1
Q
What are the indications for spirometry?
A
- Diagnostic
- Monitoring
- Disability/Impairment Evaluations
- Public Health
These categories outline the various reasons spirometry is performed.
2
Q
List the diagnostic indications for spirometry.
A
- Evaluate symptoms, signs or abnormal lab tests
- Measure the effect of disease on pulmonary function
- Screen individuals at risk of having pulmonary disease
- Assess pre-operative risk
- Assess prognosis
- Assess health status before beginning strenuous physical activity programs
Diagnostic indications help in identifying and evaluating pulmonary conditions.
3
Q
List the monitoring indications for spirometry.
A
- Assess therapeutic intervention
- Describe the course of disease that affect lung function
- Monitor people exposed to injurious agents
- Monitor for adverse reactions to drugs with known pulmonary toxicity
Monitoring indications are crucial for tracking lung function over time.
4
Q
List the disability/impairment evaluations for spirometry.
A
- Assess patients as part of a rehabilitation program
- Assess risks as part of an insurance evaluation
- Assess individuals for legal reasons
These evaluations are important for determining the impact of lung function on daily activities and legal matters.
5
Q
List the public health indications for spirometry.
A
- Epidemiological surveys
- Derivation of reference equations
- Clinical Research
- Pre-employment and lung health monitoring for at-risk occupations
- Assess health status before beginning at-risk physical activities
Public health indications focus on broader health assessments and research.
6
Q
What are the relative contraindications for spirometry related to increases in myocardial demand or changes in blood pressure?
A
- Recent acute MI
- Hypertension
- Cardiac arrhythmias
- Heart failure
- Cor pulmonale
- Pulmonary embolism
- History of syncope related to forced expiration/cough
These conditions may increase the risk during spirometry testing.
7
Q
List the relative contraindications for spirometry related to increases in intracranial or intraocular pressure.
A
- Recent brain surgery
- Recent concussion
- Recent eye surgery
These conditions can pose risks during the spirometry procedure.
8
Q
What are the relative contraindications for spirometry related to increases in sinus and/or middle ear pressure?
A
- Recent sinus surgery
- Recent middle ear infection
- Recent infection
These conditions may affect the safety of spirometry testing.
9
Q
Identify the relative contraindications for spirometry related to increases in intrathoracic and/or intra-abdominal pressure.
A
- Presence of pneumothorax
- Recent thoracic surgery
- Recent abdominal surgery
- Late-term pregnancy
These conditions can complicate the spirometry process.
10
Q
What should be done if a patient experiences pain or adverse effects during spirometry testing?
A
Stop the testing procedure
Patient safety is paramount during spirometry.
11
Q
What is the impact of age on predicted values in spirometry?
A
Predicted values decrease as patients get older
Age is a factor in determining predicted values.
12
Q
What should be recorded for a patient’s date of birth (DOB) in spirometry?
A
Record date of birth and date of testing
This information is essential for calculating age-related predicted values.
13
Q
How should body mass be reported in spirometry?
A
Report in kg/m²
Body mass is a critical measurement in assessing lung function.
14
Q
What is the proper unit for recording height in spirometry?
A
Recorded in cm to one decimal place
Height may also be recorded in inches.
15
Q
What device is used to accurately measure height?
A
Stadiometer
A stadiometer uses a vertical ruler with a sliding horizontal rod.
16
Q
What is the procedure for measuring height using a stadiometer?
A
- Patient’s feet together without shoes
- Stand as tall as possible
- Look straight ahead
- Measure within 1 decimal place
Proper positioning is crucial for an accurate measurement.
17
Q
How often should a stadiometer be calibrated?
A
Calibrated annually or whenever values are grossly abnormal
Regular calibration ensures measurement accuracy.
18
Q
What is an alternate method for estimating height in spirometry?
A
Ulnar length
This method involves measuring the distance from the olecranon process to the styloid process.
19
Q
What is the first step in measuring ulnar length for height estimation?
A
Measure the distance from the point of the elbow (olecranon process) to the protrusion of the outer wrist (styloid process)
A table is used to convert this distance to an estimated height.
20
Q
What is the impact of age on predicted values in spirometry?
A
Predicted values decrease as patients get older
Age is a factor in determining predicted values.
21
Q
What should be recorded for a patient’s date of birth (DOB) in spirometry?
A
Record date of birth and date of testing
This information is essential for calculating age-related predicted values.
22
Q
How should body mass be reported in spirometry?
A
Report in kg/m²
Body mass is a critical measurement in assessing lung function.
23
Q
What is the proper unit for recording height in spirometry?
A
Recorded in cm to one decimal place
Height may also be recorded in inches.
24
Q
What device is used to accurately measure height?
A
Stadiometer
A stadiometer uses a vertical ruler with a sliding horizontal rod.
25
What is the procedure for measuring height using a **stadiometer**?
* Patient's feet together without shoes
* Stand as tall as possible
* Look straight ahead
* Measure within 1 decimal place
## Footnote
Proper positioning is crucial for an accurate measurement.
26
How often should a **stadiometer** be calibrated?
Calibrated annually or whenever values are grossly abnormal
## Footnote
Regular calibration ensures measurement accuracy.
27
What is an **alternate method** for estimating height in spirometry?
Ulnar length
## Footnote
This method involves measuring the distance from the olecranon process to the styloid process.
28
What is the first step in measuring **ulnar length** for height estimation?
Measure the distance from the point of the elbow (olecranon process) to the protrusion of the outer wrist (styloid process)
## Footnote
A table is used to convert this distance to an estimated height.
29
What is **Arm Span** used for in spirometry?
To estimate height for patients with spinal deformities (kyphoscoliosis)
## Footnote
Procedure involves arms extended horizontally, measuring from middle finger to middle finger.
30
Describe the **procedure** for measuring Arm Span.
* Arms extended horizontally
* Feet against the wall
* Measure with tailor's tape or ruler mounted on a wall
* Measure middle finger to middle finger
* Regression equation applied to estimate height
## Footnote
This method is used for patients with spinal deformities.
31
True or false: **Females** have larger lung volumes than males of the same age and height.
FALSE
## Footnote
Females have smaller lung volumes than males, which is an important factor in determining predicted values.
32
What should be used instead of gender identity when determining predicted values in spirometry?
Birth gender
## Footnote
If birth gender is not disclosed, it should be documented in the notes.
33
How should **weight** be measured for spirometry?
* Measured to within 0.5 kg
* May be reported in pounds
* Use electronic scales
## Footnote
Weight is not commonly used to calculate typical lung volumes but is important for VO2 for exercise and metabolic measurements.
34
What is the significance of **Body Mass Index (BMI)** in lung volume interpretation?
May be helpful for interpretation of lung volumes
## Footnote
Morbidly obese patients may show a restrictive pattern.
35
What is the recommended practice regarding **weight** in spirometry?
Use ideal body weight (IBW) instead of actual weight
## Footnote
Weight is used for VO2 for exercise and metabolic measurements.
36
What factors are considered in the calculation of **predicted values** for lung function?
* Gender/Sex
* Weight
* Race/Ethnicity
## Footnote
Each factor plays a role in determining lung volume predictions.
37
According to the Global Lung Function Initiative (GLI), how should **race/ethnicity** be reported?
* African American
* Northeast Asian
* Southeast Asian
* White (European ancestry)
* Other/Mixes
## Footnote
If ethnicity is not disclosed, it should be documented in the notes.
38
What must be used by a **qualified professional** to obtain accurate data in spirometry?
