SHOULD NOT CONTINUE
• SAVE AT A MINIMUM THE THREE BEST MANEUVERS
17
Source: Arief Bakhtiar, Wirya Sastra Amran Departemen Pulmonologi dan Ilmu Kedokteran Respirasi, Fakultas Kedokteran Universitas Airlangga/RSUD Dr. Soetomo. 2016
TERIMA KASIH