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PubMed2003

[GOLD guideline and recommendation for role of spirometry in COPD].

COPD is currently the fourth leading cause of death in the world, and further increase in its prevalence and mortality have been predicted for the coming decades. To decrease the morbidity and mortality due to COPD, better recognition of the risk of COPD and improvement in prevention and management of COPD is required. Many national and international societies of respiratory diseases have developed guidelines for COPD. In the GOLD report, COPD is a disease status characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Airflow limitation in COPD is best measured through spirometry, which is a key to the diagnosis and management of the disease. It is the most standardized, reproducible, and objective measurement of airflow limitation available. A decrease in the ratio of FEV1 to FVC is often the first sign of developing airflow limitation. In Japan, a major problem is the lack of guidelines for standardization of spirometry. To achieve consistently accurate test results, not only standardization of spirometry but also propagation of proper procedure and evaluation of spirometry are required.

Humans↗

PubMed2004

An approach to interpreting spirometry.

Spirometry is a powerful tool that can be used to detect, follow, and manage patients with lung disorders. Technology advancements have made spirometry much more reliable and relatively simple to incorporate into a routine office visit. However, interpreting spirometry results can be challenging because the quality of the test is largely dependent on patient effort and cooperation, and the interpreter's knowledge of appropriate reference values. A simplified and stepwise method is key to interpreting spirometry. The first step is determining the validity of the test. Next, the determination of an obstructive or restrictive ventilatory patten is made. If a ventilatory pattern is identified, its severity is graded. In some patients, additional tests such as static lung volumes, diffusing capacity of the lung for carbon monoxide, and bronchodilator challenge testing are needed. These tests can further define lung processes but require more sophisticated equipment and expertise available only in a pulmonary function laboratory.

Family Practice↗

PubMed2006

Normal spirometry, gas transfer and lung volume values in Papua, Indonesia.

Spirometry is an efficient and clinically useful tool in the diagnosis and management of chronic lung disease. It relies on an appreciation of normal lung function that can vary between populations. In order to improve the utility of spirometry, gas transfer and lung volume measures for clinical and research use in Papua, Indonesia, we determined lung function in Papuan and non-Papuan Indonesian adults who did not have evidence of lung disease. A cross-sectional survey of Papuan and non-Papuan Indonesians 18 years or older with no history of chronic cough or recent wheeze was made. Spirometry, gas transfer and total lung capacity (TLC) were determined and regression models developed for normal values. The spirometry values were similar but not directly comparable to similar studies in Papua New Guinea populations. Papuan highland residents demonstrated independently greater values of gas transfer and total lung capacity in comparison to lowland Papuans. Values for lung function in apparent respiratory health were shown to differ between Papuan and non-Papuan Indonesian populations and in comparison to reference values derived from non-indonesian populations. Differences in age-related decline in lung function would suggest that simple proportional correction based on values derived from non-Indonesian populations may be inappropriate and would support the development of similar reference values in other populations. Whether differences seen here are innate or occur as a consequence of in-utero and post-partum environmental exposure remains to be accurately elucidated.

Adult↗

PubMed1996

Granulocyte proteins in serum in childhood asthma: relation to spirometry and therapy.

BACKGROUND: Measurement of markers of eosinophil activation in asthmatics provides information indicative of ongoing inflammatory processes in the airways. OBJECTIVES: This study was conducted to determine the correlations between serum markers of allergic inflammation with spirometry parameters in asthmatic children in different treatment groups. METHODS: Blood eosinophils, serum levels of eosinophil cationic protein (ECP), eosinophil protein X (EPX), myeloperoxidase (MPO) and tryptase were measured simultaneously with serial measurements of FEV1/FVC, FEF25-75 and FEF in 60 children with acute asthma on admission and after 2, 14, 30 and 60 days. Group A received bronchodilators only (n = 20), group B received sodium cromoglycate (SCG) (n = 20) and group C received oral and/or inhaled corticosteroids (n = 20). RESULTS: Oral steroid treatment (2 mg/kg/day), given at the onset of the asthma attack, resulted in significant reduction in the ECP and EPX levels in all the children. However, these reduced ECP and EPX levels were not sustained in the children, even in those who continued on maintenance steroid treatment. Significant, but inconsistent, correlations between ECP, EPX with total eosinophil count, Percentage eosinophils and spirometry parameters were observed at the different time-points. Tryptase levels were normal in all subjects. There were no significant correlations between myeloperoxidase levels and the spirometry parameters or eosinophil parameters. Serial monitoring of ECP and EPX levels was found to be of some use in predicting clinical outcome in certain steroid-dependent asthmatics (group C) but of no value in the mild asthmatics (group A). CONCLUSION: While elevation of ECP, EPX and MPO in the serum of childhood asthmatics suggests ongoing inflammation and may inversely correlate with spirometry parameters in some patients, the relationship between these markers and airway function is not a simple one.