Calipers
## Footnote
Calipers are utilized during cardiopulmonary exercise testing.
39
What type of **history** assists in the diagnosis during spirometry?
Occupational History
## Footnote
Occupational history may be the only information the technologist has about the patient.
40
What should the technologist inquire about in a patient's **occupational history**?
* Mine quarry or foundry work
* Mill work
* Farming
* Exposure to gas or fumes
* Dusty environment
## Footnote
These factors are important for diagnosing conditions like sarcoidosis, pneumoconiosis, and histoplasmosis.
41
What is the formula for calculating **pack years** in smoking history?
Pack years = number of packs smoked per day × number of years smoked
## Footnote
Example: 2 packs per day for 20 years = 40 pack year smoking history.
42
True or false: Patients should avoid smoking for a minimum of one hour prior to **spirometry testing**.
TRUE
## Footnote
This is important to ensure accurate test results.
43
What chronic respiratory diseases should be inquired about in a patient's **medical/surgical history**?
* Asthma
* Tuberculosis
* Chronic bronchitis
* Recurrent colds
* Infections
* Pneumonia
## Footnote
The presence of allergies or hay fever should also be recorded.
44
What should be noted regarding a patient's **chronic cough**?
* Time of day it is worst
* Time of year it is worst
* Color and volume of sputum produced if productive
## Footnote
This information aids in interpreting test results.
45
What is the **normal range** for **respirations** per minute?
10 - 20 breaths per minute
## Footnote
Pattern and depth may be important if abnormal.
46
What is the **normal pulse rate** in beats per minute?
60 - 100 beats per minute
## Footnote
Strength of pulse is significant.
47
What are the two types of pulse strength?
* Strong and regular
* Weak and thready
## Footnote
These characteristics can indicate different health conditions.
48
What is the **normal blood pressure** reading?
120/80 mm Hg
## Footnote
Changes in blood pressure may result from increased pressures in the thorax during forced expiratory maneuvers.
49
What must a patient be to ensure the validity of spirometry results?
* Alert
* Oriented
* Able to follow commands
## Footnote
If the patient is groggy or confused, the validity of the results should be questioned.
50
What should be done regarding **oxygen therapy** before spirometry testing?
* Patients may need to be placed on oxygen between maneuvers
* Oxygen should be removed at least 20 minutes prior to drawing an arterial blood gas
## Footnote
If the patient cannot be without oxygen for that length of time, the oxygen should be reported on the blood gas record.
51
What should be done with **aerosolized bronchodilators** prior to testing?
The medication should be held prior to testing
## Footnote
Bronchodilator administration for post-bronchodilator testing should be given by the same method the patient uses at home.
52
What can **serial pulmonary function tests** evaluate?
The effectiveness of a rehabilitation program
## Footnote
This is part of pulmonary rehabilitation.
53
What environmental factors should be recorded during spirometry?
* Room temperature
* Barometric pressure
* Time of day
## Footnote
These factors can affect test results.
54
What should be done with **dentures** during spirometry testing?
They should be left in place unless they are loose
## Footnote
This ensures proper mouth closure during the test.
55
What should be available during spirometry testing for patient comfort?
* Drinking water
* Tissues for secretions
## Footnote
These items help maintain patient comfort and hygiene.
56
What is the purpose of using **nose clips** or manual pinching of the nose during testing?
To prevent air from escaping through the nose
## Footnote
This ensures accurate measurement of lung function.
57
What is the **standard position** for spirometry?
Sitting
## Footnote
Sitting is preferred for safety reasons and the chair should have arms and no wheels.
58
What should be done with **wheelchair wheels** during spirometry?
Locked
## Footnote
This ensures safety during the procedure.
59
For **obese patients** or those with excessive weight in the mid-section, what position is preferred for spirometry?
Standing
## Footnote
Standing provides more accurate volumes and flow.
60
What is the effect of the **supine position** on FVC during spirometry?
Smaller FVC
## Footnote
It is important to report the patient's position and effort during the test.
61
What should be assessed in a patient in the **supine position** during spirometry?
Diaphragmatic weakness or paralysis
## Footnote
This assessment is crucial for understanding the patient's respiratory function.
62
What is the **withholding time** for SABA medications like Albuterol?
4 - 6 hours
## Footnote
SABA stands for Short-Acting Beta Agonists.
63
What is the **withholding time** for SAMA medications such as Ipratropium?
12 hours
## Footnote
SAMA stands for Short-Acting Muscarinic Antagonists.
64
What is the **withholding time** for LABA medications like Formoterol?
24 hours
## Footnote
LABA stands for Long-Acting Beta Agonists.
65
What is the **withholding time** for Ultra-LABA medications such as Indacaterol?
36 hours
## Footnote
Ultra-LABA refers to ultra-long-acting beta agonists.
66
What is the **withholding time** for LAMA medications like Tiotropium?
36 - 48 hours
## Footnote
LAMA stands for Long-Acting Muscarinic Antagonists.
67
If multiple bronchodilators are being used, what should be considered regarding **withholding times**?
Select the withholding time for the longest-acting drug
## Footnote
This ensures accurate spirometry results.
68
Which medications **do not need to be held** prior to spirometry testing?
* Inhaled steroids
* Cardiac medications
* Antibiotics
## Footnote
These medications are important to note but do not affect the test.
69
What type of medications should be **recorded** prior to spirometry testing?
Type and dosage of all medications affecting pulmonary function
## Footnote
Example: beta-blockers like propranolol used for hypertension.
70
What activities should be avoided **prior to spirometry testing**?
* Smoking, vaping, and/or use of water pipe within 1 hour
* Performing vigorous exercise within 1 hour
* Consuming intoxicants within 8 hours
* Wearing clothing that restricts full chest and abdominal expansion
## Footnote
These precautions help ensure accurate spirometry results.
71
Define **Slow Vital Capacity (SVC)**.
Maximum expiration following a maximum inspiration
## Footnote
SVC is measured with a spirometer attached to a recorder.
72
In spirometry, values are recorded in _______ or _______.
liters or milliliters
## Footnote
Values are corrected to BTPS (body temperature and pressure saturated).
73
All spirometry values are measured at **ATPS** and should be reported at **BTS**.
ATPS (ambient temperature and pressure saturated) and BTS (body temperature and pressure saturated)
## Footnote
The ATPS measurement is multiplied by a factor to determine the TPS value.
74
The **BPS factor** is based upon which three conditions?
* Ambient temperature
* Barometric pressure
* Humidity level
## Footnote
Accuracy in ambient temperature is within 1°C; variations over 3°C within 30 minutes require corrections.
75
What spirometry measurements are included in **Maximal Inspiratory Level**?
* IRV (Inspiratory Reserve Volume)
* IC (Inspiratory Capacity)
* VC (Vital Capacity)
* TLC (Total Lung Capacity)
## Footnote
These measurements help assess lung function.
76
What spirometry measurements are included in **Resting Expiratory Level**?
* FRC (Functional Residual Capacity)
* RV (Residual Volume)
* ERV (Expiratory Reserve Volume)
## Footnote
These measurements are crucial for understanding lung volumes.
77
True or false: **Humidity level** does not affect spirometry measurements.
FALSE
## Footnote
Humidity level is one of the factors that influence spirometry results.
78
What is the **definition** of **Vital Capacity (VC)**?
Maximum inspiration followed by maximum expiration
## Footnote
Typical value = 4800 mL or 4.8 L. Significance: decreased with restrictive disease.
