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spirometry article Flashcards

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1
Q

What is spirometry used for?

A

Detecting, following, and managing patients with lung disorders

Spirometry is a powerful tool that has become more reliable and simple to incorporate into routine office visits.

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2
Q

True or false: The quality of spirometry tests is largely dependent on patient effort and cooperation.

A

TRUE

The interpreter’s knowledge of appropriate reference values also plays a crucial role in the quality of the test.

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3
Q

What is the first step in interpreting spirometry results?

A

Determining the validity of the test

A simplified and stepwise method is key to interpreting spirometry.

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4
Q

After determining the validity of the test, what is the next step in interpreting spirometry?

A

Determination of an obstructive or restrictive ventilatory pattern

If a ventilatory pattern is identified, its severity is then graded.

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5
Q

What additional tests may be needed for some patients after spirometry?

A
  • Static lung volumes
  • Diffusing capacity of the lung for carbon monoxide
  • Bronchodilator challenge testing

These tests can further define lung processes but require more sophisticated equipment and expertise.

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6
Q

Where are more sophisticated tests for lung processes typically conducted?

A

Pulmonary function laboratory

These facilities have the necessary equipment and expertise for advanced lung testing.

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7
Q

What does COPD stand for?

A

Chronic obstructive pulmonary disease

COPD is the most common respiratory disease and the fourth leading cause of death in the United States.

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8
Q

In the past decade, the number of new patients with COPD has _______.

A

doubled

This trend is likely to continue despite preventive efforts.

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9
Q

What is the preferred test for the diagnosis of COPD?

A

Spirometry

Spirometry provides adequate information in a cost-effective manner.

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10
Q

A complete pulmonary function test provides the most accurate assessment of what?

A

Lung impairment

However, spirometry is preferred for diagnosing COPD.

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11
Q

True or false: A patient’s history and physical examination are sufficient for diagnosing mild and moderate obstructive ventilatory impairments.

A

FALSE

Evidence indicates that these methods are inadequate for such diagnoses.

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12
Q

What must be correlated with spirometry results for optimal clinical application?

A
  • Clinical data
  • Roentgenographic data

Correlation with these data enhances the interpretation of spirometry results.

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13
Q

What does this article review regarding spirometry?

A
  • Indications for use
  • Stepwise approach to interpretation
  • When additional tests are warranted

These aspects are crucial for effective clinical application.

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14
Q

What did the National Health Survey of 1988 to 1994 find regarding COPD?

A

High rates of undiagnosed and untreated COPD in current and former smokers

This survey highlighted the prevalence of COPD among smokers.

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15
Q

What is identified as a powerful prognostic indicator in patients with COPD?

A

Vital capacity (VC)

VC is crucial for assessing the severity and progression of COPD.

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16
Q

The Framingham study identified a low forced vital capacity (FVC) as a risk factor for what?

A

Premature death

This finding emphasizes the importance of lung function in predicting mortality.

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17
Q

What potential benefits were shown for patients with early identification, intervention, and treatment of COPD?

A

Improved outcomes and management of the disease

Early intervention can significantly alter the course of COPD.

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18
Q

Which study was the first to show that early identification and intervention in smokers could affect the natural history of COPD?

A

Lung Health Study

This study was pivotal in demonstrating the benefits of early treatment.

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19
Q

What can simple spirometry detect even in asymptomatic patients?

A

Mild airflow obstruction

Spirometry is a key tool for early diagnosis of COPD.

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20
Q

Increased public awareness of COPD led to the formation of the National Lung Health Education Program (NLHEP) for what purpose?

A

To combat chronic lung disease

NLHEP is part of a national strategy to improve lung health.

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21
Q

What initiative was published by the World Health Organization and the U.S. National Heart, Lung, and Blood Institute to increase awareness of COPD?

A

Global Initiative for Chronic Obstructive Lung Disease

This initiative aims to address the global burden of COPD.

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22
Q

Normal lungs can empty more than 80 percent of their volume in how many seconds?

A

six seconds or less

This indicates the efficiency of lung function in healthy individuals.

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23
Q

What does spirometry measure?

