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PubMed1996

[Compliance with the "recommendations SEPAR" on spirometry].

The objective of this study was to assess Spanish performance of spirometry and to determine the extent to which practice is in accordance with the 1985 SEPAR recommendations. To that end we formulated a questionnaire with 31 items in two sections, 10 covering basic aspects of compliance with necessary techniques and 21 general questions. The questionnaire was sent to all SEPAR members. One hundred eight responses were received. The results show that the typical spirometric measurement was forced expiration without a bronchodilator test by way of a pneumotacograph, with simultaneous representation of the flow/volume curve. Calibration, when performed, is done daily with a 3 1 syringe and atmospheric data are checked. Spirometric measurements are usually obtained by a registered nurse, who also collects anthropometric data directly from the patient. The patient is usually seated with the nose occluded. At least three and at most eight satisfactory readings are obtained. The criteria for starting and ending the maneuver and the reference values used are those recommended by SEPAR. The equipment is washed weekly with soap and water; calibrations and equipment incidences are not recorded. The level of compliance with 1985 SEPAR norms for forced spirometry is adequate with respect to some technical equipment questions but deficient on basic procedure and quality control.

Data Collection↗

PubMed1999

Office spirometry: temperature conversion of volumes measured by the Vitalograph-R bellows spirometer is not necessary.

The aim of the present study was to investigate the relevance of BTPS (gas at body temperature, atmospheric pressure and saturated with water vapour) conversion of volumes measured with the Vitalograph bellows spirometer. The Vitalograph bellows were tested against a MicroMedical turbine spirometer in extreme temperatures (0-37 degrees C) using a biological control to deliver expired gas at BTPS. Before testing, it was shown that the accuracy of the DairyCard turbine was stable in the relevant temperature range. In a clinical trial six patients with emphysema performed home spirometry b.i.d for 1 month using both the Vitalograph and the turbine. Both the DairyCard and the Vitalograph showed stable accuracy at extreme temperatures when results were reported without any BTPS conversion. These findings were supported by the clinical trial but the conclusions from the clinical setting were weakened by the surprising fact that domiciliary temperatures showed almost no variation. We conclude that the Vitalograph bellows, during dynamic spirometry, measures expired volume at conditions closer to BTPS (than to ATPS) gas at ambient temperature, atmospheric pressure and saturated with water vapour). The use of the BTPS correction based on ambient temperature seems unjustified at office temperatures close to 23 degrees C and at extreme temperatures the conversion of volume will introduce significant over or underestimation.

Adult↗

PubMed2003

[Office spirometry].

Spirometry is a simple technique for assessment of pulmonary function. Analysis of airflow and lung volume recorded during standardized breathing maneuvers quantifies ventilatory limitation and classifies pulmonary function disturbances according to pathophysiological criteria. As an adjunct to clinical evaluation spirometry provides essential diagnostic and prognostic information for evaluation of cardio-pulmonary disorders, and for assessment of the course of lung diseases and their response to treatment.

Adult↗

PubMed1999

The relative importance of socio-economic status, parental smoking and air pollution (SO2) on asthma symptoms, spirometry and bronchodilator response in 11-year-old children.

The aim of this study was to evaluate the relative contribution of several risk factors to the prevalence of allergic respiratory symptoms, and the positivity of the bronchodilator test with fenoterol, and to establish the relative importance of these factors on the variability of FVC, FEV1, PEF, MEF25, MEF50 and MEF75. A total of 340 11-year-old children attending school in polluted and non-polluted areas of the city of Cartagena, Spain, were studied. The polluted area had had an annual mean of 75 microg/m3 of SO2 over the last 10 years and the non-polluted area had < 20 microg/m3 during this period. A questionnaire about allergic respiratory symptoms was completed by the parents. Specific questions about parental smoking habits and socio-economic level were included. Each child's performance in spirometry before and after administration of 0.2 mg of inhaled fenoterol was evaluated. The only significant predictive variables in the logistic regression (for suffering any symptom or a positive bronchodilator response) were male sex for nasal symptoms (RR 1.37; p = 0.04) and housing near heavy traffic for eye symptoms (RR 1.45; p = 0.01). Living in the polluted area reduced the risk of a positive bronchodilator response (RR 0.61; p = 0.004). Maternal smoking, even though not statistically significant, tended to increased the risk of suffering any symptom (RR 1.26; p = 0.07) or of having a positive bronchodilator response (RR 1.23; p = 0.1). None of the risk factors studied was of significant importance in explaining the variability of spirometry results. Although none of the risk factors were specifically determinant to the symptom questions, bronchodilator test or spirometric measurements, having a mother who smokes seems more important than living in a polluted area if statistically non-significant trends are considered.