79
What is the typical value of **Vital Capacity (VC)**?
4800 mL or 4.8 L
## Footnote
The best volume to diagnose restrictive disease.
80
What does a **decreased Vital Capacity (VC)** indicate?
Restrictive lung disease
## Footnote
Decreased volumes are associated with restrictive lung disease.
81
What are the formulas for calculating **Vital Capacity (VC)**?
* VC = IRV + VT + ERV
* VC = IC + ERV
* VC = TLC - RV
## Footnote
These formulas represent different components of lung volumes.
82
What is the **definition** of **Tidal Volume (VT)**?
Normal, resting breathing volume
## Footnote
Typical value = 500 mL or 0.5 L.
83
How is **Tidal Volume (VT)** measured?
With a spirometer and recording device
## Footnote
Reported in liters or milliliters, corrected to BTPS.
84
What is the typical value of **Tidal Volume (VT)**?
500 mL or 0.5 L
## Footnote
Significance: decreased with restrictive disease.
85
What is the formula for calculating **minute volume**?
Tidal volume X respiratory rate
## Footnote
This represents the total volume of air inhaled or exhaled in one minute.
86
What are the formulas for calculating **Tidal Volume (VT)**?
* VT = IC - IRV
* VT = VC - IRV - ERV
* VT = TLC - IRV - ERV - RV
## Footnote
These formulas show the relationships between different lung volumes.
87
What is the **definition** of **Inspiratory Reserve Volume (IRV)**?
Largest volume of gas that can be inspired above a normal tidal volume
## Footnote
Typical value = 3100 mL or 3.1 L.
88
How is **Inspiratory Reserve Volume (IRV)** measured?
With a spirometer and recording device
## Footnote
Reported in liters or milliliters, corrected to BTPS.
89
What does a **decreased Inspiratory Reserve Volume (IRV)** indicate?
Restrictive disease
## Footnote
This volume is typically decreased in patients with restrictive lung disease.
90
What are the formulas for calculating **Inspiratory Reserve Volume (IRV)**?
* IRV = IC - VT
* IRV = VC - ERV - VT
## Footnote
These formulas illustrate the relationship between different lung volumes.
91
What is the **definition** of **Expiratory Reserve Volume (ERV)**?
Largest volume of gas that can be expired from a resting end-expiratory level
## Footnote
Typical value = 1200 mL or 1.2 L.
92
How is **Expiratory Reserve Volume (ERV)** measured?
With a spirometer and recording device
## Footnote
Reported in liters or milliliters, corrected to BTPS.
93
What does a **decreased Expiratory Reserve Volume (ERV)** indicate?
Restrictive disease
## Footnote
This volume is typically decreased in patients with restrictive lung disease.
94
What are the formulas for calculating **Expiratory Reserve Volume (ERV)**?
* ERV = VC - IC
* ERV = FRC - RV
## Footnote
These formulas show the relationships between different lung volumes.
95
What is the **definition** of **Inspiratory Capacity (IC)**?
Largest volume that can be inspired from resting end-expiration
## Footnote
Measured with a spirometer and recording device.
96
How is **Inspiratory Capacity (IC)** recorded?
In liters or milliliters, corrected to BTPS
## Footnote
Typical value = 3600 mL or 3.6 L.
97
What happens to **Inspiratory Capacity (IC)** in restrictive disease?
Decreased
## Footnote
IC is significant in assessing lung function.
98
What are the formulas for calculating **Inspiratory Capacity (IC)**?
* IC = IRV + V
* IC = VC - ERV
* IC = TLC - FRC
## Footnote
These formulas relate different lung volumes.
99
Given the following values, which capacity is erroneous?
1. IRV: 3.0 L
2. ERV: 1.5 L
3. FRC: 2.0 L
4. RV: 1.0 L
5. VC: 5.0 L
6. IC: 0.5 L
B. FRC
## Footnote
The values must adhere to physiological limits.
100
What is the **definition** of **Forced Vital Capacity (FVC)**?
Maximum inspiration followed by a forced and rapid maximum expiration
## Footnote
This maneuver generates the FVC, which is a volume.
101
What should be compared if both **SVC** and **FVC** are given?
The SVC and FVC
## Footnote
A patient with normal lung function will have values that are approximately the same for both volumes.
102
If the **SVC** is greater than the **FVC**, what should be suspected?
Obstructive lung disease or poor patient effort on the FVC
## Footnote
Patients with obstructive lung disease can exhale more air slowly than rapidly.
103
If the **FVC** is greater than the **SVC**, what should be questioned?
The patient's effort on the SVC
## Footnote
This can indicate issues with the patient's performance during the test.
104
What is the first step in the **procedure for FVC maneuver**?
Wash hands or use approved sanitizer
## Footnote
This is essential for maintaining hygiene before patient interaction.
105
List the steps to **prepare the patient** for the FVC maneuver.
* Dispense hand sanitizer for the patient
* Confirm patient identification and information
* Ask about activities prior to testing
* Ask about medication use prior to testing
* Assess for any relative contraindications
* Note any respiratory symptoms
* For an adult patient, sit upright, shoulders back, chin up a little
* Use a chair with arms, no wheels, adjustable to keep feet flat on the floor
## Footnote
Proper preparation ensures accurate test results and patient safety.
106
What is the correct posture for an adult patient during the **FVC maneuver**?
Sit upright, shoulders back, chin up a little
## Footnote
Correct posture is crucial for accurate spirometry results.
107
What should be done after attaching the **nose clip** during the FVC maneuver?
Place mouthpiece in mouth and close lips tightly around the mouthpiece
## Footnote
This ensures a proper seal for accurate measurements.
108
What is the maximum time allowed for a pause at **TLC** during the FVC maneuver?
<2 sec
## Footnote
A quick pause is necessary to ensure proper inhalation before exhalation.
109
What should be done if the patient **passes out** during the FVC maneuver?
This may indicate decreased venous return (vaso-vagal response)
## Footnote
Immediate attention is required to ensure patient safety.
110
An increase in **FVC** of > 10% after bronchodilator can suggest what?
Peripheral air trapping or a positive post-bronchodilator response
## Footnote
This indicates potential improvements in lung function.
111
What time should be recorded before **exhalation starts** during the FVC maneuver?
0.25 seconds to 1.0 seconds
## Footnote
This timing is critical for accurate spirometry results.
112
What must the last **2.0 seconds** show during the FVC maneuver?
Satisfactory 'end of test'
## Footnote
This ensures that the test is completed properly.
113
How is **FVC** calculated from a graph?
* Draw a horizontal line at maximum expiration (A) to volume axis
* Mark volume at this level
* Draw a horizontal line at maximum inspiration (B) to volume axis
* Mark volume at this level
* FVC is the vertical distance between the two lines
## Footnote
This method provides a visual representation of lung capacity.
114
In the example, what is the **FVC** calculated from the graph?
3.2 liters ATPS (4.4 - 1.2 = 3.2)
## Footnote
This calculation demonstrates how to derive FVC from graphical data.
115
What is the **BTPS conversion factor** when the spirometer temperature is 25°C?
1.075
## Footnote
This factor is used to convert measured volumes to body temperature and pressure saturated conditions.
116
Calculate the **FVC** in liters when the measured volume is 3.20 liters at 25°C.
3.44 liters BTPS
## Footnote
This value should be reported for Forced Vital Capacity (FVC).
117
Define **Peak Expiratory Flow (PEF)**.