Adolescent↗

PubMed1992

The importance of spirometry in the assessment of childhood asthma.

OBJECTIVE: To assess the pulmonary function of children with asthma at the time of a routine follow-up visit when they were judged to be clinically well. DESIGN: Pulmonary function tests were performed on children with a previous diagnosis of asthma. None had had any symptoms for at least 6 weeks. All had normal Wright peak flow rates and normal findings at physical examination. SETTING: General pediatric and pediatric pulmonary clinic at a municipal hospital in the Bronx, NY. PATIENTS: Sixty-five children with asthma who fit the above criteria. All were able to perform spirometry adequately. Their mean (+/- SD) age was 11 +/- 3 years, and their median age was 10 years. SELECTION PROCEDURES: All clinic patients were screened as possible participants. The 65 patients were deemed eligible, and were willing and able to perform spirometry. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The group's mean (+/- SD) forced expiratory volume in 1 second/forced vital capacity ratio was 80% +/- 8%, and their mean mid-maximal expiratory flow was 66% +/- 23% of the predicted value. Of the 65 patients, 11 (17%) had forced expiratory volume in 1 second/forced vital capacity ratios of less than 72%, and 35 (54%) had a mid-maximal expiratory flow of less than 65% of the predicted value. CONCLUSION: Failure to perform spirometry in children with asthma results in underdiagnosis of airflow obstruction. This may result in obstruction persisting into adulthood and/or progression to hyperinflation.

Adolescent↗

PubMed2004

Assessment of airway function in young children with asthma: comparison of spirometry, interrupter technique, and tidal flow by inductance plethsmography.

The assessment of airway function in young children requires adaptation of techniques designed for adults and/or application of techniques that do not require complex respiratory maneuvers. We sought to assess two methods of measuring airway function: time to peak expiratory flows as a ratio of expiratory time (T(PTEF)/T(E)), derived from respiratory inductance plethysmography, and total respiratory resistance by the interrupter technique (Rint), both obtained during quiet tidal breathing. Both techniques were referenced to FEV1 and flow at 50% expired volume (FEF50) from conventional spirometry in 30 children aged 4-8 years (median age, 6.9; range, 4.5-8.5 years) with a physician diagnosis of asthma and who were able to perform FEV1 with a repeatability of at least 8%. T(PTEF)/T(E) and Rint were performed in random order followed by spirometry, in order to reduce the possible effects of pulmonary stretch on tidal breathing measures. Coefficients of variation (CV) and mean absolute change/baseline standard deviation were derived for each measurement. Baseline FEV1 did not correlate significantly with T(PTEF)/T(E) (r = 0.025), but did correlate with Rint (r = 0.737, P < 0.001); respective relationships for change after bronchodilator were r = 0.09 (ns) and r = 0.64 (P < 0.001). FEF50 also correlated significantly with Rint (R = 0.769, P < 0.001) but not with T(PTEF)/T(E). FEV1 and FEF50 both increased postbronchodilator, with respective mean changes of 11.4% and 28% (P < 0.001), while Rint decreased by 24.3% (P < 0.001). No significant changes were noted for T(PTEF)/T(E). T(PTEF)/T(E) derived from inductance plethysmography does not detect mild airway obstruction or modest changes in airway caliber following bronchodilator in young children with asthma. The interrupter technique may have a role in assessing baseline airway function and response to therapy in children unable to perform reliable spirometry, and/or when the investigator wishes to avoid the possible influence of forced maneuvers on airway tone.

Age Factors↗

PubMed1994

The superiority of exercise testing over spirometry in the evaluation of postoperative lung function for patients with pulmonary disease.

