Respiratory > Spirometry > Flashcards

Spirometry Flashcards

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1
Q

What is the term spirometry given to?

A

The basic lung function tests that measure the air that is expired and inspired

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2
Q

What three basic related measurements does spirometry consist of?

A

Volume
Time
Flow

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3
Q

Characteristic of spirometry

A

Objective
Non-invasive
Sensitive to early change
Reproducible

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4
Q

Advantages of spirometry

A

Can be performed almost anywhere due to the available portable meters
With the right training, can be performed by anyone

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5
Q

Why is spirometry performed?

A

Detect the presence or absence of lung disease
Quantify lung impairment
Monitor the effects of occupational/environmental exposures
Determine the effects of medications

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6
Q

What is FEV1?

A

Forced expiratory volume in 1 second

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7
Q

What is FVC?

A

Forced vital capacity
The maximum amount of air that can be exhaled when blowing out as fast as possible

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8
Q

What is VC?

A

Vital capacity
The maximum amount of air that can be exhaled when blowing out at a steady rate

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9
Q

What is PEF?

A

Peak expiratory flow
The maximal flow that can be exhaled when blowing out as fast as possible

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10
Q

What is FEF?

A

Forced expiratory flow
Also know as mid-expiratory flow
The rates at 25%, 50% and 75% FVC are given

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11
Q

What is IVC?

A

Inspiratory vital capacity
The maximum of air that can be inhaled after a full expiration

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12
Q

What needs to be done before performing spirometry?

A

The equipment used must be calibrated
OR
The calibration needs to be checked at the beginning of the session

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13
Q

How is calibration achieved?

A

Depending on the type of equipment
a 3-L syringe that is pumped through the check that the meter is reading correctly
Or
a 1-L syringe that is pumped a litre at a time to a max of 7L
This checks the linearity as well as the centre point of the volume measurement

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14
Q

Which portable meters don’t need calibration?

A

Those that use ultrasound technology

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15
Q

Which equipment is exempt from calibration?

A

Sophisticated equipment you would find in a lung function laboratory which can update its output based on the calibration

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16
Q

How often should spirometric values be checked?

A

On a weekly basis using a biological control (a healthy person working in the lab)

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17
Q

How is flow calibrated?

A

Very difficult to calibrate
Not calibrated routinely
Requires a sophisticated computer-driven syringe to reproduce forced expiration

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18
Q

What needs to be checked before performing spirometry?

A

Patient’s identity
Heigh without shoes/boots
Weight
Age
Sex
Race

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19
Q

What can be used if patient is unable to stand for height measurement?

A

Arm spam can be used as an estimate

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20
Q

What should be avoided before spirometry?

A

Drinking alcohol 4 hours before
Eating a large meal 2 hours before
Vigorous exercise 30 minutes before
Smoking 1 hour before
Medication use should be documented and when last taken

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21
Q

What should be avoided for reversibility testing?

A

SABAs 6 hours before
LABAs or BD preparations 24 hours before
Tiotropium or OD preparations 48 hours before

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22
Q

Why is it important to know what medication the patient is taking before spirometry?

A

So the patient’s lung function can be known on and off therapy.
If spirometry is repeated over time, conditions can be kept the same.

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23
Q

Contraindications for spirometry

A

Haemoptysis of unknown origin
Pneumothorax
Unstable cardiovascular status, recent myocardial infarction or pulmonary embolism
Thoracic, abdominal or cerebral aneurysms
Recent eye surgery
Acute disorder affecting test performance like nausea or vomiting
Recent thoracic or abdominal surgical procedures

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24
Q

How should the patient be positioned during spirometry?

A

Sit upright
Feet flat on the floor with legs uncrossed
Loosen tight-fitted clothing
Dentures normally left in
Use a chair with arms