The maximum flowrate achieved during a forced expiratory maneuver
## Footnote
Measured in liters/second or liters/minute ATPS corrected to BTPS.
118
What is the **typical value** for Peak Expiratory Flow?
10 L/sec or 600 L/minute
## Footnote
This value indicates normal peak flow rates in healthy individuals.
119
True or false: **Peak Expiratory Flow** is nonspecific in terms of diagnosis.
TRUE
## Footnote
It is very dependent on patient effort and may not indicate specific conditions.
120
What is a common use for measuring **Peak Expiratory Flow**?
Monitoring patients with asthma
## Footnote
It helps to measure gross changes in airway function before and after bronchodilator administration.
121
List the **criteria for acceptability** when measuring Peak Expiratory Flow.
* Patient standing or sitting up straight
* Patient inhales rapidly and maximally
* Patient exhales forcefully without holding breath
* Minimum of three efforts recorded
* Largest two efforts within 0.67 L/sec (40 L/min)
* Report the largest peak flow
## Footnote
These criteria ensure accurate and reliable peak flow measurements.
122
What should be done if **peak flow readings** are consistently decreasing?
Investigate fatigue as a cause
## Footnote
This may indicate that the patient does not have mild restrictive disease.
123
What does **FEF 25% - 75%** measure?
Average flowrate during the middle half of a forced expiratory maneuver
## Footnote
It is a critical measure for assessing small airway function.
124
How is **FEF 25% - 75%** measured?
In liters/second ATPS corrected to BTPS
## Footnote
This ensures accurate representation of flow rates under standard conditions.
125
What is the **typical value** for **FEF 25% - 75%**?
4 - 5 L/sec
## Footnote
Values outside this range may indicate potential airway obstruction.
126
What does a decreased **FEF 25% - 75%** indicate?
Obstructive disease
## Footnote
It is the most sensitive test for early small airway disease detection.
127
True or false: **FEF 25% - 75%** may appear decreased if **FVC** and **FEV** are greatly increased in a post bronchodilator study.
TRUE
## Footnote
This can lead to misinterpretation of small airway function.
128
What does **FEV** stand for?
Forced Expiratory Volume
## Footnote
It measures the volume of gas expired over a specified time interval.
129
What are the most common **FEV** measurements?
* FEV 0.5
* FEV 1.0
* FEV 2.0
* FEV 3.0
* FEV 6.0
## Footnote
FEV 1.0 is the only value needed to diagnose obstructive disease.
130
How is **FEV** measured?
In liters ATPS with the subscript indicating the time interval, corrected to BTPS
## Footnote
This standardization is crucial for accurate clinical assessments.
131
What does **FEF 25% - 75%** measure?
Average flowrate during the middle half of a forced expiratory maneuver
## Footnote
It is a critical measure for assessing small airway function.
132
How is **FEF 25% - 75%** measured?
In liters/second ATPS corrected to BTPS
## Footnote
This ensures accurate representation of flow rates under standard conditions.
133
What is the **typical value** for **FEF 25% - 75%**?
4 - 5 L/sec
## Footnote
Values outside this range may indicate potential airway obstruction.
134
What does a decreased **FEF 25% - 75%** indicate?
Obstructive disease
## Footnote
It is the most sensitive test for early small airway disease detection.
135
True or false: **FEF 25% - 75%** may appear decreased if **FVC** and **FEV** are greatly increased in a post bronchodilator study.
TRUE
## Footnote
This can lead to misinterpretation of small airway function.
136
What does **FEV** stand for?
Forced Expiratory Volume
## Footnote
It measures the volume of gas expired over a specified time interval.
137
What are the most common **FEV** measurements?
* FEV 0.5
* FEV 1.0
* FEV 2.0
* FEV 3.0
* FEV 6.0
## Footnote
FEV 1.0 is the only value needed to diagnose obstructive disease.
138
How is **FEV** measured?
In liters ATPS with the subscript indicating the time interval, corrected to BTPS
## Footnote
This standardization is crucial for accurate clinical assessments.
139
What does **decreased flows** in spirometry indicate?
Obstructive disease, particularly the FEV 1.0
## Footnote
FEV 1.0 is also used to assess the degree of improvement after bronchodilator administration.
140
How long should you wait after administering a **bronchodilator** before re-testing?
10 - 15 minutes
## Footnote
This waiting period allows for accurate assessment of lung function post-medication.
141
What is the **definition** of FEV/FVC%?
The forced expiratory volume for a given time interval expressed as a percentage of the vital capacity
## Footnote
This ratio helps assess lung function and airflow obstruction.
142
What are the **minimum acceptable values** for FEV/FVC%?
* FEV 0s/FVC% = 60%
* FEV 1.0/FVC% = 70%
* FEV 2.0/FVC% = 94%
* FEV 3.0/FVC% = 97%
* FEV 6.0/FVC% = 99%
## Footnote
These values are used to determine normal lung function.
143
What is the age adjustment for FEV/FVC% for individuals **over 60 years**?
> 70%
## Footnote
Age adjustments are important for interpreting spirometry results accurately.
144
What is the age adjustment for FEV/FVC% for individuals **between 40 - 60 years**?
> 75%
## Footnote
This adjustment helps account for normal variations in lung function with age.
145
What is the age adjustment for FEV/FVC% for individuals **between 20 - 39 years**?
> 80%
## Footnote
Younger individuals typically have better lung function, hence higher percentage values.
146
What is the age adjustment for FEV/FVC% for individuals **under 20 years**?
> 85%
## Footnote
This reflects the peak lung function typically seen in younger populations.
147
True or false: FEV/FVC% is **decreased** with obstructive disease.
TRUE
## Footnote
In obstructive diseases, airflow limitation leads to lower FEV values.
148
True or false: FEV/FVC% is **normal** with restrictive disease.
TRUE
## Footnote
Even in the presence of decreased VC and/or decreased FEV, the ratio may remain normal.
149
What does **FEV** stand for in spirometry?
Forced Expiratory Volume
## Footnote
FEV is a key measurement in assessing lung function.
150
In spirometry, how is **FEV/FVC%** calculated?
* Use the largest values for FVC and FEV
* Divide FEV by FVC
* Multiply by 100 to get a percentage
## Footnote
Example: If FVC is 5.0 L and FEV is 3.0 L, then 3.0/5.0 = 60%.
151
What is the **definition** of Maximum Voluntary Ventilation (MVV)?
Largest volume of air inhaled and exhaled over a 12 second period
## Footnote
The value is extrapolated to 1 minute and reported in liters per minute, corrected to BTPS.
152
What is a typical value for **Maximum Voluntary Ventilation (MVV)**?
170 L/min
## Footnote
This value provides insights into respiratory function.
153
What does the **MVV** provide information about?
* Status of the respiratory muscles
* Compliance of the lungs and thorax
* Airway resistance
## Footnote
These factors are crucial for understanding lung health.
154
What is the **technique** for performing spirometry?
Patient breathes into a spirometer as deeply and as rapidly as possible for a minimum of 12 seconds
## Footnote
The breathing should not be panting.
155
What is the formula for calculating **L/min** in spirometry?
# of breaths X volume X 5 = L/min
## Footnote
Example: 14 breaths X 2L X 5 = 140 L/min.
156
What is the **temperature correction factor** in spirometry?
140 L/min. X temperature correction factor = 150 L/min.
## Footnote
This adjusts the spirometry results based on temperature.
157
What are the **criteria for acceptability** in spirometry?
