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PubMed1982

Assessment of time-volume and flow-volume components of forced vital capacity. Measurement with spirometry, body plethysmography and respiratory inductive plethysmography in nonsmokers and smokers.

The purpose of this investigation was to assess the effectiveness of the time-volume and flow-volume components of the forced vital capacity measured by simultaneous spirometry, respiratory inductive plethysmography, and body plethysmography in detecting small airway disease. Spirometry measured the exit of gas from the lungs, whereas body plethysmography measured both the exit of gas and alveolar gas compression. Respiratory inductive plethysmography, which reflected change in thoracic volume, provided semi-quantitative data f both gas exit and alveolar gas compression which generally lay between spirometry and body plethysmography. In nine nonsmokers and 12 smokers (six with small airway disease as defined by abnormal closing volumes and alveolar uniformity), analysis of forced vital capacity revealed that the only test which differentiated nonsmokers from smokers was the higher spirometric estimation of maximum expiratory flow measured at 25 percent VC in nonsmokers. Combining flow measure at the mouth with volume referenced to change in alveolar gas volume as measured by body or respiratory inductive plethysmography did not differentiate nonsmokers from smokers. Moment analysis performed of forced vital capacity with all of the three devices did not distinguish nonsmokers from smokers. The data in this study and a review of other investigations indicate that the time-volume and flow-volume components of the forced vital capacity on air breathing are not very sensitive in detecting early lung disease in smokers.

Adolescent↗

PubMed1997

Office spirometry: equipment selection and training of staff in the private practice setting.

Spirometry is a basic pulmonary function test that is widely used for the detection of airflow limitation. Its use will continue to grow in the medical office setting because it is useful for both diagnostic and monitoring purposes. Additionally, the assessment of airflow reversibility is a quick, safe, and useful adjunct to baseline spirometry. Many manufacturers offer various models and types of spirometers. Before purchasing, determine the needs and characteristics of the office and its staff, and then choose an appropriate device. There is no "holy grail" for selecting what instrument is best for a specific office. Rather, it requires time and effort to make a good choice. Carefully assess the instrument before purchase and, ideally, compare several instruments. Once an instrument is purchased and it arrives, carefully validate it before reporting results. Proper training of the technicians who perform the testing is perhaps the most important factor in obtaining good spirometric testing. After adequate training, it is also important to have continued competency assessments, periodic inservices, and careful review of test results. The ATS and American Association for Respiratory Care (AARC) published extensive guidelines on the performance of spirometry. These recommendations should be followed to ensure quality and reduce interlaboratory variability. Patients should be properly prepared, the instrumentation properly calibrated, and the test conducted so that there is a good start, adequate exhalation time, satisfactory end-of-test, and good reproducibility between trials.

Age Factors↗

PubMed2004

Spirometry values in adults in northern Finland.

OBJECTIVES: If reference values do not accurately reflect the distribution of lung function in the population, the interpretation of spirometry results may be incorrect. Differences in lung function exist between populations, which supports the use of local reference values. In Finland, the national reference values for spirometry are currently in use. The aim of this study was to assess the correlation between measured spirometric values from healthy adults and the reference values used in Finland. METHODS: In the present population-based study, spirometry results were assessed in healthy adults aged 21 to 70 years in northern Finland. After exclusions for any chronic pulmonary disease or symptom, 206 men and 215 women remained in the group. We calculated regression equations for spirometric reference values in adults and compared these with European recommendations, and with the reference values currently used in Finland. RESULTS: These comparisons revealed large differences. The linear models do not take into account the physiological changes in both young and old adults and, thus, the reference values calculated according to the European recommendations differed from the real measured results at both ends of the 20- to 70-year age scale. Moreover, values from the logarithmic Finnish reference equations also diverged from our measurements; the differences were largest in subjects younger than 30, and in elderly men. CONCLUSION: Differences between populations and reference equations make international comparisons difficult, and divergence between reference values and real results may lead to incorrect clinical interpretation.

Adult↗

PubMed1997

The predictive value of spirometry. Identifying patients at risk for lung cancer in the primary care setting.

