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Why do Spirometry?

Why do Spirometry?. Farah Madhani-Lovely, MD Pulmonologist/Intensivist Oct 24 th 2007. Objectives. Aware of current guidelines in use of spirometry Understand the use of spirometry in diagnosis of pulmonary disease Understand the use of spirometry in management of pulmonary disease

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Why do Spirometry?

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  1. Why do Spirometry? Farah Madhani-Lovely, MD Pulmonologist/Intensivist Oct 24th 2007

  2. Objectives • Aware of current guidelines in use of spirometry • Understand the use of spirometry in diagnosis of pulmonary disease • Understand the use of spirometry in management of pulmonary disease • Occupational use of spirometry • Contraindications of spirometry • Introduction to spirometry

  3. Current Guidelines • Lung function testing is a measure of global health • Change in lung function correlates with increased risk of: • Lung Cancer • CAD • CHF • Stroke • Other heart and blood vessel disease Ferguson et al. CHEST 2000;117:1146-1161

  4. Indications • To evaluate symptoms and signs of lung disease • To assess the progression of lung disease • To monitor the effectiveness of therapy • To evaluate preoperative patients • Screen people at risk of pulmonary disease • To monitor for potentially toxic effects of certain drugs/chemicals

  5. Current Guidelines • Early identification of lung abnormalities is related to improved • Smoking cessation rates • Occupational changes • Environmental changes • Vocational changes Ferguson et al. CHEST 2000;117:1146-1161

  6. Diagnosing and management of pulmonary diseases • COPD • Asthma • Restrictive lung disease

  7. COPD • 4th leading cause of death • COPD is the cause of: • 100000 deaths/yr • 550,000 hospitalizations/yr • 16 million hospital visits/yr

  8. Spirometry and COPD • Diagnosis of COPD • Many smokers have quit once knowing their spirometry data • Clotet et al. Archives of bronchology. 2007 • Evaluates prognosis in COPD patients

  9. Symptom Improval

  10. FEV1 ScaleCOPD Risk and Smoking Cessation

  11. Facts • Nationally, lung cancer is the leading cause of cancer death among American Indians and Alaska Natives • 1/5 of the deaths in the United States are smoking related. • Cigarette smoking = 10x risk of dying from chronic obstructive lung disease. • Cigarette smoking causes 87 percent of lung cancer deaths and is responsible for most cancers of the larynx, oral cavity and pharynx.

  12. Lung Cancer Distribution

  13. Asthma • Diagnosis of asthma • Guidelines by NHBLI • Measurement of severity of asthma • Response to medications

  14. Classification of Asthma Severity

  15. Restrictive Pulmonary Disease • Extraparenchymal Disease • Chest wall deformity (kyphoscoliosis) • Neurological disorder (myasthenia gravis) • Muscular disease (myopathy) • Abdominal pressure (ascites, obesity) • Pleural Disease (effusion, fibrothorax)

  16. Restrictive Pulmonary Disease • Pulmonary parenchymal disease • Pulmonary fibrosis • Pneumoconiosis • Granulomatous dz(Sarcoidosis) • Vasculitis

  17. Occupational screening • Lung disease associated with occupation • Lung cancer • Occupational asthma • Asbestosis • Mesothelioma • Byssinosis • Coal workers’ pneumoconiosis • Silicosis • Hypersensitivity pneumonitis

  18. Contraindications • Patient in respiratory isolation • Inability to cooperate or sit up straight • Acute illness • Acute coronary syndrome • Pneumonia • Chest pain • Current tracheostomy

  19. Clinic set up • Accurately measure FEV1 and FVC • Daily caliberation • Quality control • Must be acceptable • Must be reproducible

  20. Spirometry • Measurement of air movement in and out of the lung during different respiratory maneuvers. • Values measured are: • FVC: Forced Vital Capacity • FEV1: The forced expiratory volume in one second • MVV: Maximum Voluntary Ventilation

  21. FEV1 & FVC • Forced expiratory volume in 1 second • 4.0 L • Forced vital capacity • 5.0 L • usually less than during a slower exhalation • FEV1/FVC = 80% FEV1 FVC

  22. Coaching a patient

  23. Unacceptable spirometry Uptodate.com

  24. Spirometry in different lung diseases

  25. Obstructive Airway Disease • Obstruction • FEV1 < 80% predicted • FEV1/FVC < 70%

  26. Restrictive Lung Disease • VC, FRC, TLC < 80% • FEV1/FVC = Normal • Pseudorestriction • NMDz • Obesity

  27. FLOW-VOLUME CURVE in respiratory patients • Restrictive disease •  expansion of the lung • e.g., interstitial fibrosis • Obstructive disease •  resistance to airflow • e.g., COPD, asthma  FEV1  FVC

  28. Summary • Spirometry is used to diagnose and manage patients with: • COPD • ASTHMA • OCCUPATIONAL LUNG disease • Knowledge of lung function helps in smoking cessation • Spirometry i.e. lung function is an assessment of global health

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