* Tracing shows continuous rhythmic effort for a minimum of 12 seconds
* Volume is about 50% of vital capacity and the rate is 90 - 110 breaths per second
* Two acceptable maneuvers within 20% of each other should be performed
* Report the highest value
## Footnote
These criteria ensure reliable and valid spirometry results.
158
What indicates **significance** in spirometry results?
* Only large reductions in values are significant and will indicate severe obstructive disease
* Depends largely upon patient effort
* To estimate patient effort, multiply the patient's FEV1 by 40
## Footnote
If the MVV is less than that value, suspect poor patient effort.
159
If the patient's **FEV1** is 2 liters, what is the calculated effort value?
2 X 40 = 80 L/min
## Footnote
An MVV less than 80 liters/minute should be repeated and the patient encouraged to work harder.
160
What does it indicate if the **MVV** is 55% of predicted with a normal FEV1?
The patient gave a poor effort
## Footnote
This suggests that the results may not accurately reflect the patient's lung function.
161
What does a **low tidal volume** and a fast respiratory rate during the MVV procedure indicate?
Restrictive lung disease
## Footnote
This finding can help in diagnosing the type of lung disease present.
162
What is the **definition** of FVC in spirometry?
A forced expiratory vital capacity maneuver followed by a forced inspiratory vital capacity
## Footnote
This maneuver is essential for generating a flow-volume loop.
163
In a flow-volume loop, how is **volume** displayed?
Horizontally (side-to-side)
## Footnote
Flow is displayed vertically (up and down).
164
In a flow-volume loop, where is **expiration** represented?
Above the baseline
## Footnote
Inspiration is represented below the baseline.
165
What is emphasized when instructing a patient to perform the **FVC maneuver**?
Maximal inspiration followed by a maximal forced rapid exhalation without coughing
## Footnote
Proper technique is crucial for accurate results.
166
How is **PEF** measured?
With the patient starting at TLC
## Footnote
TLC stands for Total Lung Capacity.
167
How is **PIF** measured?
With the patient starting at RV
## Footnote
RV stands for Residual Volume.
168
What is the **criteria for Flow Volume Loop Acceptability** regarding rise time?
Rapid rise from maximal inspiration to peak expiratory flow (PEF) in less than 150 milliseconds
## Footnote
This ensures the accuracy of the maneuver.
169
What should occur during the **maximum expiratory effort** in a flow-volume loop?
Flow should return to zero
## Footnote
This indicates a complete exhalation.
170
What must be avoided during the **1st second of expiratory effort**?
Cough or artifact
## Footnote
This ensures the integrity of the measurement.
171
What follows the maximum expiratory effort in a flow-volume loop?
Maximum inspiratory effort immediately follows to the point of maximal inspiration
## Footnote
This is necessary for a complete loop.
172
What does it indicate if the **loop does not close**?
* Initial inspiratory effort was not maximal
* Final inspiratory effort was not maximal
* Equipment error
## Footnote
A closed loop is crucial for valid results.
173
What is the maximum acceptable difference between **FVC** and **FIVC**?
Less than 100 ml
## Footnote
This comparison helps ensure the accuracy of spirometry results.
174
How many **acceptable efforts** should be recorded in spirometry?
A minimum of 3
## Footnote
These efforts should be displayed side-by-side or superimposed for comparison.
175
What should be reported with the highest sum of **FVC** and **FEV**?
F-V loop
## Footnote
This reporting is crucial for accurate interpretation of lung function.
176
What does a **normal** flow-volume loop indicate?
PEF, FVC, and PIF are all normal with smooth flow patterns
## Footnote
There should be no artifact present in the loop.
177
Describe the appearance of a **restrictive** flow-volume loop.
Tall and Skinny
## Footnote
Lung volumes are decreased with normal flow rates.
178
What does a **scooped out** flow-volume loop indicate?
Small Airway Obstruction
## Footnote
Conditions like asthma and emphysema can cause this appearance.
179
What shape characterizes a **fixed large airway obstruction** flow-volume loop?
Pancake Shape
## Footnote
Both expiratory and inspiratory flows are reduced almost equally.
180
What is the significance of **FEF 50%** in evaluating airway obstruction?
Useful in determining the site of obstruction
## Footnote
If the obstruction is located at the level of the upper airway, trachea, or mainstem bronchi.
181
What does **fixed airway obstruction** appear as on a flow-volume loop?
* Decreased FEF 50%
* Decreased FIF 50%
* Values approximately equal
## Footnote
Example: Tracheal stenosis.
182
What characterizes **variable extrathoracic obstruction**?
* Normal expiratory flows
* Decreased inspiratory flows
* Increased FEF 50%/FIF 50% ratio (greater than 1.2)
## Footnote
Example: Vocal cord paralysis.
183
What is the characteristic of **variable intrathoracic obstruction**?
* Normal inspiratory flows
* Decreased expiratory flows
* Decreased FEF 50%/FIF 50% ratio (less than 0.8)
## Footnote
Example: Tumor near the carina.
184
True or false: Both expiratory and inspiratory flow rates are largely effort dependent.
TRUE
## Footnote
It is important to evaluate patient effort during spirometry.
185
What can be superimposed to readily detect any **improvements** in spirometry?
Pre and post bronchodilator loops
## Footnote
This method allows for a visual comparison of lung function before and after bronchodilator administration.
186
List the **troubleshooting** issues in FVL.
* Poor initial effort
* Poor terminal effort
* Variable effort
* Poor inspiratory effort
* Cough
## Footnote
These issues can affect the accuracy of spirometry results.
187
What does **poor initial effort** refer to in spirometry?
Inadequate force or technique at the beginning of the test
## Footnote
This can lead to inaccurate measurements of lung function.
188
What does **poor terminal effort** indicate in spirometry?
Inadequate force or technique at the end of the test
## Footnote
This can also result in inaccurate lung function measurements.
189
Define **variable effort** in the context of spirometry.
Inconsistent effort during the test
## Footnote
This can lead to fluctuating results and unreliable data.
190
What is meant by **poor inspiratory effort** in spirometry?
Inadequate inhalation technique during the test
## Footnote
This can affect the measurement of lung volumes.
191
How does **coughing** impact spirometry results?
It can disrupt the flow of air during the test
## Footnote
Coughing can lead to erroneous readings and should be minimized.
192
What is a potential issue indicated by **Patient Fatigue** during spirometry trials?
* Trial 1
* Trial 2
* Trial 3
* Trial 4
## Footnote
Patient fatigue can affect the accuracy of spirometry results.
193
What does **Negative Flow Sensor Drift** indicate in spirometry?
Successive efforts keep drifting to the left
## Footnote
This drift can lead to inaccurate flow measurements.
194
What does **Positive Flow Sensor Drift** indicate in spirometry?
Successive efforts keep drifting to the right
## Footnote
This drift can also lead to inaccurate flow measurements.
195
What is the purpose of **Pre and Post-Bronchodilator Testing**?
To determine degree of responsiveness of airway obstruction
## Footnote
Common indications include FEV below predicted value, cough of unknown etiology, known asthmatic condition, and suspected airway hyperreactivity.
196
List the **indications** for Pre and Post-Bronchodilator Testing.
* FEV below predicted value
* Cough of unknown etiology
* Known asthmatic condition
* Suspected airway hyperreactivity
## Footnote
These indications help identify patients who may benefit from bronchodilator testing.
197
True or false: **Bronchodilators** should be administered prior to testing.
