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PubMed1992

The utility of spirometry in the diagnosis of reversible airways obstruction.

Patients with suspected reversible airways obstruction (RAO) sometimes report subjective benefit after bronchodilator treatment despite no objective spirometric improvement. One possible explanation for this is improvement in volume-related or plethysmographic parameters in the absence of spirometric improvement. One hundred patients with RAO were assessed before and after inhaled bronchodilator to determine the prevalence of improvement by plethysmographic parameters in the absence of improvement in spirometric parameters. Spirometry alone (FEV1, FVC, and FEF25-75%) identified reversibility of airflow limitation in 82 patients. Reversibility was identified by body plethysmography (specific conductance [SGaw], thoracic gas volume [TGV], and isovolume maximum expiratory flow rates [IVMEF]) in 15 of the remaining patients. The percent predicted FEF25-75% at baseline was higher in patients who required plethysmography to identify reversibility, but could not be used to predict the lack of a spirometric response for any individual patient. We conclude that spirometry alone fails to identify reversibility in approximately 15 percent of patients, and that most of these patients can be identified by additional plethysmographic measurements of volume-related parameters. At any one point in time, multiple tests must be used together to adequately identify the majority of patients with reversible airways obstruction. Improvement in volume-related parameters may explain why some patients with RAO improve subjectively with bronchodilators but show no spirometric improvement.

Adrenergic beta-Agonists↗

PubMed1993

Spirometry and maximal respiratory pressures in patients with facial paralysis.

The study included 17 patients with facial paralysis (FP) (10 male, 7 female) aged 47.6 +/- 21.0 years. Twelve of the 17 patients had Bell's palsy. The other causes of FP were as follows: one, polyradiculoneuritis; one, war injury; one, cerebrovascular accident; one, sarcoidosis; and one, dermatomyositis. Spirometry and maximal respiratory pressures (PImax and PEmax) were performed with three different techniques: without holding the lips, with patient holding lips, and with technician holding lips. We observed significant differences for PImax and PEmax among the three methods. There were no differences for spirometric values. In nine of the patients with Bell's palsy, PImax, PEmax, and spirometry tests were repeated two months after the first determination. With respect to the first determination, the values of Pmax-w/v holding lips increased, yet spirometric values were similar. In conclusion, PImax and PEmax can be an index of clinical FP evolution. Spirometric maneuvers can be performed with either patient or technician holding lips to ensure a perfect seal between lips and mouthpiece.

Adult↗

PubMed1997

Incentive spirometry performance. A reliable indicator of pulmonary function in the early postoperative period after lobectomy?

OBJECTIVES: The purpose of our study was to validate the incentive spirometry (IS) as a simple mean to follow pulmonary function at the bedside after lung surgery. MATERIALS AND METHODS: We studied prospectively 19 patients (16 men, 3 women; mean +/- SE age, 60 +/- 2.8 years) undergoing lobectomy for lung cancer. All the patients had an obstructive pattern with FEV1/FVC below 75%. Lung volumes, including functional residual capacity (FRC) and residual volume (RV), measured using spirometry and the helium dilution technique, and IS were measured preoperatively and postoperatively at days 1, 2, 3, and 8, and at 2 months. RESULTS: Our results showed that in the postoperative period after lung resection, IS performance was well correlated (R) during the first 8 postoperative days with vital capacity (VC) (R between 0.667 and 0.870) mainly due to the excellent correlation with the inspiratory reserve volume (IRV, R between 0.680 and 0.895) but was poorly correlated with expiratory reserve volume (R below 0.340), RV (R below 0.180), and FRC (R below 0.470). CONCLUSIONS: IS can be used as a simple mean to follow lung function, especially VC and IRV, in the postoperative period in spontaneously breathing patients. IS is noninvasive and can be performed repeatedly at the bedside in the intensive care setting.

Expiratory Reserve Volume↗

PubMed1997

Peak flow lability: association with asthma and spirometry in an older cohort.