Spirometry can predict lung health and monitor disease and response to therapy. This noninvasive test can and should be done regularly by primary care providers. It can identify patients at risk for lung cancer as well as heart attack and stroke. Patients with abnormal spirometric findings can be warned that airflow obstruction has begun, which may provide the motivation to quit smoking. Abnormal spirometry measurements correlate with all-cause mortality. Approaches to early diagnosis of lung cancer continue to expand. For example, use of the new fluorescent bronchoscope can increase diagnostic accuracy in lung cancer by highlighting lesions that are malignant or likely to be malignant. For now, however, identification of airflow obstruction with spirometry and follow-up with sputum cytology provide the widest benefit.

Family Practice↗

PubMed2000

Spirometry in normal subjects in sitting, prone, and supine positions.

OBJECTIVE: Determine whether pulmonary function testing is affected by patient positioning. METHODS: In a descriptive study with measurements made in a sequential but randomized order at a university-based pulmonary function laboratory, 20 healthy men, ages 18-50 years, were evaluated with spirometric assessment of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and maximum voluntary ventilation (MVV) in the sitting, supine, and prone positions. Subjects were excluded for body mass index (BMI) > 30 kg/m2 or abnormal baseline spirometry. RESULTS: Comparing sitting to supine and prone positions, there was a statistically significant decline in the spirometry values (reported as percent of predicted normal +/- standard error of the mean). FVC was 102% +/- 4% while sitting, 95% +/- 4% while supine, and 94% +/- 4% while prone. FEV1 was 104% +/- 3% while sitting, 96% +/- 3% while supine, and 94% +/- 3% while prone. MVV was 115% +/- 4% while sitting, 102% +/- 4% while supine, and 97% +/- 3% prone. CONCLUSION: In healthy men with BMI < 30 kg/m2, changing from the sitting to supine or prone position results in statistically significant change in respiratory pattern. However, all spirometry values in each position were normal by American Thoracic Society definitions.

Adolescent↗

PubMed2000

Improving the quality of spirometry in an epidemiological study: The Renfrew-Paisley (Midspan) family study.

Population studies in Britain and elsewhere report deficiencies in quality of pulmonary function measurements. Methods were tested to improve the standardisation of spirometry in an epidemiological study. The spirometer provided visual feedback about acceptability and reproducibility to American Thoracic Society (ATS) standards. After 14 weeks technicians (research nurses) were given feedback and further training. Measurements were repeated in a 5% sample. Participant characteristics and technical factors (technician and technician feedback) predicted unacceptable forced expiratory volume in 1 second (FEV1) and excessively variable FEV1 and forced vital capacity (FVC). Only participant characteristics predicted unacceptable FVC. Feedback to technicians reduced test failure for FEV1 by half and excessive within-session variability by one-third. In the reproducibility study, coefficients of variation for FEV1 and FVC were 3%. Epidemiological studies can achieve standards of between-session reproducibility for spirometry comparable to levels reported by pulmonary function laboratories. Performance feedback to technicians improves the level of minimally acceptable spirometry, and within-session reproducibility.

Adult↗

PubMedDate not supplied

[Reproducibility of spirometry in Mexican workers and international reference values].

OBJECTIVE: To describe spirometric function and adjustment to foreign prediction equations in Mexican workers claiming work related disability. MATERIAL AND METHODS: We reviewed 5771 spirometries done at the Mexican National Institute of Respiratory Diseases performed with equipment and methods proposed by the American Thoracic Society. With the spirometries we generated multiple regression equations separated for men and women based on age and height, compared to other in common use reported by Knudson and Hankinson in North America and by Quanjer in europeans. RESULTS: 80% of the tests were reproducible for FVC and FEV1 according to ATS, whereas 10% were reproducible for neither. Mean FVC in men was 12% above values reported by Quanjer, 22% above Knudson, 3% above Hankinson and 6% above Rodriguez-Reynaga, whereas similar values for women were 18%, 10%, 0% and 1%. Excluding obese and those who had less than 2 acceptable maneuvers, the numbers increase by 1-2%. FEV1 was also above predicted. CONCLUSIONS: Most workers requesting disability are able to generate a reproducible spirometry. However for the same gender, age and height, workers had a FEV1 and a FVC above normal values reported by Knudson and Quanjer and are more similar to those reported by Hankinson in Mexican-Americans. While a set of appropriate reference values are obtained, regression equations obtained from the studied group will generate less error in the evaluation of disability in mexican workers. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Age Factors↗

PubMed2003

How to make sure your spirometry tests are of good quality.