FALSE
## Footnote
Bronchodilators should be withheld prior to testing to ensure accurate results.
198
What type of bronchodilators are used in testing?
* Short-acting B-2 agonist (SABA)
* Short-acting muscarinic antagonist (SAMA)
## Footnote
These are administered via a metered dose inhaler (MDI).
199
Name two examples of **bronchodilators** and their dosages.
* Albuterol - 4 puffs, 100 mcg/puff
* Ipratropium bromide - 4 puffs, 40 mcg/puff
## Footnote
Each puff should be taken every 30 seconds.
200
What is the procedure for **testing** after bronchodilator administration?
* Perform 3 acceptable FEV and FVC maneuvers pre-bronchodilator
* Administer bronchodilator
* Perform 3 or more acceptable FEV and FVC maneuvers post-bronchodilator
* Report best FVC, FEV, and FEV/FVC
## Footnote
Additional parameters to report include PEF, FET, and FIVC.
201
What indicates a **responsive condition** post-bronchodilator?
FEV or FVC % of predicted should increase more than 10%
## Footnote
This indicates a significant response to bronchodilator therapy.
202
Fill in the blank: To calculate the percent change after bronchodilator administration, use the formula: (Post drug - Pre drug) + Predicted = _______.
% change
## Footnote
This formula helps quantify the improvement in lung function.
203
In the example provided, if Pre drug = 1.31 L and Post drug = 1.61 L with a Predicted value of 2.10 L, what is the **percent change**?
14%
## Footnote
Calculation: (1.61 L - 1.31 L) ÷ 2.10 L = 0.14 X 100.
204
Patients with **asthma** may improve by as much as what percentage following bronchodilator administration?
50%
## Footnote
This indicates a significant potential benefit from bronchodilator therapy.
205
What might patients with **moderate to severe chronic obstructive pulmonary disease** show after bronchodilator administration?
Minimal change or values lower than pre-bronchodilator
## Footnote
Symptomatic improvement may still occur, indicating potential benefit from continued bronchodilator use.
206
What should be reported after bronchodilator testing?
* Absolute change (L)
* Percent change
## Footnote
These metrics provide insight into the effectiveness of the bronchodilator.
207
What is the recommended wait time after administering **SABA bronchodilators** before performing the post-bronchodilator test?
5 minutes
## Footnote
This allows sufficient time for the medication to take effect before testing.
208
What is the recommended wait time after administering **SAMA drug (ipratropium)** before performing the post-bronchodilator test?
30 minutes
## Footnote
This longer wait time is necessary for the effects of ipratropium to be fully realized.
209
True or false: Large increases in **FVC** following bronchodilation may cause the **FEV1/FVC%** to decrease.
TRUE
## Footnote
This phenomenon can occur due to the dynamics of lung function changes post-bronchodilation.
210
If **FVC** increases in the post-bronchodilator study, what does it suggest?
Highly suggestive of peripheral air trapping
## Footnote
This indicates potential underlying lung issues that may need further investigation.
211
What is the acceptable difference in volume between acceptable pre-bronchodilator and post-bronchodilator tests?
150 ml
## Footnote
Each acceptable test must be within this range to ensure reliability.
212
What should be confirmed regarding medications before performing spirometry testing?
Correct medications were withheld
## Footnote
This is crucial for accurate test results.
213
Initial spirometry testing for diagnostic purposes should include post-bronchodilator testing even if pre-bronchodilator spirometry is __________.
normal
## Footnote
This ensures comprehensive assessment of lung function.
214
Follow-up spirometry may or may not include **post-bronchodilator response testing**. What is this testing at the discretion of?
The clinician
## Footnote
Clinicians may choose to include this based on individual patient needs.
215
Post-bronchodilator response testing may be more useful for patients with **COPD** due to what?
Variability in their lung function
## Footnote
This variability can affect treatment and management strategies.
216
What is the interpretation for a patient with a vital capacity of 65% of predicted and an **FEV1** of 34% of predicted?
Moderate restriction and very severe obstruction
## Footnote
This indicates significant impairment in lung function.
217
If the **FEV1** post-bronchodilator was 48% of predicted, how would this be interpreted?
Significant improvement post-bronchodilator
## Footnote
This suggests a positive response to bronchodilator therapy.
218
What does **spirometry testing** measure?
* Lung volumes
* Flows
## Footnote
Spirometry testing evaluates two major characteristics of lung function.
219
Decreased flows in spirometry indicate what type of disorder?
Obstructive disorder
## Footnote
This indicates a problem with airflow in the lungs.
220
Decreased lung volumes in spirometry indicate what type of disorder?
Restrictive disorder
## Footnote
This indicates a limitation in lung expansion.
221
Name the **five obstructive diseases** identified in spirometry testing.
* Bronchitis
* Asthma
* Cystic Fibrosis
* Bronchiectasis
* Emphysema
## Footnote
These diseases are characterized by decreased airflow.
222
What are examples of **restrictive diseases**?
* Neuromuscular disorders
* Cardiomuscular disorders
* Pulmonary conditions
* Trauma
## Footnote
Examples include Myasthenia gravis, Guillain Barre, polio, and more.
223
What factors are used to determine **predicted values** in spirometry?
* Age
* Height
* Gender/Sex
* Ethnic origin
* Weight or body surface area
## Footnote
These factors help in comparing measured PFT values to expected norms.
224
How is the **% predicted** value calculated in spirometry?
Measured value divided by predicted value
## Footnote
This calculation helps assess lung function relative to expected norms.
225
What does a % predicted value of **≥ 80%** indicate in spirometry interpretation?
Normal
## Footnote
This value signifies that lung function is within the normal range.
226
What does a % predicted value of **< 80%** indicate in spirometry interpretation?
Mild dysfunction
## Footnote
This value suggests a mild impairment in lung function.
227
What does a % predicted value of **< 70%** indicate in spirometry interpretation?
Moderate
## Footnote
This value indicates a moderate level of dysfunction in lung function.
228
What does a % predicted value of **< 60%** indicate in spirometry interpretation?
Moderate/Severe
## Footnote
This value reflects a significant impairment in lung function.
229
What does a % predicted value of **< 50%** indicate in spirometry interpretation?
Severe
## Footnote
This value indicates a severe level of dysfunction in lung function.
230
What does a % predicted value of **< 35%** indicate in spirometry interpretation?
Very Severe
## Footnote
This value signifies a critical impairment in lung function.
231
What is the **Lower Limit of Normal (LLN)** in spirometry?
Defined as the 5th percentile of normal healthy patients
## Footnote
Values below the LLN are interpreted as abnormal.
232
How is the **LLN** calculated?
By multiplying the residual standard deviation (RSD) by -1.64
## Footnote
This calculation helps to correct for age and height variations.
233
What is the **Z-score** in the context of spirometry?
The number of standard deviations (SD) the measured value is away from the mean predicted value
## Footnote
It provides a way to evaluate PFT data.
234
What is the formula for calculating the **Z-score**?
Z-score = (measured - predicted) / RSD
## Footnote
RSD is the residual standard deviation of the reference population.
235
What range of Z-scores is considered **normal**?
Between 0 and +/- 1.65
## Footnote
This range indicates values above the 5th percentile.
236
What Z-score range indicates **mild obstructive disease**?
Z-score between -1.65 and -2.5
## Footnote
This range suggests a mild level of obstructive lung disease.
237
What Z-score range indicates **moderate obstructive disease**?
Z-score between -2.50 and -4.0
## Footnote
This range reflects a moderate level of obstructive lung disease.