OBJECTIVE: To determine the success rate and correlates of ambulatory peak expiratory flow (PEF) monitoring in an epidemiologic study. DESIGN: An observational survey. SETTING: Several communities in California. PARTICIPANTS: We studied 1,223 nonsmoking men and women (mean age, 66 years) from an established cohort. OUTCOME MEASURES: A standard respiratory symptoms and diagnoses questionnaire, spirometry before and after bronchodilator, and a diary of PEF recorded four times per day for 7 days at home. RESULTS: A physician diagnosis of asthma was reported in 8.6% of the women and 9.4% of the men. Of those who agreed to complete PEF diaries at home, 87% successfully provided a valid measure of PEF lability. The mean PEF lability from those with asthma was significantly higher than the others (12.0% vs 8.9% in women and 10.2% vs 8.1% in men). Independent correlates of higher PEF lability included asthma, wheezing symptoms, airways obstruction by spirometry, older age, and male gender. CONCLUSIONS: Middle-aged and elderly persons are largely successful at providing a measure of PEF lability at home. In nonsmoking adults living in California, increased PEF lability is correlated with asthma, wheezing, airways obstruction, and older age, validating its use in epidemiology studies as an index of airways hyperreactivity.

Adult↗

PubMed2001

The effect of incentive spirometry on postoperative pulmonary complications: a systematic review.

OBJECTIVE: To systematically review the evidence examining the use of incentive spirometry (IS) for the prevention of postoperative pulmonary complications (PPCs). METHODS: We searched MEDLINE, CINAHL, HealthSTAR, and Current Contents databases from their inception until June 2000. Key terms included "incentive spirometry," "breathing exercises," "chest physical therapy," and "pulmonary complications." Articles were limited to human studies in English. A secondary search of the reference lists of all identified articles also was conducted. A critical appraisal form was developed to extract and assess information. Each study was reviewed independently by one of three pairs of group members. The pair then met to reach consensus before presenting the report to the entire review group for final agreement. RESULTS: The search yielded 85 articles. Studies dealing with the use of IS for preventing PPCs (n = 46) were accepted for systematic review. In 35 of these studies, we were unable to accept the stated conclusions due to flaws in methodology. Critical appraisal of the 11 remaining studies indicated 10 studies in which there was no positive short-term effect or treatment effect of IS following cardiac or abdominal surgery. The only supportive study reported that IS, deep breathing, and intermittent positive-pressure breathing were equally more effective than no treatment in preventing PPCs following abdominal surgery. CONCLUSIONS: Presently, the evidence does not support the use of IS for decreasing the incidence of PPCs following cardiac or upper abdominal surgery.

Abdomen↗

PubMed2006

Role of spirometry and exhaled nitric oxide to predict exacerbations in treated asthmatics.

OBJECTIVE: To evaluate the complementary roles of exhaled nitric oxide (NO) and spirometry to predict asthma exacerbations requiring one or more tapering courses of systemic corticosteroids. METHODS: We prospectively studied 44 nonsmoking asthmatics (24 women) aged 51 +/- 21 years (mean +/- SD) who were clinically stable for 6 weeks and receiving 250 mug of fluticasone/50 mug of salmeterol or equivalent for 3 years. Total exhaled NO (FENO), small airway/alveolar NO (CANO), large airway NO flux (J'awNO), and spirometry were measured. RESULTS: Baseline FEV(1) was 2.1 +/- 0.7 L, 70 +/- 20% of predicted after 180 mug of albuterol. Twenty-two of 44 asthmatics had one or more exacerbations over 18 months, 16 of 22 asthmatics had two exacerbations, and 6 of 22 asthmatics were hospitalized, including 1 asthmatic with near-fatal asthma. When baseline FEV(1) was </= 76% predicted, exacerbations occurred in 20 of 31 asthmatics (65%). If baseline FEV(1) was > 76% of predicted, exacerbations occurred only in 2 of 13 asthmatics (15%) [p = 0.003, chi(2)]. Using a receiver operating characteristic (ROC) curve for first exacerbation, the area under the curve was 0.67 with cutoff FEV(1) of 76% of predicted (sensitivity, 0.91; specificity, 0.50; positive predictive value, 0.65; negative predictive value, 0.85; positive likelihood ratio [LR(+)], 1.8; negative likelihood ratio [LR(-)], 0.18). When baseline FENO was >/= 28 parts per billion (ppb), exacerbations occurred in 13 of 17 asthmatics (76%); if baseline FENO was < 28 ppb, exacerbations occurred in only 9 of 27 asthmatics (33%) [p = 0.005, chi(2)]. Using the ROC curve for first exacerbation, the area under the curve was 0.71 with FENO cutoff point of 28 ppb (sensitivity, 0.59; specificity, 0.82; positive predictive value, 0.77; negative predictive value, 0.87; LR(+), 3.3; LR(-), 0.5). Independent of baseline FEV(1), FENO >/= 28 ppb increased the relative risk (RR) for exacerbation by 3.4 (95% confidence interval [CI], 1.3 to 9.1; Mantel-Haenszel, p = 0.007). An abnormal increase in CANO increased RR by 3.0 (95% CI, 0.9 to 9.9; p = 0.04), and abnormal J'awNO increased RR by 2.4 (95% CI, 1.0 to 5.6; p = 0.04). Independent of baseline FENO, FEV(1) </= 76% predicted increased RR by 1.7 (95% CI, 1.0 to 2.7; p = 0.02). Combined baseline FENO >/= 28 ppb and FEV(1) </= 76% of predicted identified 13 stable asthmatics with 85% probability for future exacerbation, whereas 9 asthmatics with FENO < 28 ppb and FEV(1) > 76% of predicted had a 0% probability of exacerbation. CONCLUSION: Combining FENO and FEV(1) percentage of predicted can stratify risk for asthma exacerbation.