Poorly performed spirometry greatly increases the risk of misinterpreting spirometry results. The most common cause of erroneous results is suboptimal patient coaching. Use exaggerated body language to demonstrate each of the 3 phases of the forced vital capacity (FVC) maneuver. The first phase of the maneuver (the maximally deep breath) is the most important and should receive the most emphasis. In the second phase (the blast) startle the patient to prompt maximum flow during the first second. In the third phase do not yell at the patient to keep blowing; instead, draw the patient's attention to the movement of the bell of the volume spirometer, the computer incentive display, or the audio tone of the flow-sensing spirometer, which shows that he or she is continuing to get some air out. Pay attention to the patient's body language as you coach him or her through the 3 phases. Facial expressions and body language are much more important than telling the patient what to do. Use the latest National Health and Nutrition Examination Survey (NHANES III) reference equations and the ratio of forced expiratory volume in the first second to forced expiratory volume in the first 6 seconds (FEV(1)/FEV(6)). Young, old, and sick patients can produce high-quality, reproducible pulmonary function test results. Grade pulmonary function test efforts with the scholastic grading system (A, B, C, D, and F). Implement a centralized spirometry quality assurance program. Test your spirometers daily. Be cautious in making corrections for body-temperature-and-pressure-saturated.

Humans↗

PubMed2005

Negative expiratory pressure in the assessment of bronchodilator response: comparison of spirometry and the interrupter method.

BACKGROUND AND PURPOSE: The negative expiratory pressure (NEP) method offers a simple and rapid assessment of expiratory flow limitation (EFL) during tidal respiration. This study compared the value of NEP in the assessment of the bronchodilator test (BDT) with those of spirometry and the interrupter method. METHODS: Thirty two patients referred to the lung function laboratory for BDT were investigated. All patients underwent spirometry, interrupter airway resistance (Rint) and NEP measurements in the sitting position before and after inhalation of 500 microg of terbutaline. A positive BDT was defined as an increase in the forced expiratory volume in 1 second (FEV1) of > or = 12%. RESULTS: The ratio of FEV1 to forced vital capacity (FVC) was less than 70% in 21 (65.6%) patients, but EFL as demonstrated by NEP (EFL-N) was present in only 10 patients (31.3%). The baseline EFL-N was only weakly correlated with FEV1 (r = -0.36, p = 0.04), but not with Rint or FEV1/FVC. Among the 14 patients with positive BDT results, the change in FEV1 was correlated with the change in Rint (r = -0.69, p < 0.01), but not with the change in EFL-N. CONCLUSIONS: These data suggest that, compared with spirometry and the interrupter method, NEP applied in the sitting position is not sensitive in the assessment of bronchodilator response in patients with obstructive airway disorders.

Aged↗

PubMed2005

Comparative analysis of the bronchodilator response measured by impulse oscillometry (IOS), spirometry and body plethysmography in asthmatic children.

BACKGROUND: Asthma is common among young children. The assessment of respiratory resistance by the impulse oscillometry system (IOS), based on the superimposition of respiratory flow by short-time impulses, requires no patient active collaboration. AIM: We evaluated the baseline repeatability and bronchodilator response of IOS indices in preschool children, their correlation with spirometry and whole body plethysmography, and differences between atopic and nonatopic children. PATIENTS AND METHODS: Thirty-three asthmatic children (3-6 yrs.) underwent IOS measurement (R5rs, R20rs and X5rs) by triplicate at the baseline, after placebo and after salbutamol inhalation. Spirometry (FEV1) and whole body plethysmography (sRaw) were made at the baseline and after salbutamol. Baseline within-test (coefficient of variation: CV%) and between-test repeatability (baseline-placebo) were addressed. Bronchodilator response was evaluated by the SD index (change in multiples of the between-test repeatability). RESULTS: Baseline repeatability for R5rs was 4.1%. Its values decreased by 2SD after salbutamol inhalation, and correlated with FEV1 and sRaw at both, baseline (r=-0.51 and r=0.49) and post-salbutamol (r=-0.63 and r=0.54). A trend towards correlation between salbutamol-induced changes in R5rs and in sRaw (r=0.33) was observed. Atopic and non-atopic children showed no differences in lung function. CONCLUSION: IOS was well accepted by young asthmatic children and provided reproducible and sensitive indices of lung function. Resistance values obtained by IOS at low frequency (R5rs) were reproducible and correlated with spirometry and plethysmographic values.