238
What Z-score indicates **severe obstructive disease**?
Z-score less than -4.0
## Footnote
This indicates a severe level of obstructive lung disease.
239
What is the **spirometry** measurement for **obstructive disease**?
* Normal VC
* Decreased FEV1/FVC%
## Footnote
Obstructive diseases show a normal vital capacity (VC) but a reduced ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC).
240
What is the **spirometry** measurement for **restrictive disease**?
* Decreased VC
* Normal FEV1/FVC%
## Footnote
Restrictive diseases are characterized by a reduced vital capacity (VC) while maintaining a normal ratio of FEV1 to FVC.
241
In **Example #1**, what are the measured values for **VC** and **FEV1**?
* VC: 4.81 L
* FEV1: 2.50 L
## Footnote
The predicted values for VC and FEV1 in this example are 5.01 L and 4.11 L, respectively.
242
In **Example #1**, what is the interpretation of the spirometry results?
Moderate obstructive only
## Footnote
The interpretation is based on the measured values compared to predicted values.
243
In **Example #2**, what are the measured values for **VC**, **FEV1**, and **FRC**?
* VC: 3.43 L
* FEV1: 0.83 L
* FRC: 1.21 L
## Footnote
The predicted values for VC, FEV1, and FRC in this example are 5.04 L, 0.74 L, and 2.13 L, respectively.
244
In **Example #2**, what is the interpretation of the spirometry results?
Moderate restrictive only
## Footnote
The interpretation is based on the measured values compared to predicted values.
245
What is the **% of Predicted** for **VC** in **Example #2**?
68%
## Footnote
This percentage indicates how the measured VC compares to the predicted VC.
246
What is the **Z-score** for **FEV1** in **Example #2**?
-3.63
## Footnote
The Z-score indicates how many standard deviations the measured value is from the predicted value.
247
What does **VC** stand for in spirometry?
Vital Capacity
## Footnote
VC is a measure of the maximum amount of air a person can expel from the lungs after a maximum inhalation.
248
What does **FEV** represent in spirometry?
Forced Expiratory Volume
## Footnote
FEV measures how much air a person can forcefully exhale in a specific time frame.
249
What is the significance of the **% Predicted** value in spirometry?
It compares the measured values to expected values based on population norms
## Footnote
This helps determine the severity of lung function impairment.
250
What does a **Z-score** indicate in spirometry results?
It shows how many standard deviations a measured value is from the mean of the population
## Footnote
A Z-score helps assess the degree of deviation from normal lung function.
251
In spirometry, what does a **% of Predicted** value of 33% indicate?
Very Severe Restrictive only
## Footnote
This indicates significant impairment in lung function.
252
What does a **% of Predicted** value of 64% signify?
Moderate Restrictive
## Footnote
This indicates a moderate level of restriction in lung function.
253
What does a **% of Predicted** value of 91% indicate?
Normal Spirometry
## Footnote
This indicates that the lung function is within normal limits.
254
What is the **LLN** in the context of spirometry?
Lower Limit of Normal
## Footnote
LLN is used to define the threshold below which lung function is considered abnormal.
255
What does a **Z-score** of -6.41 indicate?
Severe impairment
## Footnote
A Z-score this low indicates a significant deviation from normal lung function.
256
What does a **Z-score** of -0.85 suggest?
Mild impairment
## Footnote
A Z-score close to zero indicates that the lung function is relatively normal.
257
What is the purpose of **home testing** in spirometry?
To monitor daily peak flows and assess lung function
## Footnote
Many types of flow-sensing spirometers can interface with portable personal computers for testing.
258
What are **portable peak flowmeters** used for?
To monitor daily peak flows in home testing
## Footnote
They are essential for patients with asthma to track their condition.
259
True or false: **Peak flow monitoring** is incorporated into an asthma action plan for patient monitoring.
TRUE
## Footnote
Serial measurements guide treatment for asthma patients.
260
What difficulties may patients with **asthma** face during peak flow measurements?
Difficulty repeating measurements, especially during exacerbations
## Footnote
This can affect the accuracy of monitoring.
261
Name the **two types** of peak flow meters.
* Resistor
* Flow tube
## Footnote
Both types have a movable indicator deflected by the patient's exhaled flow.
262
How is peak flow measured on a **calibrated scale**?
Read on a calibrated scale
## Footnote
This ensures accurate assessment of lung function.
263
What are the **different ranges** available for peak flow measurements?
* High flow: up to 850 L/min with scale divisions of 10 L/min
* Low flow: up to 400 L/min with scale divisions of 5 L/min
## Footnote
These ranges help in assessing different patient needs.
264
In spirometry, is **accuracy** or **precision** more important?
Precision (repeatability) is more important than accuracy
## Footnote
This ensures consistent results over time.
265
What should peak flow **variability** be less than?
Less than 5% or 0.15 L/sec or 10 L/min, whichever is greater
## Footnote
This indicates stable lung function.
266
What is the maximum **peak flow variability** allowed?
Less than 10% or 0.3 L/sec. or 20 L/min, whichever is greater
## Footnote
This ensures consistency in peak flow measurements.
267
Why must **altitude adjustments** be made for peak flow meters?
They will underestimate flows as the altitude increases
## Footnote
This is important for accurate assessments in different geographical locations.
268
What should be followed for cleaning **peak flow meters**?
Manufacturers recommendations
## Footnote
Proper maintenance ensures accurate readings and longevity of the device.
269
How often should **peak flow meters** be replaced?
Periodically, using the same model if possible
## Footnote
Regular replacement is necessary to maintain accuracy.
270
Most peak flow meters comply with the **guidelines** of which program?
National Asthma Education Program
## Footnote
Compliance ensures that the meters meet established standards for asthma management.
271
How long should the **personal best** peak flow be obtained?
Over a 2 - 3-week period
## Footnote
This allows for accurate baseline measurements.
272
When should daily peak flow measurements be performed?
In the morning and in the evening
## Footnote
This helps detect exacerbations and patterns.
273
How often should the **personal best** be re-evaluated?
Annually
## Footnote
This accounts for growth in children or disease progression in adults.
274
What should be compared periodically to assess lung function?
PEF to FEV
## Footnote
This comparison helps in monitoring respiratory health.
275
What is the preferred **position** for performing the peak flow maneuver?
Standing position
## Footnote
This position helps achieve optimal flow readings.
276
What should be done before using the peak flow meter?
Set the indicator to zero
## Footnote
This ensures accurate starting measurements.
277
What is the recommended **inspiratory pause** duration during the maneuver?
Less than 1 second
## Footnote
Longer pauses can lead to falsely low peak flow readings.
278
How long should the **exhalation** last during the maneuver?
1-2 seconds
## Footnote
This duration is sufficient for accurate peak flow measurement.
279
How many maneuvers should be performed and recorded?
At least 3 maneuvers
## Footnote
All maneuvers should be recorded to assess for effort-induced bronchospasm.
280
What should be reported after performing the peak flow maneuver?
The largest maneuver
## Footnote
This provides the most accurate peak flow reading.
281
What is the maximum allowable variability between the **two largest efforts**?
No more than 0.67 L/sec. or 40 L/min
## Footnote
This ensures reliability in the measurements taken.
282
What does a **Green zone** indicate in spirometry results?
80-100% of personal best
## Footnote
Good control, continue current therapy.
283
What does a **Yellow zone** indicate in spirometry results?