Adrenal Cortex Hormones↗

PubMed1985

Prevention of postoperative pulmonary complications with CPAP, incentive spirometry, and conservative therapy.

Continuous positive airway pressure (CPAP) administered at intervals with a mask and incentive spirometry (IS) were compared with a regimen of coughing and deep breathing (CDB) to determine which promoted the most rapid recovery of pulmonary function after upper abdominal operations in 65 adults. Postoperatively, FRC of patients in all groups was similar relative to preoperative values. However, mean FRC of patients who received CPAP increased more rapidly than did mean FRC of those receiving CDB when compared to the values obtained following operation (p less than 0.05). Incentive spirometry did not increase FRC to a greater extent than did CDB. Roentgenographic evidence of atelectasis 72 hours postoperatively was observed in 23 percent of CPAP patients (five of 22) and 42 percent and 41 percent of patients who received CDB (eight of 19) and IS (nine of 22). Two patients (3 percent) developed pneumonia. The low incidence of pneumonia regardless of the type of therapy may be attributable to vigorous, vigilant respiratory care in a population at high risk for developing pneumonia. Frequency and supervision of respiratory therapy may be more important than the type of therapy delivered after upper abdominal operations. Mask CPAP offers advantages because it requires no effort from the patient, and therapy is not painful.

Abdomen↗

PubMed1985

Is the MVV:FEV1 ratio useful for assessing spirometry validity?

The ratio between the maximal voluntary ventilation (MVV) and the forced expiratory volume in one second (FEV1) has been proposed as an indicator of the adequacy of a subject's efforts in disability determinations and other spirometry applications. Data from a large population of industrial workers tested in a university pulmonary function laboratory were examined and a smaller clinical population was used to validate the conclusions. The MVV:FEV1 ratio was not affected to a clinically significant degree by age, degree of functional abnormality, or administration of an aerosolized bronchodilator. The ratio was too variable to be of use in determining whether an individual's results are reliable, but the determination of the average ratio for a large group of subjects may be useful in evaluating the overall performance of a spirometry laboratory.

Adult↗

PubMed1990

The use of home spirometry in detecting acute lung rejection and infection following heart-lung transplantation.

The value of home spirometry in detecting acute lung rejection and opportunistic infections was studied in 15 heart-lung transplant recipients over a six-month period. The patients measured their FEV1 and FVC twice daily at home using a portable turbine spirometer. The records were then reviewed in relation to the results of transbronchial lung biopsy carried out during occurrences of respiratory symptoms and during routine posttransplant assessment. FEV1 and FVC fell by a mean (+/- SD) of 10.4 +/- 6.9 percent and 9.3 +/- 7.9 percent, respectively, during 20 episodes of lung rejection. The corresponding figures during opportunistic infections were 12.8 +/- 10.1 percent and 12.5 +/- 14.3 percent. No such change was observed during routine normal biopsies. Regular home spirometry offered early detection of these complications allowing early transbronchial lung biopsy as well as assessing efficacy of their therapy. Above all, measurements can be made daily, which is unique in the assessment of solid organ transplants.

Acute Disease↗

PubMedDate not supplied

[Effect of tobacco smoking, respiratory symptoms and asthma on spirometry among adults attending a check-up clinic in Mexico City].