Adult↗

PubMed2003

The use of nasal spirometry for the assessment of unilateral nasal obstruction associated with changes in posture in healthy subjects and subjects with upper respiratory tract infection.

Nasal spirometry was used to measure the effect of acute rhinitis associated with upper respiratory tract infection (URTI) on the changes in nasal airflow that occur with postural change. Results in 12 healthy subjects and 12 subjects with URTI were expressed as the nasal partitioning of airflow ratio (NPR), a new measure of nasal airflow. Values of NPR range from 0 (equality of airflow) to 1 (unilateral nasal obstruction). In subjects with URTI there was a significant change (P < 0.006) in the median NPR from 0.19 sitting to 0.87 supine, with five subjects having complete unilateral nasal obstruction. The change in the median NPR in the healthy subjects from 0.09 sitting to 0.13 supine was not significant. The results illustrate the incidence of complete unilateral nasal obstruction associated with URTI when lying flat and demonstrate the usefulness of nasal spirometry in studying nasal airflow partitioning in health and disease.

Acute Disease↗

PubMed2003

The use of nasal spirometry as an objective measure of nasal septal deviation and the effectiveness of septal surgery.

Nasal spirometry, after decongestion, was used to assess the severity of septal deviation in 31 patients before and after nasal septal surgery. Patients were divided into two groups on the basis of their preoperative nasal partitioning of airflow ratio (NPR). The NPR ranges from 0.00 (equality of airflow) to 1.00 (total unilateral obstruction) with the normal range defined as 0.00-0.34. In 14 patients with a preoperative NPR within the normal range, the median NPR was not influenced by surgery (preop 0.14 to postop 0.12, P= 0.07). In 17 patients with a preoperative NPR outside the normal range, there was a significant reduction of the median NPR after surgery (preop 0.50 to postop 0.16, P < 0.01). The correlation of NPR with subjective assessment of the deviation was r = 0.85 (P < 0.01), and with patient subjective symptom assessment r= 0.94 (P < 0.01) preoperatively and r= 0.51 (P < 0.01) postoperatively. The findings indicate that nasal spirometry may be useful in patient selection for septal surgery.

Adult↗

PubMed1975

[Scintigraphic radio-spirometry. Methods and indications].

Scintigraphic radio-spirometry combines conventional spirometry with the advantages of a functional isotope technique, thereby providing a clinically useful method for the study of pulmonary function. The advantage of the method consist principally in the ability to estimate physiological values separately for the two lungs, and also for selective portions of each lung. The apparatus, method and quantitative evaluation of the results are discussed in detail and the method is critically evaluated. Indications for radiospirometry are given.

Air↗

PubMed1985

[Value of spirometry in the early diagnosis of respiratory system diseases].

During routine use of spirometry in a general medical practice in 31% of a group of 301 patients ventilation disorders were detected, which had not been known before. In 67 patients there was a positive result of a broncholysis test while pulmonary function values were normal (latent obstruction). During detailed interrogation risk factors for a respiratory disease were discovered, although there was no serious discomfort. If spirometry is routinely combined with a broncholysis test, latent respiratory obstruction can be easily recognized. This enables early diagnosis of respiratory diseases in low age groups.

Adolescent↗

PubMed1981

Spirometry in clinical practice.

The practicality of office spirometry has been established. Two basic parameters can be quickly and accurately measured in the physician's office or clinic: forced vital capacity (FVC) as a test of volume, indicative of restrictive lung disease, and forced expiratory volume in one second (FEV1) as a test of flow, indicative of obstructive lung disease. The ratio of FEV1 to FVC (FEV1/FVC%) is a valuable screening tool. Test results are compared with normal values, and abnormalities must be interpreted in the context of the individual patient's history and condition. Office spirometry provides a simple, noninvasive, inexpensive tool for assessing and managing respiratory disease.

Forced Expiratory Volume↗

PubMed2005

Correlation of exhaled nitric oxide, spirometry and asthma symptoms.

Asthma is the most common chronic disease of childhood. Asthma severity is monitored by spirometry. However, this does not directly measure airway inflammation. Exhaled nitric oxide (FeNO) is a proposed method to measure airway inflammation non-invasively. Previous studies have shown that FeNO correlates with endobronchial biopsies and symptoms in patients with asthma. We monitored daily asthma symptoms compared to monthly spirometry and FeNO. Total monthly symptom scores correlated with both forced expiratory volume at 1 sec (FEV1) and FeNO. FeNO had a strong correlation than FEV1. FeNO and FEV1 were not correlated. We propose that FeNO should be used as an additional monitoring tool for asthma.