50-79% of personal best
## Footnote
Caution is indicated. The patient's asthma may not be under good control.
284
What action should be taken when spirometry results are in the **Red zone**?
< 50% of personal best
## Footnote
Represents a medical alert, take a SABA immediately, call the physician or go to the emergency department.
285
List the factors that can indicate **poor patient effort** in spirometry.
* Inconsistent patient effort
* Flows that vary greatly without effort induced bronchospasm
* Decreasing flows with repeated efforts in asthma patients
## Footnote
Patients with normal airways typically have repeatability with repeated efforts.
286
What is **Home Pulse Oximetry (SpO2)**?
Noninvasive estimate of SaO2 by analyzing the absorption of light
## Footnote
It uses transmission or reflectance through a capillary bed.
287
What is the acceptable correlation between **SpO2** and **SaO2**?
Within 2% (between 85% and 100% saturation)
## Footnote
Documentation of adequate correlation with measured SaO2 should be available.
288
What are some **known interfering substances** that should be eliminated for accurate pulse oximetry results?
* Poor perfusion
* Skin pigmentation
* Skin thickness
* Hypothermia
* Fingernail polish
* Movement of that extremity
## Footnote
These factors can affect the accuracy of pulse oximetry readings.
289
What are the **limitations of pulse oximetry**?
* Motion artifact
* Ambient light
* Hypotension
* Hypothermia
* Carboxyhemoglobin
## Footnote
These limitations can affect the reliability of the readings.
290
What does **serial pulmonary function testing** consist of?
Repeating testing at regular intervals
## Footnote
This method provides objective evidence of improvement or deterioration of lung involvement.
291
What does **serial lung function testing** provide evidence for?
Improvement or deterioration of lung involvement for many different pathologies and disorders
## Footnote
The frequency and type of testing is determined by the nature of the pathology or disorder.
292
True or false: Children can be tested using the same equipment and methods as adults for **spirometry testing**.
TRUE
## Footnote
This applies to children 5 years of age and older, and even younger children with normal cognitive and neuromuscular function.
293
At what age can children start performing acceptable **spirometry**?
5 years of age
## Footnote
Children as young as 2.5 years old can be tested if they have normal cognitive and neuromuscular function.
294
What is the **most difficult part** of the spirometry test for children?
Getting the child to continue to exhale after the initial blast
## Footnote
This can be challenging during the testing process.
295
What does the term **usable** mean in pediatric testing?
Test results meet ERS-ATS standards
## Footnote
This includes blowing out forcefully for at least 1 second without cough or artifact.
296
What is a **good start** in pediatric spirometry testing?
Ensuring that the child takes in a maximal inspiration
## Footnote
This is crucial for obtaining accurate results.
297
What does **unacceptable** mean in the context of pediatric spirometry results?
Test results that cannot be used
## Footnote
For example, if the child stops exhaling when the flow is within 10% of the peak flow.
298
What is the criterion for **repeatable** results in children aged > 6 years?
FVC and FEV should be within 150 ml
## Footnote
For children ≤ 6 years, the largest and next largest FVC and FEV should be within 100 ml or 10% of the highest value, whichever is greatest.
299
What does **Lower Limit of Normal (LLN)** refer to?
The lowest number, below the predicted value, that is still acceptable
## Footnote
This is important for interpreting spirometry results.
300
What is a key challenge in **pediatric spirometry** testing?
Children stop exhaling once they feel their lungs are empty
## Footnote
This can hinder their ability to apply expiratory pressure.
301
How can children improve their **spirometry efforts**?
Through practice
## Footnote
Repeated attempts can enhance their performance.
302
What teaching method is recommended for children during spirometry testing?
Show and tell method
## Footnote
This approach helps children understand the process better.
303
What should happen to a child's **spirometry results** as they grow?
They should increase
## Footnote
If results do not improve, it may indicate an underlying issue.
304
What spirometry measure may provide better information for children under 6 years?
FEV or FEVors
## Footnote
These measures may be more informative than standard FEV.
305
How many attempts may be necessary for a **pediatric patient** during spirometry?
More than 8 attempts
## Footnote
This is above the upper limit for adults.
306
What is an important consideration for creating a **comfortable environment** during pediatric spirometry?
Ensure comfort for the child
## Footnote
A relaxed setting can improve test performance.
307
What tool can be used to help children understand how to blow during spirometry?
A pinwheel
## Footnote
It visually demonstrates the need to keep blowing until it stops moving.
308
What is preferred but not always tolerated by children during spirometry?
A nose clip
## Footnote
Some children may find it uncomfortable.
309
What should be used when coaching children for spirometry?
Words they understand and expressive coaching
## Footnote
This helps engage the child and improve their efforts.
310
What may post-bronchodilator improvement in spirometry results indicate?
Practice rather than medication
## Footnote
Improvement may be due to better effort rather than the bronchodilator's effects.
311
If post-bronchodilator FVC increases proportionally with FEV, what does this suggest?
Improved effort
## Footnote
This indicates that the increase is likely not due to the bronchodilator.
312
What does an increase in post-bronchodilator FEV1 without a change in FVC indicate?
Positive response to the bronchodilator
## Footnote
This suggests that the medication is effective.
313
What can be measured on a pediatric patient regarding **Raw**?
Raw can be measured
## Footnote
The nonpanting value is expected to be higher than the panting value.
314
What lung tests can be performed on a child using a **Body Plethysmograph**?
* FRC
* RV
* TLC
* Raw
## Footnote
These tests assess various lung volumes and capacities.
315
What may be required during lung testing on a child in a Body Plethysmograph?
A parent may need to hold the child in their lap
## Footnote
This helps the child feel secure during the test.
316
What must be determined during lung testing when an adult is present?
The volume displaced by the adult's weight
## Footnote
This is necessary for accurate measurement.
317
What can be used for **bronchial provocation testing**?
* Methacholine
* Histamine
* Adenosine
* Cold air
* Hyperventilation
* Exercise
## Footnote
These methods assess airway responsiveness in patients with suspected asthma.
318
What is the purpose of **pulmonary exercise testing**?
* Assess limits to exercise
* Diagnose vocal chord disease (VCD)
* Identify exercise induced bronchospasm (EIB)
## Footnote
This testing helps evaluate respiratory function during physical activity.
319
Increased levels of **fractional exhaled nitric oxide (FENO)** are associated with what condition?
Airway inflammation (asthma)
## Footnote
FENO is a biomarker used to assess airway inflammation in asthma patients.
320
What spirometry result indicates **moderate to severe asthma**?
Decreased flows with each effort
## Footnote
This pattern suggests significant airway obstruction.
321
What spirometry result may indicate **mild asthma**?
Increased flows with each effort
## Footnote
Increased temperature from effort can cause bronchodilation.
322
A **positive test for airway disease** is indicated by a decrease in FEV1 of _______ from predicted normal.
15 - 20%
## Footnote
This criterion helps in diagnosing obstructive airway diseases.
323
Interpret the spirometry results of a 6-year-old boy: **Pre Bronchodilator FEV1** is 1.3 L and **Post Bronchodilator FEV1** is 1.5 L.
Normal Spirometry. Improvement in FVC and FEV1 is the result of improved effort
## Footnote
This indicates that the boy's lung function is within normal limits.
324
Interpret the spirometry results of a 6-year-old girl: **No change in FVC**, but post bronchodilator improvement in FEV1 and peak flow indicates what?
Significant response to bronchodilator
## Footnote
This suggests that the girl has reversible airway obstruction.