OBJECTIVE: To evaluate the effect of tobacco smoking, respiratory symptoms, and asthma on lung function among Mexican adults who were evaluated during a medical exam in a private health clinic. MATERIAL AND METHODS: Reference prediction equations were generated for spirometry parameters [forced vital capacity (FVC), forced expired volume in one second (FEV1) and FEV1/FVC] based on multiple linear regression models. The effect of tobacco smoking, respiratory symptoms and asthma on these equations were explored. RESULTS: Spirometry tests were performed on 919 subjects from 14 to 86 years of age. Asthma decreased FVC and FEV1 in men with a R2 change <1%. Respiratory symptoms decreased the FEV1/FVC ratio in both sexes. Tobacco smoking was associated with a significant reduction in FEV in women. CONCLUSIONS: Asthma lightly reduced lung function in males while tobacco smoking decreased FEV, particularly in females.

Adolescent↗

PubMed2004

A smoking-cessation program consisting of extensive counseling, pharmacotherapy, and office spirometry: results of a pilot project in a Veterans Administration Medical Center.

STUDY OBJECTIVE: To describe the 1-year outcomes of a Veterans Administration smoking-cessation program that demonstrates a standard of care comprising extensive counseling, pharmacotherapy, and office spirometry. DESIGN: Prospective one-group pretest-posttest, with an intervention of state-of-the-art practice in smoking cessation. SETTING: Outpatient clinic in a Veterans Administration Medical Center (VAMC). PATIENTS: Two hundred fifty-two veterans receiving health care at the VAMC. MEASUREMENTS AND MAIN RESULTS: The primary outcome measured was the 1-year cessation rate of smokers. Demographic and clinical covariates also were collected. Of the 252 patients who enrolled in the program, 120 never quit smoking for even 1 day. Of the remaining 132 patients, 32 (24%) achieved long-term (1 yr) cessation. The number of visits to the clinic and the number of methods used during the attempt to quit were the only variables significantly associated with long-term smoking cessation (p<0.0001 for each). CONCLUSION: The availability of a standard-of-practice clinic for smoking cessation within a primary care clinic can help patients who have a desire to quit. A combination of intensive counseling, pharmacotherapy, and office spirometry helped patients in a Veterans Administration population to achieve long-term smoking cessation.

Adult↗

PubMed1980

Determination of functional residual capacity with 133-xenon radiospirometry. Comparison with body plethysmography and helium spirometry. Effect of body position.

This study was undertaken to estimate the accuracy of 133-xenon radiospirometry for determination of FRC in healthy subjects. Forty healthy volunteers, both smokers and non-smokers, were examined. The FRC of each subject was concurrently determined with radiospirometric, He-dilution in closed circuit, and body plethysmographic methods. The radiospirometric and He-dilution measurements were done in supine and in sitting positions, the body plethysmography on sitting subjects, only. The mean FRC measured by radiospirometry (FRCRS) was 0.72 1 larger than that measured by helium spirometry (FRCHe) in sitting position (P < 0.01). In supine position the FRCRS was 0.65 1 larger than the FRCHe (P < 0.01). The body plethysmography gave FRC (TGV) 0.35 1 larger than the FRCHe sitting (P < 0.01). The FRCHe and the FRCRS in the sitting position were 0.48 and 0.55 1 larger than in the supine position (P < 0.01), respectively. Trapped air correlated significantly (P < 0.01) with the difference FRCRS-FRCHe, when sitting. The results indicate that the FRC determined radiospirometrically is significantly larger than the FRC determined with He-spirometry. The difference is systematic, suggesting that it is caused by 133-xenon dissolved in blood and accumulated in tissues of the thoracic cage and by dissimilar representation of trapped air in FRCRS and FRCHe. With eventual correction of the systematic error, the FRC obtained as a by-product of radiospirometry may be used, e.g. for clinical purposes.

Adult↗

PubMedDate not supplied

Spirometry: a key diagnostic test in pulmonary medicine.

Spirometry is a simple and informative test for evaluating airflow obstruction. Measurements from a forced expiratory maneuver are conventionally displayed as volume vs time (spirogram) and flow vs volume (flow-volume loop) tracings. Spirometric measurements like the forced expiratory volume in 1 second inform about the degree of airflow obstruction, whereas the flow-volume loop helps identify the presence and anatomic location of upper airway obstruction, which may mimic symptoms of obstructive lung disease. As a simple, inexpensive, and informative test, spirometry should be used liberally in assessing patients with respiratory symptoms.

