Spirometry for Primary Care Physician Office

Spirometry for the Primary
Care Physicians Office
Randy Clare
Respiratory Diagnostics
2016

Spirometry
© 2015 CareFusion Corporation or one of its subsidiaries. All rights reserved.
• Spirometry (spy-ROM-uh-tree) is a common
office test used to assess how well your lungs
work by measuring how much air you inhale, how
much you exhale and how quickly you
exhale. Spirometry is used to diagnose asthma,
chronic obstructive pulmonary disease (COPD)
and other conditions that affect breathing.
http://www.mayoclinic.org/tests-procedures/spirometry/basics/definition/prc-20012673

Asthma
• Asthma (AZ-ma) is a chronic (long-term) lung disease
that inflames and narrows the airways. Asthma causes
recurring periods of wheezing (a whistling sound when
you breathe), chest tightness, shortness of breath,
and coughing. The coughing often occurs at night or
early in the morning.
• Asthma affects people of all ages, but it most often
starts during childhood. In the United States, more
than 25 million people are known to have asthma.
About 7 million of these people are children –
NIH/NHLBI
http://www.nhlbi.nih.gov/health/health-topics/topics/copd

COPD
• COPD, or chronic obstructive pulmonary (PULL-mun-
ary) disease, is a progressive disease that makes it
hard to breathe. "Progressive" means the disease gets
worse over time.
• COPD can cause coughing that produces large
amounts of mucus (a slimy substance), wheezing,
shortness of breath, chest tightness, and other
symptoms.
• Cigarette smoking is the leading cause of COPD. Most
people who have COPD smoke or used to smoke.
Long-term exposure to other lung irritants—such as
air pollution, chemical fumes, or dust—also may
contribute to COPD. – NIH/NHLBI

Spirometry for Diagnosis of COPD
Spirometry measurements used for diagnosis of COPD
include:
• FVC (forced vital capacity): maximum volume of air that
can be exhaled during a forced maneuver.
• FEV1 (forced expired volume in one second): volume
expired in the first second of maximal expiration after a
maximal inspiration. This is a measure of how quickly the
lungs can be emptied.
• FEV1/FVC: FEV1 expressed as a percentage of the FVC,
gives a clinically useful index of airflow limitation.
The ratio FEV1/FVC is between 70% and 80% in normal
adults; a value less than 70% indicates airflow limitation and
the possibility of COPD. FEV1 is influenced by the age, sex,
height, and ethnicity, and is best considered as a percentage
of the predicted normal value.

4 Stages of COPD and Spirometric
Classifications
• Stage I: Mild COPD • Mild airflow limitation
(FEV1/FVC < 70%;
FEV1 > 80% predicted)
and sometimes, but not
always, chronic cough
and sputum
production. At this
stage, the individual
may not be aware that
his or her lung function
is abnormal.

Classifications
• Stage II: Moderate COPD • Worsening airflow
limitation (FEV1/FVC <
70%; 50% < FEV1 <
80% predicted), with
shortness of breath
typically developing
during exertion. This is
the stage at which
patients typically seek
medical attention
because of chronic
respiratory symptoms or
an exacerbation of their
disease.

Classifications
• Stage III: Severe COPD • Further worsening of
airflow limitation
(FEV1/FVC < 70%;
30% < FEV1 < 50%
predicted), greater
shortness of breath,
reduced exercise
capacity, and repeated
exacerbations which
have an impact on
patients’ quality of life.

Classifications
• Stage IV: Very Severe
COPD
• Severe airflow limitation
(FEV1/FVC < 70%; FEV1
< 30% predicted) or
FEV1 < 50% predicted
plus chronic respiratory
failure. Patients may have
Very Severe (Stage IV)
COPD even if the FEV1 is
> 30% predicted,
whenever this
complication is present.
At this stage, quality of
life is very appreciably
impaired and
exacerbations may be life
threatening.