Airway Resistance↗

PubMed2005

Applicability of commonly used Caucasian prediction equations for spirometry interpretation in India.

BACKGROUND & OBJECTIVE: The applicability of Caucasian prediction equations in interpreting spirometry data in Indian patients has not been studied. The present study was undertaken to see if Caucasian and north Indian prediction equations can be used interchangeably while interpreting routine spirometric data. METHODS: Forced vital capacity (FVC), forced expiratory volume in first second (FEV(1)), and FEV(1)/FVC ratio were recorded from 14733 consecutive spirometry procedures in adults. Predicted values and lower limits of normality were calculated using regression equations previously derived at this centre, and four commonly used Caucasian equations described by Knudson, Crapo, European Community for Coal and Steel (ECCS) and the Third National Health and Nutrition Examination Survey (NHANES III). For men, 90 per cent of predicted values were also derived. Kappa estimates were used to study agreement, and Bland Altman analysis was performed to quantify differences, between interpretations from Indian and Caucasian equations. Receiver operating characteristic (ROC) curves were constructed to assess utility of using a fixed percentage of Caucasian predicted values in categorizing FVC or FEV(1) as abnormal. RESULTS: The use of Caucasian prediction equations (and 90% of predicted values in men) resulted in poor agreement with Indian equation in most height and age categories among both men and women. Bland Altman analysis revealed a large bias and wide confidence limits between Caucasian and Indian equations, indicating that the two cannot be used interchangeably. ROC analysis failed to yield good results with use of any single fixed percentage of Caucasian predicted value while categorizing FVC or FEV(1). INTERPRETATION & CONCLUSION: Our results showed that the use of Caucasian prediction equations, or a fixed percentage of their predicted values, resulted in misinterpretation of spirometry data in a significant proportion of patients. There is a need to assess performance of more than one regression equation before choosing any single prediction equation.

Adolescent↗

PubMed2006

Screening spirometry to detect respiratory allergy.

BACKGROUND: Recently, it has been evidenced that the forced expiratory flow at the 25 and 75% of the pulmonary volume (FEF25-75) might be considered as a possible marker of early bronchial impairment in patients with allergic rhinitis alone. OBJECTIVES: The aim of this study was to determine whether a spirometric impairment may predict allergy during screening visit. METHODS: The study included 283 Navy soldiers (255 males, mean age 27.1 + 8.2) who had to undergo spirometry for attending specific courses. Fifty-four showed slight spirometric anomalies. Thus, they referred to Navy Hospital of La Spezia for standardized tests: skin prick test, spirometry, and methacholine bronchial challenge. RESULTS: Forty seven (87%) subjects were sensitized (47% monosensitized and 53% polysensitized). Allergic rhinitis was diagnosed in 25 subjects with median nasal TSS 5. FVC and FEV1 values were normal, whereas FEF25-75 values were reduced (61.8 + 14.8 % of predicted), bronchodilation test was significant for FEF25-75 (82.9 + 16.8% of predicted; p<0.001) only. Bronchial hyperreactivity (BHR) was detected in 28 subjects, all but 1 were sensitized. CONCLUSIONS: This study provides evidence, relevant to clinical care, that mild spirometric impairment may generate the suspect of allergic disorders, thus spirometry could be more frequently performed in general population screening.

Adult↗

PubMed1989

[Postoperative respiratory therapy using incentive spirometry].

The optimal methods of prophylaxis and therapy of postoperative respiratory complications in surgical patients are still open to discussion. In spite of numerous recent clinical investigations, there is still no specific and universally acceptable therapeutic concept. In our department, we identify patients at risk of pulmonary complications by adequate screening, i.e. medical history, physical examination, chest X-ray, and spirometry. In the postoperative period there are a sequence of stages starting with early mobilization, respiratory therapy (including incentive spirometry and IPPB), and when necessary, controlled mechanical ventilation. We have measured and documented the flows and volumes required of patients using various types of incentive spirometer. In addition, we review on the literature and describe our experience with the technique, handling, and organization of sustained maximal inspiration (SMI). After thoracic or major upper abdominal surgery, all lung volumes decrease due to impairment of rib cage movement, changes in chest wall muscle tone, an increase in lung recoil, and airway closure. At the end of each expiration some of the smallest airways collapse either partly or totally. This process continues to some extent until, normally, a deep breath recruits the alveoli. Sighs to the limit of total lung capacity or oscillations of the expiratory baseline ought to be responsible for this effect in healthy humans; the same purpose is intended in incentive spirometry. For this therapy, it is mandatory that the central airways are not occluded by mucus and that the patient is able to breath volumes exceeding his normal tidal volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed1986

Prediction of ventilatory function after subtotal lung resection using preoperative dynamic spirometry and radiospirometry.

