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Patient guide to spirometry.docxPatient Guide to Spirometry
Welcome to Me Cure Healthcare Limited.
This information booklet aims to answer questions that you may have about your
Frequently Asked Questions
Spirometry is the most commonly performed pulmonary function test (PFT). The test can be performed at the bedside, in a physician's office, or in a pulmonary laboratory. It is often the first test performed when a problem with lung function is suspected. Spirometry may also be suggested by an abnormal x ray, arterial blood gas analysis, or other diagnostic pulmonary test result. The National Lung Health Education Program recommends that regular spirometry tests be performed on persons over 45 years old who have a history of smoking. Spirometry tests are also recommended for persons with a family history of lung disease, chronic respiratory ailments, and advanced age. Spirometry measures ventilation, the movement of air into and out of the lungs. The spirogram will identify two different types of abnormal ventilation patterns, obstructive and restrictive. Common causes of an obstructive pattern are cystic fibrosis, asthma, bronchiectasis, bronchitis, and emphysema. These conditions may be collectively referred to by using the acronym CABBE. Chronic bronchitis, emphysema, and asthma result in dyspnea (difficulty breathing) and ventilation deficiency, a condition known as chronic obstructive pulmonary disease (COPD). COPD is the fourth leading cause of death among Americans. Common causes of a restrictive pattern are pneumonia, heart disease, pregnancy, lung fibrosis, pneumothorax (collapsed lung), and pleural effusion (compression caused by chest fluid). Obstructive and restrictive patterns can be identified on spirographs using both a "y" and "x" axis. Volume (liters) is plotted on the y-axis versus time (seconds) on the x-axis. A restrictive pattern is characterized by a normal shape showing reduced volumes for all parameters. The reduction in volumes indicates the severity of the disease. An obstructive pattern produces a spirogram with an abnormal shape. Inspiration volume is reduced. The volume of air expelled is normal but the air flow rate is slower, causing an elongated tail to the FVC.
A flow-volume loop spirogram is another way of displaying spirometry measurements. This
requires the FVC maneuver followed by a forced inspiratory volume (FIV). Flow rate in liters per
second is plotted on the y-axis and volume (liters) is plotted on the x-axis. The expiration phase is
shown on top and the inspiration phase on the bottom. The flow-volume loop spirogram is helpful in
diagnosing upper airway obstruction, and can differentiate some types of restrictive patterns.
Some conditions produce specific signs on the spirogram. Irregular inspirations with rapid
frequency are caused by hyperventilation associated with stress. Diffuse fibrosis of the lung causes
rapid breathing of reduced volume, which produces a repetitive pattern known as the penmanship
sign. Serial reduction in the FVC peaks indicates air trapped inside the lung. A notch and reduced
volume in the early segments of the FVC is consistent with airway collapse. A rise at the end of
expiration is associated with airway resistance.
Spirometry is used to assess lung function over time, and often to evaluate the efficacy of
bronchodilator inhalers such as albuterol. It is important for the patient to refrain from using a
bronchodilator prior to the evaluation. Spirometry is performed before and after inhaling the
bronchodilator. In general, a 12% or greater improvement in both FVC and FEV-1, or an increase
in FVC by 0.2 liters, is considered a significant improvement for an adult patient.
The patient should inform the physician of any medications he or she is taking, or of any medical conditions that are present; these factors may affect the validity of the test. The patient's smoking habits and history should be thoroughly documented. The patient must be able to understand and respond to instructions for the breathing maneuvers. Therefore, the test may not be appropriate for very young, unresponsive, or physically impaired persons. Spirometry is contraindicated in patients whose condition will be aggravated by forced breathing, including: • Hemoptysis (spitting up blood from the lungs or bronchial tubes) • Pneumothorax (free air or gas in the pleural cavity) • Recent heart attack • Unstable angina • Aneurysm (cranial, thoracic, or abdominal) • Thrombotic condition (such as clotting within a blood vessel) • Recent thoracic or abdominal surgery • Nausea or vomiting The test should be terminated if the patient shows signs of significant head, chest, or abdominal
pain while the procedure is in progress.
Spirometry is dependent upon the patient's full compliance with breathing instructions, especially
his or her willingness to extend a maximal effort at forced breathing. Therefore, the patient's
emotional state must be considered.
The patient's age, gender, and race are recorded, and height and weight are measured before the
procedure begins. The patient should not have eaten heavily within three hours of the test. He or
she should be instructed to wear loose-fitting clothing over the chest and abdominal area. The
respiratory therapist or other testing personnel should explain and demonstrate the breathing
maneuvers to the patient. The patient should practice breathing into the mouthpiece until he or she
is able to duplicate the maneuvers successfully on two consecutive attempts.
In most cases, special care is not required following spirometry. Occasionally, a patient may
become lightheaded or dizzy. Such patients should be asked to rest or lie down, and should not be
discharged until after the symptoms subside. In rare cases, the patient may experience
pneumothorax, intracranial hypertension, chest pain, or uncontrolled coughing. In such cases,
additional care directed by a physician may be required.
The results of spirometry tests are compared to predicted values based on the patient's age, gender, and height. For example, a young adult in good health is expected to have the following FEV values: • FEV-0.5—50-60% of FVC • FEV-1—75-85% of FVC • FEV-2—95% of FVC • FEV-3—97% of FVC In general, a normal result is 80–100% of the predicted value. Abnormal values are: • mild lung dysfunction—60–79% • moderate lung dysfunction—40–59% • severe lung dysfunction—below 40%
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