How to perform a Spirometry Test
Pregame
• Calibration Of Spirometry equipment
• Collect biometric information
• Ready a supply of filters
• Describe the test to the patient
• Demonstrate the Spirometry maneuver

Daily Calibration of Spirometer
• The importance of
properly calibrated
spirometers has been
repeatedly Stressed by
the American Thoracic
Society (ATS)
• Calibration checks of the
flow sensor are needed to
verify spirometer
accuracy each day it is in
use. A 3.0 L calibration
syringe should be used
for this verification

Calibration Step By Step
• Select a calibration check@ from the menu of the spirometer
(so that the software does not apply a BTPS correction factor to
the results).
• First fill the syringe with air completely, then attach it firmly to
the flow sensor, and empty it smoothly and completely.
• End the maneuver carefully until a soft click is heard, meaning
that the syringe was emptied completely.
• Do not bang the syringe while emptying it, to avoid damage
• Refill with air, and then empty the syringe three times, each
time at a different speed: First, empty it in less than one
second (fast), next in 2 or 3 seconds (medium), and the third
time take about six seconds (slow).
• Count a-one-one-thousand, two-one-thousand@ etc, while
emptying the syringe, to gauge the speed of emptying.
• The resulting FVC for all 3 of these maneuvers should be
between 2.91 and 3.09 liters. Record all three results on the
daily worksheet or quality log.
http://www.cdc.gov/niosh/docs/2004-154c/pdfs/2004-154c-c
Centers for Disease Control. (n.d.). NIOSH Spirometry Training
Guide. Retrieved from http://www.cdc.gov/niosh/docs/2004-
154c/pdfs/2004-154c-ch3.pdf

Care and Feeding of a Cal Syringe
• Store the calibration syringe near the spirometer so
that the two devices remain at the same temperature.
• Store the syringe with the plunger pushed all the way
in.
• Take care not to drop the syringe.
• Don’t loosen the metal rings on the shafts, since this
will disrupt the factory calibration. Periodically check
the syringe for leaks by filling with air, holding your
palm against the outlet snout, and trying to empty the
syringe. If any air is expelled with the outlet plugged,
the syringe has a leak and must be repaired.
• A dropped or damaged syringe should be considered
out of calibration until it is checked by the factory

Biometric Calculations
• Measure Height Accurately.
Predicted FVC and FEV1 values
are greatly influenced by height.
• Standing height should be
measured to the nearest half
inch (or centimeter) in stocking
feet prior to administering the
first spirometry test.
• If the patient has obvious spinal
deformities, measure the arm
span from fingertip to fingertip
with arms outstretched against a
wall.
• Arm span should then be entered
into the spirometer in place of
standing height.

Avoid Cross-Contamination
• There have been no
documented cases of a
patient contracting a
respiratory infection from a
spirometer contaminated by a
previously tested patient.
• minimize the risk of cross-
contamination, always replace
the single use disposable
mouthpiece between patients.
• Routine hand-washing, proper
cleaning of permanent flow
sensors, and instructing
patients not to inhale from
the spirometer are equally
important precautions.

Explain the Procedure
• Explain to the patient that the
purpose of spirometry is to
determine how hard and fast air
can be exhaled.
• It should be “like blowing out
candles on a birthday cake.”
• The patient should inhale as
deeply as possible
• When the lungs are completely
full, quickly seal the lips around
the mouthpiece and exhale as
hard and fast as possible.
• Testing should be done in the
sitting position. If the patient
sniffs air through the nose at the
end of the test, use nose clips.
• Even better, just use nose
clips

Demonstrate the Maneuver
• Demonstrate the FVC spirometry
maneuver with a separate
mouthpiece or flow sensor.
• To emphasize that you are taking
a very deep breath, throw back
your shoulders, widen your eyes,
and stand on your toes.
• Next, stick out your tongue,
place the mouthpiece on top of
your tongue, and seal your lips
around it.
• Finally, dramatically BLAST out as
hard and as fast as possible for
at least 6 seconds.
• Your vigorous demonstration will
prevent time and effort from
being wasted on unacceptable
maneuvers.