Adolescent↗

PubMed2005

Exacerbations of COPD diagnosed in primary care: changes in spirometry and relationship to symptoms.

The study objective was to assess spirometric changes during resolution of acute exacerbations of COPD diagnosed and treated in primary care and their relationship to clinical features. Spirometry was carried out on 101 patients with AECOPD presenting to a primary care physician on the day of presentation, days 5, 10-14, 28, and 56 after presentation and traces were analyzed including quality and reproducibility. Eighty-three patients produced at least one technically acceptable spirometer trace at presentation and 60 patients produced acceptable traces at all time points. The increase in FEV1 and VC occurred during the first 5 days after presentation, with a median increase in postbronchodilator FEV1 of 55 ml (IQR, -63 to 128, p = 0.003) and VC of 90 ml (IQR -78 to 308 ml, p < 0.001). The improvement in prebronchodilator values related to the bronchodilator reversibility at presentation and was strongest for VC (by day 28: r = 0.522, p < 0.001). Patients presenting with purulent sputum demonstrated improvements in FEV1 and VC but this was limited to FEV1 in those with mucoid sputum. The initial dyspnoea score related to the changes in spirometry. It is possible to obtain clinically useful spirometric traces in most patients presenting with an acute exacerbation in primary care. Some patients present with changes in sputum characteristics and cough without increased breathlessness. However, exacerbations characterized by increased breathlessness are associated with increases in airflow obstruction that may be influenced by sputum characteristics and/or changes in airway reactivity.

Adult↗

PubMed1983

Are maximal inspiratory breathing exercises or incentive spirometry better than early mobilization after cardiopulmonary bypass?

Forty-nine adults who had undergone cardiopulmonary bypass surgery were randomly assigned to one of three exercise programs to determine if either maximal inspiratory breathing exercises or incentive spirometry offered a therapeutic advantage over early mobilization alone. After extubation, the patients started their assigned exercise programs. A physical examination and pulmonary function tests were performed preoperatively, at the start of the exercise program, and 24 and 48 hours after the start of the program. The results showed a significant decrease (approximately 50%) in lung volumes but no airflow obstruction in patients who had coronary artery bypass graft. In those patients who had valve replacement, lung volumes fell, and in addition, mild airflow obstruction occurred. A majority of patients had postoperative pulmonary complications. There were no significant differences among the exercise programs in improving lung volumes and airflow or in preventing postoperative complications. We conclude that maximal inspiratory breathing exercises or incentive spirometry, when used in addition to early mobilization, offers no therapeutic advantage over early mobilization alone after cardiopulmonary bypass surgery.

Adult↗

PubMed2000

Incentive spirometry does not enhance recovery after thoracic surgery.

OBJECTIVE: To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections. DESIGN: Randomized controlled trial. SETTING: University hospital, intensive care unit, and surgical department. PATIENTS: Sixty-seven patients (age, 59 +/- 13 yrs; forced expiratory volume in 1 sec, 93% +/- 22% predicted) undergoing elective thoracic surgery for lung (n = 40) or esophagus (n = 27) resection. INTERVENTIONS: Physiotherapy (breathing exercises, huffing, and coughing) (PT) plus incentive spirometry (IS) was compared with PT alone. MEASUREMENTS AND MAIN RESULTS: Lung function, body temperature, chest radiograph, white blood cell count, and number of hospital and intensive care unit days were all measured. Pulmonary function was significantly reduced after surgery (55% of the initial value) and improved significantly in the postoperative period in both groups. However, no differences were observed in the recovery of pulmonary function between the groups. The overall score of the chest radiograph, based on the presence of atelectasis, was similar in both treatment groups. Eight patients (12%) (three patients with lobectomy and five with esophagus resection) developed a pulmonary complication (abnormal chest radiograph, elevated body temperature and white blood cell count), four in each treatment group. Adding IS to regular PT did not reduce hospital or intensive care unit stay. CONCLUSIONS: Pulmonary complications after lung and esophagus surgery were relatively low. The addition of IS to PT did not further reduce pulmonary complications or hospital stay. Although we cannot rule out beneficial effects in a subgroup of high-risk patients, routine use of IS after thoracic surgery seems to be ineffective.

Analysis of Variance↗

PubMedDate not supplied

Use of spirometry to predict risk of pneumothorax in CT-guided needle biopsy of the lung.