Thoracic surgeons have often been embarrassed by the discrepancy between an improvement in symptoms and the unchanged or even worse results of spirometry in postoperative patients with either bullae or inflammatory lung disease. Forty-four patients with lung diseases, who underwent a total of 47 operations, were categorized as follows: 12 cases of empyema, 16 cases of giant bulla (undergoing surgery a total of 19 times), 4 cases of bronchiectasis, and 12 cases of other miscellaneous diseases. All patients were tested preoperatively and again 4-6 months after surgery on both the spirometer and treadmill exercise tests. The forced vital capacity (FVC) and forced expiratory volume (FEV1.0) results were as follows: the empyema group 1.82 +/- 0.52 liters preoperatively to 1.93 +/- 0.69 liters postoperatively and 1.47 +/- 0.44 liters to 1.56 +/- 0.53 liters, respectively; and the giant bulla group, 3.49 +/- 0.96 liters to 3.35 +/- 0.77 liters and 2.35 +/- 0.96 liters to 2.48 +/- 0.69 liters, respectively. However, the exercise time was prolonged in the empyema group from 6.00 +/- 3.77 min to 8.33 +/- 3.80 min (P < 0.01) and in the giant bulla group from 11.83 +/- 3.71 min to 12.92 +/- 2.84 min (P < 0.05). It was thus concluded that exercise testing should be chosen for the postoperative evaluation of patients with inflammatory pulmonary disease and giant bullae, especially if any discrepancies are seen between spirometry and performance status, because on the basis of our results, it appears that the benefits obtained by surgery are best measured by the dynamic values of exercise testing and not by the static values of spirometry at rest.

Adult↗

PubMed2004

Preoperative spirometry versus expired gas analysis during exercise testing as predictors of cardiopulmonary complications after lung resection.

PURPOSE: As cardiopulmonary load increases with the amount of lung resected, to perform surgery safely it is important to be able to predict cardiopulmonary insufficiency. However, lung function testing with spirometry and blood gas analysis does not accurately measure cardiopulmonary reserve. We conducted this study to evaluate expired gas analysis during exercise testing for predicting postoperative complications after lung resection. METHODS: Expired gas analysis during exercise and spirometry were done 1 week preoperatively in 211 patients who underwent pulmonary resection for lung cancer. Patients were divided postoperatively according to whether cardiopulmonary complications were absent (group A) or present (group B). RESULTS: In group B there were more men than women (P < 0.01), and the mean age was greater (P < 0.05). There was no difference in disease stage, but more patients underwent pneumonectomy in group B than in group A ( P < 0.005). The results of expired gas analysis during exercise testing and of spirometry showed that maximum oxygen uptake/m(2) (P < 0.0005), anaerobic threshold/m(2) (P < 0.01), vital capacity (VC)/m(2) (P < 0.005), %VC (P < 0.0001), forced expiratory volume in 1 s (FEV(1.0))/m(2) (P < 0.0001), and FEV(1.0%) (P < 0.05) were lower in group B than in group A. CONCLUSIONS: The combination of expired gas analysis during exercise and conventional pulmonary function tests identified patients at risk for postoperative cardiopulmonary complications following pulmonary resection.

Aged↗

PubMed2006

Spirometry and smoking cessation advice in general practice: a randomised clinical trial.

RATIONALE: To assess the success rate of smoking cessation with the "minimal intervention strategy" in general practice, and to determine the influence of spirometry on this success rate. METHODS: Training in smoking cessation advice was given to 16 general practitioners (GPs). During 12 weeks, these GPs screened their practice population for smoking habits, the degree of dependence on nicotine, and the motivation to quit smoking. Patients willing to stop were randomised to a group that underwent a single office spirometry, or to a control group. The GPs were asked to support the attempts with the minimal intervention strategy. Success rates were compared after 6, 12 and 24 months. RESULTS: On a population of 5590 patients, 1206 smokers were identified (22%). To the vulnerable group, identified following the Prochaska and Di Clemente scheme, the proposal was made to change smoking behaviour. Two hundred and twenty-one patients undertook an attempt of smoking cessation. Nicotine replacement therapy (NRT) or bupropion was prescribed in 51% of the attempts. Sixty-four sustained quitters were counted after 6 months (29%), 43 after 1 year (19%) and 33 after 2 years (15%). We found a small but statistically non-significant difference in success rate in favour of the group that underwent office spirometry. CONCLUSION: GPs can motivate almost 20% of their smoking population to quit smoking. The success rate with the minimal intervention strategy was 19% after 1 year and 15% after 2 years. We found no arguments in favour of confronting smokers with their lung function as a tool for enhancing smoking cessation.