Adult↗

PubMedDate not supplied

Issues in computerized spirometry.

Computerization of pulmonary function testing is forcing rewrites of time-honored protocols and shifting responsibilities from technician to machine. Spirometry, in particular, has become a diagnostic test virtually free of manual measurements and calculations; computerization even provides interpretation of the results. Along with these improvements, computerized spirometry also raises questions regarding reference values, interpretive criteria, and standardization.

Diagnosis, Computer-Assisted↗

PubMed2000

The effect of incentive spirometry on chest expansion and breathing work in patients with chronic obstructive airway diseases: comparison of two methods.

BACKGROUND: Chronic obstructive airway diseases (COAD), characterized by mucus hypersecretion, lead to exercise intolerance. Incentive spirometry has been used to prevent postoperative pulmonary atelectasis. METHODS: To compare the efficacy of two incentive spirometers, Coach (volume-oriented) and Triflo (flow-oriented), in the work of breathing in COAD patients, 22 patients were randomized in this study: 12 patients (Triflo-II group) initially used Triflo-II for 10 minutes and then Coach for the same period. In contrast, the Coach group, including 10 patients, started with Coach followed by Triflo-II. After receiving incentive spirometry, lung expansion and work of breathing were assessed. RESULTS: Patients in the Coach group significantly increased chest wall expansion (p = 0.041), as compared with patients using Triflo-II. Similarly, there was also a significantly increased abdominal wall expansion in the Coach group (p = 0.0056), compared with that in the Triflo-II group. The need of accessory muscle assistance for breathing in the Coach group was significantly less than in the Triflo-II group (p = 0.047). It was easier for patients in the Coach group to start a breath (p = 0.0058) than for those in the Triflo-II group. For the entire group, 17 patients (77.3%) preferred Coach to assist their breathing, and only 4 patients (18.2%) favored Triflo-II. CONCLUSION: COAD patients achieved a larger expansion of the chest and abdomen with a Coach device. Our data provide a good rationale for an outcome study on the use of incentive spirometer in COAD patients.

Adult↗

PubMedDate not supplied

Reliability of plethysmography, the single breath oxygen test, and spirometry in population studies.

Three thousand five hundred and twenty-eight residents of a census tract in Los Angeles, California underwent pulmonary function testing in a mobile laboratory (the Breathmobile). Tests included respiratory questionnaire, electronic spirometry, the single breath O2 test and body plethysmography. The reliability and sensitivity of the tests performed in the Breathmobile was measured by repeating the same tests and others on a 3% probability sample at the University of California at Los Angeles Pulmonary Function Laboratory. The reliability of the FVC and FEV1 was excellent; of the FEF 25-75% and the FEF 50-75% -- good; and of the VTG, RA and delta N2 -- reasonably good. As yet the reliability of the closing volume fraction is inadequate in our study. Grouping by individual reported symptom complexes identified different groups of people. The questionnaire and the forced expiratory flow rates identified the most people as having decreased respiratory function. Selection of the best breath or average of the two best breaths affected results of spirometry very little.

Adolescent↗

PubMed2000

[Spirometry parameters of women in various positions of delivery].

UNLABELLED: Position in labour depends mostly on women's preferences, and is chosen instinctively in order to reduce labour pain. Between two different positions: vertical and horizontal, the first of them seems to guarantee more convenient gas exchange in maternal lungs. DESIGN: To prove that the vertical position in labour increase spirometry parameters in comparison with horizontal one. METHODS: Women were divided into two groups according to position in labour and spirometry examination were performed in second period of labour. Group I were composed of 17 women in vertical position whereas group II--19 women in horizontal one. RESULTS: Whole of analysed spirometral parameters had higher values in group I (8.2%-17.1%), but the increase wasn't statistically significant (p < 0.05).

Adult↗

PubMed1975

The uses of simple spirometry.

The use of spirometry to determine pulmonary function has been complicated by the proliferation of measurements possible from the expiratory effort. Non-pulmonary physiologists face the problem of making a choice between a multiplicity of spirometric tests. Some guidelines for ventilatory testing are offered. The various uses of spirometry are indicated and those tests which best subserve these uses are suggested.

Asthma↗