In 36 patients undergoing subtotal lung resection for a peripheral lung tumour (N = 20) or an inflammatory disease (N = 16) the postoperative FEV1 and VC of the operated lung were predicted on the basis of preoperative spirometric and radiospirometric studies and the number of pulmonary segments resected. For comparison, preoperative lung function studies were used in two different ways for the prediction: 1) Preoperative dynamic spirometry alone, 2) Preoperative dynamic spirometry plus radiospirometrically determined distributions of ventilation (V), perfusion (Q) and VC. The actual postoperative FEV1 and VC correlated well with the predicted values calculated from preoperative dynamic spirometry alone (r = 0.90 and 0.86, respectively). The use of the preoperative V, Q and VC proportions of the resected lung determined radiospirometrically did not improve the prediction. The results of our study suggest that preoperative radiospirometry is not always necessary for patients having a small peripheral lesion treated by subtotal lung resection.

Adult↗

PubMed1986

Spirometry as a preoperative screening test in morbidly obese patients.

We performed spirometry on 114 morbidly obese patients considered for gastric bypass surgery to assess its efficacy as a preoperative screening test. One hundred eight subjects underwent surgery, and 61 patients returned for repeat spirometry 1 year later. The average preoperative forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and mid flow (FEF25-75%) were 100% of predicted. Spirometry identified no more of our obese subjects as abnormal than would have been identified in a group of healthy, nonobese individuals. Each surgical case was reviewed. An abnormal preoperative spirogram did not identify the patients who experienced postoperative complications. Weight loss was associated with very small increases in FVC (300 ml) and FEV1 (245 ml). Preoperative spirometric testing is not indicated in morbidly obese patients with no other identifiable risk factors for postoperative respiratory complications.

Adult↗

PubMed1981

Incentive spirometry. Prevention of pulmonary complications after abdominal surgery.

The postoperative period after laparotomy is characterized by a decrease in pulmonary volumes combined with a maldistribution of the ventilation and the perfusion. Together with manual techniques, intermittent pressure breathing and incentive spirometry have been suggested to maintain open alveoli and to prevent atelactasissis. The shortcomings related to the use of pressure-controlled devices include patient's resistance to the technique, overinflation of normal alveoli, excessive total ventilation, decrease in venous return and various gastrointestinal side effects. The incentive spirometry has been designed to promote sustained maximal inspirations and reproduce sighing mechanisms. The decrease in pleural pressure can result in high transpulmonary pressures. For many investigators, incentive spirometry represents a very easy and efficient method to prevent atelectasis.

Abdomen↗

PubMed1982

Influence of incentive spirometry on pulmonary volumes after laparotomy.

Twenty patients undergoing an upper abdominal procedure were randomly assigned in two groups. One group was treated with both chest physical therapy and incentive spirometry and the other was treated with chest physical therapy alone. Spirometric values, respiratory rate, tidal volume and vital capacity were determined during the postoperative course. We observed that patients treated with incentive spirometry bad a faster return to preoperative pulmonary volumes. This observation confirms the prophylactic role of incentive spirometry in the prevention of pulmonary complications after laparotomy.

Adult↗

PubMedDate not supplied

[Comparative study of plethysmography and spirometry in asthmatic children].

The aim of the study was to evaluate the results of plethysmography in comparison to spirometry. A retrospective study of pulmonary function tests was performed in 50 asthmatic children, 6 to 15 years old, free of acute symptoms. Mild airway obstruction was found in 8 spirometries, while the other 42 were found within normal limits. In the plethysmography, obstruction was found in 27 cases, 23 without abnormalities in resistance or specific conductance. Eleven cases suggested pulmonary air trapping and/or hyperinflation. Airway obstruction was evident in 54% of plethysmographies. The difference between both studies was significant, also as well as the airway obstruction and intensity of the clinical disease. We therefore conclude that the plethysmography shows more alteration in their parameters than spirometry for the detection or suggestion of airway obstruction in asthmatic children during asymptomatic periods.

Adolescent↗