Adolescent↗

PubMed1997

The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection.

BACKGROUND: A predicted postoperative forced expiratory volume in 1 second (FEV1) of less than 800 ml or 40% of predicted is a common criterion for exclusion of patients from lung resection for cancer. Usually, the predicted postoperative lung function is calculated according to a formula based on the number of lung segments that will be resected. Incentive spirometry and specific inspiratory muscle training are two maneuvers that have been used to enhance lung expansion and inspiratory muscle strength in patients with chronic obstructive pulmonary disease and after lung operation. METHODS: Thirty-two patients with chronic obstructive pulmonary disease who were candidates for lung resection were randomized into two groups: 17 patients received specific inspiratory muscle training and incentive spirometry, 1 hour per day, six times a week, for 2 weeks before and 3 months after lung resection (group A) and 15 patients were assigned to the control group and received no training (group B). RESULTS: Inspiratory muscle strength increased significantly in the training group, both before and 3 months after the operation. In group B, the predicted postoperative FEV1 value consistently underestimated the actual postoperative FEV1 by approximately 70 ml in the lobectomy subgroup and by 110 ml in the pneumonectomy subgroup. In group A, the actual postoperative FEV1 was higher than the predicted postoperative FEV1 by 570 ml in the lobectomy subgroup and by 680 ml in the pneumonectomy subgroup of patients. CONCLUSIONS: In patients undergoing lung resection the simple calculation of predicted postoperative FEV1 underestimates the actual postoperative FEV1 by a small fraction. Lung functions can be increased significantly when incentive spirometry and specific inspiratory muscle training are used before and after operation.

Adult↗

PubMed1999

Testing patients' lungs: spirometry as part of the physical examination.

Spirometric measurements of lung function are vital signs that unfortunately are not as widely used as blood pressure or cholesterol testing. Spirometry is an uncomplicated procedure that can easily be incorporated by primary care physicians into routine physical examinations, especially now that simple handheld spirometers suitable for all offices are available. Abnormal spirometric patterns can alert physicians to patients' additional risk of developing chronic lung disease and to the need for interventions that prevent or forestall morbidity and mortality. Spirometry also is an important tool for monitoring patients' response to therapy in a number of disorders (eg, asthma). Spirometric testing in adults should begin at age 40 for smokers and patients with unexplained dyspnea, cough, wheezing, or excessive mucus. Children with asthma and cystic fibrosis should be identified and followed with spirometry.

Family Practice↗

PubMed1989

Relationship between arterial blood gases and spirometry in acute exacerbations of chronic obstructive pulmonary disease.

Previous studies have established spirometric criteria for arterial blood gas analysis during acute asthmatic attacks. However, only general guidelines have been available regarding the need for blood gas analysis during an acute exacerbation of chronic obstructive pulmonary disease (COPD). We conducted a study to determine the relationship between arterial blood gases and spirometry in 70 emergency department patients during acute exacerbations of COPD. Arterial blood gas analysis and spirometry were performed on arrival at the emergency department. All of the patients with a pCO2 of more than 45 mm Hg had an FEV1 of less than 35% of the predicted normal. We found patients with a pO2 of less than 60 mm Hg who had an FEV1 as high as 54% of the predicted normal. There was no correlation between the FEV1 and pO2. Because spirometry was not reliable for identifying patients with significant hypoxemia, we conclude that arterial blood gas analysis is indicated for patients presenting to the ED with acute exacerbations of COPD. Spirometric criteria that have been used to eliminate the need for arterial blood gases in asthmatic patients cannot be applied safely to patients with COPD.

Acute Disease↗

PubMed2002

[Spirometry: quality in the respiratory medicine clinics of a public health care area].