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25
Why should the patient have their feet flat on the floor?
So there is no use of abdominal muscles for leg position
26
Why is it best for dentures to be left in?
It gives some structure to the mouth area unless the dentures are very loose
27
Why is it best to use a chair with arms?
Patients can become light-headed when exhaling maximally and possibly sway or faint
28
What are some different techniques for performing spirometry?
Before performing the forced expiration, tidal breaths can be taken first, then a deep breath taken in while still using the mouthpiece, followed by a further quick, full inspiration. A deep breath can be taken in then the mouth placed tightly around the mouthpiece before a full expiration is performed. Patient can be asked to completely empty the lungs then take in a quick full inspiration, followed by a full expiration.
29
Which technique is useful in patients who may achieve a larger inspiration following expiration?
Patient can be asked to completely empty the lungs then take in a quick full inspiration, followed by a full expiration.
30
How should a patient do FVC and FEV1?
Take a deep breath in, as large as possible Blow out as hard and fast as possible Keep going until there is no air left
31
How is PEF obtained?
The same way as FEV1 and FVC
32
How should a patient do VC?
Take a deep breath in, as large as possible Blow steadily for as long as possible until there is no air left Nose clip - air can leak out due to low flow
33
When is the IVC manoeuvre performed?
At the end of FVC or VC
34
What is the IVC manoeuvre?
Take a deep, fast breath back in after breathing all the way out
35
What can make a big difference in a patients spirometry readings?
Encouragement Don't be afraid to raise your voice to encourage them, especially near the end of the manoeuvre
36
The patient needs to keep blowing until when?
No more air comes out The volume-time trace reaches a plateau with <50mL being exhaled in 2 seconds
37
What is classed as an acceptable manoeuvre?
An explosive start with a back-extrapolation volume <150mL Performed with a maximal inspiration and expiration No glottis closure or cessation of airflow happened during the manoeuvre No coughs, inspirations during the trace or evidence of leaks Should meet the end-of-test criteria
38
What is the end-of-test criteria?
Exhaling for 6 seconds or more with less than 50mL being exhaled in the last 2 seconds
39
For FEV1 and FVC, what should the two best values be?
Within 5% or 150mL of each other, whichever is greater If FVC is <1.0L, values should be within 100mL The best FEV1 and FVC can be taken from different manoeuvres
40
What is the upper limit of manoeuvres and why?
Normally 8 Performing forced exhalations is very tiring and the patient is unlikely to get better values after this point
41
How long should be left between manoeuvres?
30 seconds or more Some may need several minutes - eg asthmatics
42
Forced expiration can cause what?
Bronchoconstriction
43
Full inspiration can cause what?
Bronchodilation so it is important to keep going until there is no further improvement in results
44
Why is reversibility testing done?
For the diagnosis of asthma
45
Describe reversibility testing
Spirometry performed After, a bronchodilator is given (either a SABA or other agents like anticholinergics)
46
What SABA would be given during reversibility testing?
4x100mcg salbutamol via a spacer Wait 15 minutes before retesting
47
What anticholinergic would be given during reversibility testing?
4x40mcg ipratropium bromide Wait 30 minutes before retesting
48
How can age affect spirometry?
Lung function generally increases with age up to about 25 years. Declines with increasing age afterwards
49
What is the problem when patients under 25 do spirometry?
Some lung function equipment will give them larger predicted values than at age 25.
50
What is done to avoid majorly overestimating the predicted value for patients under 25?
Input the age as 16 and then 25. If the predicted is larger at 16, use the value for 25
51
How does gender affect spirometry?
Pre-pubescent males and females generally have the same lung function Post-puberty, growth of the thorax is greater in males, giving marked differences in lung volume
52
How does height affect spirometry?
The taller the person, the bigger the lungs
53
How does weight affect spirometry?
Increasing weight causes increasing lung function until obesity is reached - this has the opposite effect
54
How does smoking affect spirometry?
Causes a more rapid decline in lung function compared with non-smokers over time
55
What is obstructive lung function characterised by?
Reduced FEV1 Normal or reduced VD Normal or reduced FVC Reduced FEV1/FVC ratio Concave flow-volume loop
56
In obstructive lung function, there is decreased airway calibre due to what?
Smooth muscle contraction Inflammation Mucus plugging Airway collapse in emphysema
57
Describe an asthmatic patient's spirometry
Maybe be normal unless they are experiencing an exacerbation
58
What is restrictive lung function characterised by?
Reduced FVC Normal-to-high FEV1/FVC ratio Normal looking shape on spirometry trace Possibly a relatively high PEF
59
What is lost in restrictive disorders?
Lung volume
60
Examples of restrictive lung disorders
Pulmonary fibrosis Pleural disease Chest wall disorders (kyphoscoliosis) Neuromuscular disorders Pneumonectomy Pulmonary oedema Obesity
61
Many so-called restrictive spirometry traces are due to what?
Failure to reach the end of expiration, falsely reducing FVC
Respiratory
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