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Clinical validation of automated spirometry used in surveys of large occupational groups: comparison with conventional water spirometry.

An accurate, rugged automated spirometer which provides immediate data is useful both clinically and for screening large groups with various environmental exposures. Because the need for such surveys has been increasing, we compared a computerized mass flow-meter with a conventional water spirometer. The same forced expiration was measured by both instruments in the laboratory and during an occupational survey. Mean values for forced vital capacity (FVC) were 96 cc greater by the automated technique in the laboratory (this equals 2.2% of the value by the conventional method, with a correlation, r, of 0.998) and 97 cc greater in the field (2.3% of the conventional method; r = 0.995). Differences between the two methods in the laboratory and field for forced expiratory volume in one second (FEV 1.0) were +24 cc (0.68%; r = 0.996) and +47 cc (1.6%; r = 0.996) and for forced expiratory flow (FEF)25-75--179cc/sec (4.18%; r = 0.968) and -63 cc/sec (2.1%; r = 0.992), respectively. For FVC and FEV1.0, the differences between paired values were less than or equal to 10% of the value by water spirometry in all instances and less than or equal to 5% in 95.5% and 96% of comparisons, respectively. For FEF 25-75 the differences between paired values were less than or equal to 20% in 97.2% and less than or equal to 10% in 84.7% of comparisons. These findings confirm the validity of the measurements provided by the automated spirometer.

Autoanalysis

The use of helium-oxygen spirometry in occupational lung disease.

One of the major problems in the study and management of occupational lung disease is to detect early impairment so that corrective measures can be taken before irreversible or more severe damage occurs. Unfortunately standard spirometric tests are not sensitive to functional impairment in small airways where the earliest abnormalities in many pulmonary diseases are thought to occur. A a result, several new tests have been devised in the last decade to study this so-called silent zone. Helium-oxygen spirometry, one such test, is safe, convenient, and can eaily be added to conventional air spirometry apparatus. Two studies using helium-oxygen and air spirometry done by the Appalachian Laboratory are presented. In the first, non-exposed controls were compared to flax workers with either low or high dust exposure. Both air and helium-oxygen flow volume curves showed decreased flow rates after a work-shift in the high exposure group but no change in controls. In the low-dust exposure group, only helium-oxygen spirometry detected decreased post-shift flow rates suggesting small airways disease. Coal miners were compared to controls in the second study. Subgroups of younger subjects, smokers, non-smokers, bronchitics, and non-bronchitics were also analyzed. In no case did helium-oxygen spirometry detect differences which were not present on routine air spirometry. It is concluded that further studies in this area are needed. At present, random screening with helium-oxygen spirometry for early occupational disease is not warranted, and this test remains an investigative tool.

Epidemiologic Methods

Effects of Adding Incentive Spirometry to Hospital-Based Cardiovascular Rehabilitation on Pulmonary Complications, Hospital Length of Stay, and Clinical-Functional Recovery After Cardiac Surgery: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: This study investigated the effects of combining incentive spirometry with cardiac rehabilitation compared with cardiac rehabilitation alone on postoperative pulmonary complications, clinical-functional recovery, and hospital length of stay in patients undergoing cardiac surgery. METHODS: Randomized controlled trial was conducted from May 2019 to October 2023 in two hospitals, including 46 inpatients undergoing cardiac surgery. Participants were assigned to incentive spirometry plus cardiac rehabilitation or cardiac rehabilitation alone. Both interventions were performed twice daily; spirometry used a volume-oriented device, and rehabilitation followed a seven-step protocol (2-4 METs). Outcomes included postoperative pulmonary complications, functional capacity (6-min walk test), handgrip strength, respiratory muscle function, and length of hospital stay. RESULTS: The incentive spirometry associated with cardiac rehabilitation group had a longer extracorporeal circulation time (98 ± 26 min) than the cardiac rehabilitation group (76 ± 1; p = 0.008). Both groups showed a postoperative decline in respiratory muscle strength, and walking distance (MD: -64.37 m; 95% CI: [-24.1; -104.6]; d = 0.71), with no difference in postoperative pulmonary complications and handgrip strength. The incentive spirometry associated with cardiac rehabilitation group did not significantly differ on postoperative hospital stay compared with the cardiac rehabilitation group (MD: -1 day; 95% CI: [-4.71; 2.71]; d = -0.19). CONCLUSIONS: In this study, no additional benefit was observed with the addition of incentive spirometry to cardiac rehabilitation compared with cardiac rehabilitation alone. No significant differences were detected between groups in postoperative pulmonary complications, hospital length of stay, or clinical-functional recovery among individuals undergoing cardiac surgery. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC) under the number RBR-8tsjf97.