BACKGROUND: Spirometry can be considered a routine way to evaluate patients with respiratory complaints, both inside and outside the hospital setting. OBJECTIVE: To assess the quality of spirometry in a public health care area with respect to two factors: the technicians' performance and the calibration of spirometers. MATERIAL AND METHOD: Four health care clinics were studied. Four technicians participated and the four spirometers were tested at different volumes (calibration syringes 1L and 3L) and different flows (explosive decompression). Eight patients with COPD participated in the study of inter-technician variability. RESULTS: Agreement among the technicians was very high: 0.98-0.99 for FEV1 and 0.91-0.98 for FVC. The mean results obtained by the technicians were: FEV1 = 2.15 0.03, range 2.20-2.14; FVC = 3.25 0.05, range 3.30-3.21 (ns). Volumetric readings from the spirometers were correct for the 1I calibration syringe, but 2 out of 4 spirometers lost linearity with the 3I calibration syringe. One spirometer gave readings out of range for all flow levels, and 2 out of 4 spirometers were out of range at low flows. CONCLUSIONS: 1. Results obtained by different technicians were not significantly different and there was high agreement among them, confirming that performance of spirometry was good. 2. The spirometers showed poor linearity at low flows.

Aged↗

PubMed1991

[Measurement of respiratory effects of propofol by indirect spirometry].

The effects of a continuous steady rate infusion of propofol on spontaneous ventilation were studied in eight unpremedicated ASA 1 male patients. All were non smokers, aged 29 +/- 8 years, and weighed 67 +/- 9 kg. After an initial 1 mg.kg-1 bolus, they received 10 mg.kg-1.h-1 propofol for 10 min, followed by 8 mg.kg-1.h-1 for a further 10 min, and then 6 mg.kg-1.h-1 during the whole study period. Endotracheal intubation was carried out using lidocaine for local anaesthesia. Spontaneous ventilation was assessed during three periods of five minutes: in the awake subject, using indirect spirometry (measurement of variations in chest circumference) and direct spirometry separately, and then, in the anaesthetized subject, using both methods simultaneously. This study aimed: a) to compare the results obtained with the two methods, b) to characterize the effects of propofol anaesthesia on chest wall mechanics using the partitioning of ventilation between rib cage and abdomen provided by the non-invasive method, and c) to assess abdominal compliance by means of a gastric balloon catheter. There was an increase in rib cage ventilation in the awake state, induced by the apparatus for direct spirometry (mouth piece, nose clip). This explained that the ventilatory depression induced by propofol anaesthesia was more pronounced when measured by the direct method. The major determinant of this depression was a shortened inspiratory time, and, to a lesser extent, a decreased mean inspiratory flow rate. By contrast to inhalational anaesthesia, rib cage ventilation was preserved during propofol anaesthesia. The decrease in abdominal ventilation was partly related to a lowered abdominal compliance, suggesting recruitment of the abdominal muscles.

Adult↗

PubMedDate not supplied

Acoustic rhinometry, rhinomanometry and spirometry of the asthmatics patients with rhinitis symptoms before and after oral corticoid.

INTRODUCTION: Asthma and rhinitis frequently co-exist in the same patient. It may exist a specific condition witch affects the general respiratory activity and also able to produce symptoms into upper and/ or lower airways. PURPOSE: To analyze the alteration and functional burst of upper and lower airways before and after oral corticoid. METHODS: From July of 2000 to August of 2002, sixteen (69 % was female ), acute asthmatics patients with rhinitis symptom assisted in the pneumology department, were analyzed through cross-sectional study using: symptoms questionnaire, physical examination, radiogram, spirometry, acoustic rhinometry, and rhinomanometry. RESULTS: Sixteen patients presented compromising symptoms of the upper airways. In the spirometry, FEV1, FEV1/FVC e FEF25-75%, presented major statistically differences. The acoustic rhinometry presented important statistical differences in the minimal cross- sectional area 1 e 2 in the left side and total nasal volume, after medicine intervention. CONCLUSIONS: The functional evaluations upon lower and upper airways, improvements in FEV1, FEV1/FVC e FEF25-75%, were observed through spirometry and total nasal volume, analyzing the acoustic rhinometry after oral corticoid.

Adolescent↗

PubMed1999

Comparison of exhaled nitric oxide to spirometry during emergency treatment of asthma exacerbations with glucocorticoids in children.