OBJECTIVE: Our goal was to assess the usefulness of spirometry to estimate the risk of pneumothorax in patients undergoing percutaneous needle biopsy with CT guidance for solitary pulmonary nodule (SPN). MATERIALS AND METHODS: We studied the results of 51 consecutive percutaneous needle biopsies with CT guidance for SPN obtained between 1988 and 1990. Forty-five men and six women, aged 65 +/- 11 (36-86) years, were included in the study. All biopsies were performed under CT guidance, with 90 mm 25G needles (0.5 mm thickness) fitted into luer-type syringes. The number of needle pass attempts never exceeded three. A spirometry before biopsy was performed in all patients. RESULTS: Pneumothorax occurred in only 10 cases (19%). The patients with pneumothorax showed lower lesion size, forced vital capacity (FVC), forced expiratory volume (FEV1), and FEV1/FVC ratio. The contribution of these factors to pneumothorax was analyzed by a logistic regression model. The FEV1 was most strongly associated with the incidence of pneumothorax. We developed an equation for predicting the risk of this complication. CONCLUSION: We conclude that decreasing FEV1 is associated with a higher pneumothorax rate.

Adult↗

PubMed1995

Early detection of CO2 pneumothorax with continuous spirometry during laparoscopic fundoplication.

In two patients, operated on because of gastroesophageal reflux, carbon dioxide pneumothorax developed during laparoscopic Nissen fundoplication. In both instances, decrease of lung compliance and a change of pressure-volume loop configuration, computed and illustrated with on-line spirometry, led quickly to diagnosis of this complication. We conclude that continuous spirometry is valuable as an early indicator of intraoperative pneumothorax.

Adult↗

PubMed2006

Office-based spirometry for early detection of obstructive lung disease.

PURPOSE: To review the research-based evidence supporting smoking cessation as the only proven method to reduce chronic obstructive pulmonary disease (COPD) progression and to show that early detection of disease with office-based spirometry can lead to therapeutic intervention before physiologic symptoms arise. DATA SOURCES: Extensive review of national and international scientific literature supplemented with drawings and algorithms. CONCLUSIONS: Early detection of COPD with spirometry, along with smoking cessation, and aggressive intervention can alter the insidious course of this highly preventable disease. It is imperative that nurse practitioners utilize this simple and inexpensive procedure to identify COPD in its earliest stages, so treatment can reduce individual and community disease burden, reduce morbidity and mortality, and help reduce healthcare costs. IMPLICATIONS FOR PRACTICE: Determination of early airflow obstruction supports smoking cessation education, provides objective data for patient motivation, thereby doubling patient compliance and reducing further disease burden.

Algorithms↗

PubMed2005

Comparison of spirometry and abdominal height as four-dimensional computed tomography metrics in lung.

An important consideration in four-dimensional CT scanning is the selection of a breathing metric for sorting the CT data and modeling internal motion. This study compared two noninvasive breathing metrics, spirometry and abdominal height, against internal air content, used as a surrogate for internal motion. Both metrics were shown to be accurate, but the spirometry showed a stronger and more reproducible relationship than the abdominal height in the lung. The abdominal height was known to be affected by sensor placement and patient positioning while the spirometer exhibited signal drift. By combining these two, a normalization of the drift-free metric to tidal volume may be generated and the overall metric precision may be improved.

Abdomen↗

PubMed2005

Gated CT imaging using a free-breathing respiration signal from flow-volume spirometry.

Respiration-induced tumor motion is known to cause artifacts on free-breathing spiral CT images used in treatment planning. This leads to inaccurate delineation of target volumes on planning CT images. Flow-volume spirometry has been used previously for breath-holds during CT scans and radiation treatments using the active breathing control (ABC) system. We have developed a prototype by extending the flow-volume spirometer device to obtain gated CT scans using a PQ 5000 single-slice CT scanner. To test our prototype, we designed motion phantoms to compare image quality obtained with and without gated CT scan acquisition. Spiral and axial (nongated and gated) CT scans were obtained of phantoms with motion periods of 3-5 s and amplitudes of 0.5-2 cm. Errors observed in the volume estimate of these structures were as much as 30% with moving phantoms during CT simulation. Application of motion-gated CT with active breathing control reduced these errors to within 5%. Motion-gated CT was then implemented in patients and the results are presented for two clinical cases: lung and abdomen. In each case, gated scans were acquired at end-inhalation, end-exhalation in addition to a conventional free-breathing (nongated) scan. The gated CT scans revealed reduced artifacts compared with the conventional free-breathing scan. Differences of up to 20% in the volume of the structures were observed between gated and free-breathing scans. A comparison of the overlap of structures between the gated and free-breathing scans revealed misalignment of the structures. These results demonstrate the ability of flow-volume spirometry to reduce errors in target volumes via gating during CT imaging.

Biophysical Phenomena↗