Aged

Relationships among gas exchange, spirometry and symptoms in asthma.

OBJECTIVES: The severity of asthma is usually evaluated by clinical examination and spirometry. In a small study of asthmatics considerable ventilation/perfusion (VA/Q) inequality was found, however, despite essentially normal flow rates. These findings prompted the current study. METHODS: We prospectively examined symptoms, spirometry and VA/Q inequality in 26 patients with chronic, symptomatic asthma once a week for 9 consecutive weeks. VA/Q measurements were made using a less invasive approach of the multiple inert gas elimination technique and symptoms were scored. RESULTS: Correlation coefficients between indices for VA/Q inequality (log SDQ), spirometry (FEV1.0/VC, MEF25) and symptom scores were only in the range 0.24-0.29. CONCLUSION: We conclude that even at the individual level, symptoms, spirometry and VA/Q inequality are so poorly correlated that one cannot evaluate any of these aspects of asthma without measuring each. The data support the notion that spirometric and gas exchange abnormalities in asthma are caused by different pathophysiologic events.

Asthma

Lung function changes in smokers with normal conventional spirometry.

The comparative ability to detect early abnormalities in smokers by commonly used lung function tests was studied. Sixty-five healthy male nonsmokers served as a reference group and provided standards for 1-sec forced expiratory volume, vital capacity, end-tidal spirometry, spirometric forced mid-and end-expiratory flows, single-breath diffusing capacity, static lung volumes (helium method), and single-breath N2 closing volume measurements, In the present series of 80 male smokers, the measurements of forced mid-expiratory flow and forced end-expiratory flow did not improve the ability of the more conventional indices, 1-sec forced expiratory volume and the ratio of 1-sec forced expiratory volume to vital capacity, to detect obstructive lung disease. In 71 smokers with normal 1-sec forced expiratory volume and ratio of 1-sec forced expiratory volume to vital capacity, the end-tidal spirometry, diffusing capacity, and residual volume indices revealed 14,20, and 21 per cent of abnormalities. respectively. The single-breath N2 closing volume test (Phase IV/vital capacity and slope of Phase III) detected the greatest number of subtle changes in lung function; this was abnormal in 32 per cent of smokers with normal conventional spirometry. In young or light smokers, Phase IV/vital capacity was more frequently increased than the slope of Phase III; an incerse trend was observed in older or heavier smokers. The single-breath N2 closing volume test also provided the greatest number of abnormal results when other indices were impaired in the same subjects.

Adult

Spirometry in amyotrophic lateral sclerosis.

Clinical evaluation and pulmonary function tests were performed in 218 patients with motor neuron disease, mainly amyotrophic lateral sclerosis (ALS). Serial studies were obtained in 103 patients, in 31 until death from ALS. Most patients, regardless of the pattern of motor neuron involvement, had characteristic abnormalities in pulmonary function, including reduced forced vital capacity (FVC) and maximum voluntary ventilation (MVV). Reductions in the FVC and MVV to as low as 50% were commonly missed by clinical evaluators. Spirometry is therefore of value in detecting early involvement of respiratory neurons. Progressively greater reductions in the FVC and MVV in all the fatal cases indicate that serial spirometry has prognostic value in ALS.

Adult

The radiospirometric flow-volume diagram recording technique and comparative study with conventional spirometry.

The spirometric flow-volume diagram recorded for a forced expiration gives information which is used in assessing obstructive or restrictive pulmonary diseases. Regional data of the same kind can be achieved using a simple radiospirometric technique and scintillation camera. A series of images during inspiration and expiration are defined and a time-activity curve with an integration time constant of about 100-200 ms is obtained from the images during the forced expiration phase. The equivalent of the flow-volume diagram, i.e., the time derivative of the activity vs. activity is computed. There were 21 subjects studied in this series. Normal subjects or patients with various diseases underwent classical spirometry, so that the global radioactive diagram could then be compared to the spirometric flow-volume diagram and its parameters expressed in terms of volumes and flow: vital capacity, peak flow, mean flow, flow at mean volume. The correlation with classical spirometry is highly significant. Similarly regional data are consistent with the pulmonary results.

Adult

[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

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

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

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

Prediction of postoperative respiratory complications by simple spirometry.

Spirometry was carried out before and after operation in groups of patients undergoing three preselected surgical procedures. The patterns of impairment of pulmonary function in each group are discussed. Only in patients undergoing inguinal herniorrhaphy was spirometry of value in determining an 'at-risk' group for the development of respiratory complications. Discrimination was optimal on the 1st postoperative day, making it possible for 70% of patients to be discharged from hospital 48 h after this operation with little risk of subsequent respiratory complications.