Coach The Patient
• Ensure that the spirometer is
ready to record the FVC
maneuver.
• Coach the patient to take as
deep a breath as possible. Watch
to ensure that the patient inhales
deeply.
• Encourage the patient to keep
the chin up.
• Once he or she has sealed the
lips around the mouthpiece,
shout loudly, “BLAST out the air!”
• Tell the patient more quietly to,
“Keep going, keep going, blow
out a little more air.”
• Some spirometers will help you
by indicating with a graph or
tone that the patient is
continuing to exhale air toward
the end of the maneuver.

Recognize Poorly Performed
Breathing Maneuvers
• . As soon as a poorly performed
maneuver is detected (poor
inhalation or weak exhalation),
tell the patient to stop.
• Instruct the patient how to
perform the test better.
Demonstrate the correct
maneuver again.
• Prepare the spirometer to record
another maneuver. Tell the
patient to repeat the maneuver.
• The goal is to obtain three
acceptable FVC maneuvers with
the best two matching closely.
• If the goal is not reached after
eight attempts, end the test
session and suggest that
spirometry be rescheduled for
another day.

Primary Care
Physician
Spirometer
Devices

Vyntus SPIRO
• Use your Vyntus SPIRO
for all of the essential
spirometry testing:
• Flow/Volume-loop (FVC)
• Slow Vital Capacity (SVC)
• Maximum Voluntary
Ventilation (MVV)
• Pre and Post medication
testing or therapy control
• Bronchial Challenge
testing program

MicroLab spirometer
• MicroLab spirometer is highly
portable, allowing it to be used in
physicians' offices or for bedside
testing.
• Free downloadable bronchial
provocation PC software available
with full ATS/ERS protocols for
challenge testing, using the
MicroLab spirometer.
• Full flow volume and volume time
curves for on-screen inspection
of maneuvers and internationally
recognized, on-screen test
quality prompts.
• Built-in high resolution printer
with option to direct print to
external printers using USB
connection.

MicroLoop Spirometer
• Free downloadable bronchial
provocation PC software
available with full ATS/ERS
protocols for challenge
testing, using the MicroLoop
spirometer.
• Fully configurable, allowing
up to 41 indices to be
selected including, a choice
of predicted values and
languages.
• Full flow volume and volume
time curves for on-screen
inspection of maneuvers and
internationally recognized,
on-screen test quality
prompts.

Micro 1
• Measures FEV1, FVC, FEV6, PEF,
FEV1/FVC, FEV1/FEV6, F25-75.
• Choice of 4 indices can be
displayed.
• ATS/ERS 2005 Quality prompts
for each maneuver.
• NLHEP configuration mode.
• Current maneuver and Best
maneuvers available for viewing.
• Quick examination option for
quick patient testing.
• Predicted values displayed as
either % predicted or z score.
• Post bronchodilator option with
% change displayed.
• Remembers the last patient
tested to allow testing to
continue.
• Calibration check to verify device.

References
• For more information
◦ www.mdspiro.com
References
American Thoracic Society. (1993). Guidelines for the evaluation of
impairment/disability in patients with asthma. Am Rev Respir Dis. 147:1056-1061.
American Thoracic Society. (1991). Lung function testing: selection of reference values
and interpretive strategies. Am Rev Respir Dis. 144:1202-1218.
American Thoracic Society. (1995). Standardization of spirometry: 1994 update. Am J
Respir Crit Care Med. 152:1107-1136.
Centers for Disease Control. (n.d.). NIOSH Spirometry Training Guide. Retrieved from
http://www.cdc.gov/niosh/docs/2004-154c/pdfs/2004-154c-ch3.pdf
Oaklahoma Department of Human Services. (n.d.) Stages of COPD and Spirometric
Classifications. Retrieved from
http://advantage.ok.gov/CHCC/Publications/Spirometric%20Classifications%20of%20C
OPD.pdf

References
References
National Heart, Lung and Blood Institute. (2013). What is COPD? Retrieved from
Mayo Clinic. (2014). Tests and Procedures-Spirometry- Definition. Retrieved From
http://www.mayoclinic.org/tests-procedures/spirometry/basics/definition/prc-20012673

Spirometry for Primary Care Physician Office

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