BACKGROUND: Asthma is characterized as a chronic inflammatory process; however, there is no easily measured marker for airway inflammation. Such a marker, particularly in children, would be very helpful in the management of asthma even in the acute setting. OBJECTIVE: The purposes of this study were to determine whether asthmatic children have (1) elevation of exhaled breath nitric oxide (ENO) during acute exacerbations when presenting to the emergency room, (2) reduction of ENO following glucocorticoid treatment, or (3) improvement in spirometry and clinical examination accompanying reduction of ENO levels. METHODS: Peak ENO levels were measured by chemiluminescence during exhalation into the NO analyzer. Ten asthmatic children (mean age 10 years) who presented to the Pediatric Special Care Unit at National Jewish Medical and Research Center in acute respiratory distress with an asthma exacerbation were studied. The subjects were recruited, after informed consent was obtained from the parent, on the basis of specific inclusion/exclusion criteria. Measurements of ENO in parts per billion (ppb) and spirometry, including percentiles of forced expiratory volume in one second (FEV1%) and peak expiratory flow (PEF%), were performed before and after at least 5 days of glucocorticoid therapy. RESULTS: The mean ENO level in the asthmatic children prior to glucocorticoid treatment was 48 +/- 8ppb, and after glucocorticoid treatment the ENO level was 17 +/- 1ppb; (P < .002). Prior to glucocorticoid treatment, the mean FEV1% value was 68 +/- 3% compared with the postglucocorticoid treatment FEV1% value of 100 +/- 5%; (P < .0001). Prior to glucocorticoid treatment, the mean PEF% value was 81 +/- 7%, compared with the postglucocorticoid treatment PEF% value of 105 +/- 6%; (P < .02). CONCLUSIONS: The mean peak ENO level after glucocorticoid therapy was significantly less than that measured before treatment in children with acute asthma exacerbations. Concomitant with the decrease in ENO levels, there was improvement in the spirometry values and physical examination in the asthmatic children; thus, ENO is a sensitive marker for response to anti-inflammatory treatment in children.

Anti-Asthmatic Agents↗

PubMed1999

Simple forced oscillatory technique and spirometry in assessment of bronchial responsiveness in non-asthmatic and asthmatic subjects.

Simple validity controlled forced oscillatory respiratory resistance (Rrsfo) at 8 Hz frequency was compared with flow-volume spirometry in detection of bronchial changes during induced bronchoconstriction. The methacholine provocation test was performed in subjects with mild asthma (n = 18) and in non-asthmatic subjects (n = 61) of which 44 were classified as responders (delta FEV1 > or = 15% in methacholine test). According to the index of maximal response/coefficient of variation for immediately repeated measurements (delta max/Coeffvar), Rrsfo was shown to be at least as sensitive indicator of bronchoconstriction as FEV1, and better than MMEF and FVC. The shape of the dose-response curves were similar for all parameters. In the non-asthmatic group, there were similar plateaux in Rrsfo, FEV1, and FVC at the same methacholine concentrations. In the asthmatic group, the provocative concentrations for Rrsfo and spirometric parameters correlated significantly (PC60-Rrsfo versus PC10-FEV1, P < 0.05; PC60-Rrsfo versus PC25-MMEF, P < 0.01). In the non-asthmatic responsive subjects, the correlations between PC60-Rrsfo and PC25-MMEF were significant (P < 0.05). Thus, Rrsfo at a fixed 8 Hz frequency and built-in validity control was shown to be at least as sensitive an indicator for changes in lung function in asthmatic and non-asthmatic responsive subjects as spirometry. Compared to spirometry, it may give additional information with fewer confounding factors during performance.

Adolescent↗

PubMed2004

[Evaluation of the quality of spirometries by a scoring system].

BACKGROUND: The measurement of quality will gain in importance in the future. Suitable instruments for the measurement of the quality of lung function tests have not yet been developed. In order to evaluate the quality of lung function measurements, a score is introduced, based on current guideline recommendations for lung function test. MATERIALS AND METHODS: Records of spirometries were selected at random and evaluated retrospectively. The evaluation criteria were deduced from guideline recommendations. The evaluation criteria were used to calculate a score in order to compare the quality of single records. The individual time course of lung function parameters in a group of former uranium ore miners was used to validate the score. RESULTS: 417 spirometry records from 93 physicians of different specialisation were evaluated. From 111 documented calibrations only 10 were accomplished on the same day on which the measurement was made. 147 lung function curves were classified as "good". Only in 25 records the execution of three or more measuring manoeuvres had been documented. The mean score over all physicians was 0.58, which corresponds to a middle quality level. CONCLUSIONS: The study generates and validates for the first time a score with which the quality of spirometries can be evaluated. The scoring system retrospectively analyses lung function records and it can therefore be used in the framework of quality management. The application of the score showed an inconsistent application of guideline recommendations. In agreement with studies from other countries a lack of quality was also found in Germany.

Humans↗