Forced Expiratory Volume

Spirometry in office practice: getting full measure from a useful tool.

Spirometry is a simple but underutilized test that is particularly well suited for office practice. With it, the physician can distinguish among different types of ventilatory impairment and follow the patient's course. It also permits detection of small-airway disease at an early stage, when measures to prevent development of chronic bronchitis and emphysema may be effective.

Expiratory Reserve Volume

Respiratory function in esophageal hiatus hernia. I. Spirometry, gas distribution, and arterial blood gases.

As a part of a preoperative investigation, spirometry and blood gas tensions were studied in 64 subjects with X-ray-verified hiatus hernia (34 sliding, 22 mixed, and 8 of paraesophageal variety). According to the transverse diameter of the hernia. They were divided into 3 groups, small (2-5.9 cm), medium (6-9.9 cm), and large (10-17 cm) hernias. No correlation between the size of the hernia, reflux incidence, and spirometric findings could be demonstrated. A significant reduction of the arterial oxygen tension was found in small hernias and in vital capacity and maximal voluntary ventilation (MVV) in medium-sized hernias. Significant reduction in MVV was noted in the large hernia group. A common spirometric finding in all groups was a significant increase in residual volume and wash-out volume. The incidence of restrictive or obstructive pulmonary impairment was high in large (39%) and small (32%) hernias and relatively low in medium-sized hernias (8%). Roentgenological fibrosis was not found in any of the patients, while 4 showed emphysematous changes.

Adult

[Respiratory function in liver cirrhosis. Spirometry, blood gas analysis and radioisotope study with Xenon 133].

The literature data concerning respiratory function in cirrhosis of the liver are cited and reference is made to the results of a spirometric, gas analysis and 133-Xenon investigation of this parameter in 38 patients. Spirometry pointed to slight ventilatory incapacity of the restrictive type. Arterial gas analaysis showed respiratory alkalosis, usually accompanied by metabolic acidosis and slight hypoxyaemia. Examination with 133-Xe indicated that hypoxyaemia was not due to a shunt effect, since there was no excess of perfusion with respect to district ventilation. It was clear, on the other hand, that the pulmonary capillary reserve was almost exhausted. Such complete perfusion of the capillary bed may be due to increased cardiac output and, in part, to reduction of the respiratory surface caused by raising of the diaphragm and hypoventilation of the lung bases.

Acid-Base Equilibrium

[Pediatric spirometry as a prognostic test of adult obstructive bronchopneumopathy].

Authors study the spirometry of 40 asthmatic children between 6 and 12 years in age. Spirometric determination was performed immediately after the asthmatic attack and also at least 15 days after the last attack. The cases have been subdivided into four groups for what concerns Tiffeneau's index and Mottly's index. The group of subjects with abnormal Tiffeneau's and Mottly's indices is of particular interest. There exists probably in such subjects a beginning emphysema that might lead up, at the adult age, to a picture of obstructive bronchopneumopathy.

Asthma

[Atmospheric pollution and spirometry in healthy children of the Distrito Federal].

Investigation of the vital capacity, maximum expiratory flow and maximum mean expiratory flow was carried out in children living in two areas of Mexico City, one of them with a high degree (azcapotzalco) and the other one with low degree (Tizapán) of air pollution. Timed spirometry was carried out on children attending 4th, 5th and 6th grades in two official grammar schools so both groups were as uniform as possible in their social-economical level and nutritional and health conditions. This goal was attained quite satisfactorily and groups turned similar, after comparing results and analysing statistically somatometric data, together with scholarship of the parents, economical income, history of respiratory diseases and physical examination. However, quite a significant statistical difference (p less than 0.001) was found between the parameters involving measurements of ventilation in favor of Tizapán children. The difference between Azcapotzalco and Tizapán children in terms of the three ventilatory parameters analyzed was possibly due to the fact the former lived in a greater polluted area.

Air Pollution

Spirometry in convalescent hemiplegic patients.

The forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) were determined in 20 patients with convalescent hemiplegia. The FVC and FEV1 were reduced and the PEFR was within normal range. These results indicate a restrictive ventilatory defect with an FEV% that approached the vital capacity. The physical ability of each patient was assessed on the basis of the time it took to walk a distance of 18.5 meters as quickly as possible. Although it appears from the results that physical ability did not bear any relationship to the degree of restrictive ventilatory defect, other parameters of spirometry may be needed to confirm this. The results suggest that the restrictive ventilatory defect will be of more clinical importance in exercise tolerance for strenuous exercise than in ordinary daily activities.

Adult