Spirometry. â€œSpiroâ€ â€“ from the greek for breathing â€œMetryâ€ â€“ measurement â€œSpirometryâ€ â€“ The measurement of breathing. SPIROMETRY. SPIROMETRY.
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“Spiro” – from the greek for breathing
“Metry” – measurement
“Spirometry” – The measurement of breathing
NICE (2004) – all health professionals managing patients with COPD should have access to spirometry and be competent in the interpretation of the results.
Spirometry can be performed by any health care worker who is appropriately trained and who keeps his or her skills up to date
Spirometry services should be supported by quality control processes
NICE 2004 R12
In most patients, routine spirometric reversibility testing is not necessary as a part of the diagnostic process or to plan initial therapy with bronchodilators or corticosteroids. It may be misleading or unhelpful because
History is Key in distinguishing asthma from COPD
To withhold or not to withhold medication?
If you are doing reversibility testing:
For routine monitoring of COPD patients:
VC – Vital capacity, the total amount of air that acn be expelled from the lungs from full inspiration to full expiration
FVC – Forced vital capacity, should be the same volume as VC but is sometimes reduced due to air trapping in COPD
FEV1 – Forced expiratory volume in one second from full inspiration
FEV1/FVC or FEV1% or FEV1/FVC ratio –The percentage of the FVC that is produced in the first second
Who should not perform spirometry?
The VC is a non forced measurement. It is often measured at the start of a session.
The most common reason for inacurate results is patient technique
Common problems include:
Is the test valid?
Predicted values are the mean values obtained from the survey
No surveys conducted in elderly populationsPredicted Normal values
Actual Measurement x100
Predicted FEV1 = 4.0 litres
4 x 100 = 100%
Actual FEV1 x100
e.g. FEV1 = 3.0 litres
FVC = 4.0 litres
3 x100 =75%
Pneumoconiosis (coal workers, asbestosis, silicosis, siderosis)
Pulmonary oedemaRestrictive defectsPulmonary causes
Deliver high concentration of drugs directly to lungs & bronchioles while reducing systemic side effects
Clean no more than monthly as more frequent cleaning affects performance (due to a build up of static)
Clean with water and washing up liquid and leave to air dry
Wipe mouthpiece clean of detergent before use
NOTE – Volumatic (large volume) spacer was discontinued in October 2005 and reintroduced in Feb 2006. (think patient choice/cost/ability to use)
100/6, 200/6, 400/12
Other drugs available in the turbohaler
4.Remove the inhaler from your mouth, before breathing out. Replace cover
3.Exhale, but not throughthe mouthpiece. Then inhale through the mouthpiece forcefully and deeply
2.Hold the inhaler upright and turn the grip as far as it will go in both directions (this needs to be carried out twice if using the TBH for the first time)
1.Unscrew and lift off the cover
NICE Guidelines (Thorax 2004)