A

The rate at which the lung changes volume during forced breathing maneuvers

Spirometry begins with a full inhalation, followed by a forced expiration.

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24
Q

What are the four volumes that lung function is physiologically divided into?

A
  • Expiratory reserve volume
  • Inspiratory reserve volume
  • Residual volume
  • Tidal volume

Together, these volumes equal the total lung capacity (TLC).

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25
The combination of lung volumes measures various lung **capacities** such as __________.
Functional residual capacity (FRC) ## Footnote Other capacities include inspiratory capacity and vital capacity (VC).
26
What is the most important **spirometric maneuver**?
Forced Vital Capacity (FVC) ## Footnote To measure FVC, the patient inhales maximally and then exhales as rapidly and completely as possible.
27
Normal lungs can generally empty more than **80 percent** of their volume in how many seconds?
Six seconds or less ## Footnote This is part of the FVC measurement.
28
What does **FEV1** stand for?
Forced Expiratory Volume in one second ## Footnote It is the volume of air exhaled in the first second of the FVC maneuver.
29
The **FEV1/FVC ratio** is expressed as a __________.
Percentage ## Footnote For example, FEV1 of 0.5 L divided by FVC of 2.0 L gives an FEV1/FVC ratio.
30
What is the **absolute ratio** used for in interpretation?
The value used in interpretation, not the percent predicted ## Footnote The absolute ratio is crucial for accurate assessment in spirometry.
31
What does the **FEV6** replace in some portable office spirometers?
FVC ## Footnote FEV6 is used for greater patient and technician ease.
32
The **FEV6** parameter is based on a _______ maneuver.
six-second ## Footnote This standard time frame decreases patient variability and the risk of complications.
33
What is a pitfall of using a spirometer that measures **FEV6**?
Must be calibrated for temperature and water vapor ## Footnote Calibration is essential for accurate measurements.
34
In patients with advanced **COPD**, the FEV6 spirometer should be used with caution due to its inability to detect _______.
very low volumes or flows ## Footnote This limitation can affect the accuracy of the assessment.
35
The **FEV1/FEV6 ratio** provides an accurate surrogate measure for the _______.
FEV1/FVC ratio ## Footnote This ratio is important for evaluating lung function.
36
FEV1 and FEV6 values should be rounded to the nearest _______.
0.1 L ## Footnote Percent predicted and the FEV1/FEV6 ratio should be rounded to the nearest integer.
37
The significance of the **FEV1/FVC ratio** is twofold. What are the two significances?
* Quickly identifies patients with airway obstruction * Identifies the cause of a low FEV1 ## Footnote This ratio is critical in diagnosing respiratory conditions.
38
The amount exhaled during the first second is a constant fraction of the _______.
FVC ## Footnote This holds true regardless of lung size.
39
What is the primary purpose of **spirometry**?
To identify and quantify functional abnormalities of the respiratory system ## Footnote Spirometry is a diagnostic tool used in various clinical settings.
40
According to the **NLHEP**, who should primary care physicians perform spirometry on?
* Patients 45 years or older who are current or former smokers * Patients with a prolonged or progressive cough or sputum production * Patients with a history of exposure to lung irritants ## Footnote These recommendations help identify respiratory issues early.
41
List some **indications for spirometry**.
* Determine strength and function of the chest * Follow disease progression * Assess response to treatment * Obtain baseline measurements before prescribing potentially toxic drugs * Preoperative risk assessment * Workers’ compensation and disability claims ## Footnote Spirometry is versatile in assessing lung function and risks.
42
True or false: Spirometry is not useful in **preoperative risk assessment**.
FALSE ## Footnote Spirometry is often used to evaluate respiratory function before surgeries.
43
What types of drugs might require baseline spirometry measurements due to their potential toxicity to the lungs?
* Amiodarone (Cordarone) * Bleomycin (Blenoxane) ## Footnote These drugs can have significant pulmonary side effects.
44
What are the **indications for spirometry**?
* Detecting pulmonary disease * Assessing severity or progression of disease * Risk stratification of patients for surgery * Evaluating disability or impairment ## Footnote Spirometry is a common pulmonary function test used to assess lung function.
45
What are **acute disorders** that affect spirometry test performance?
* Vomiting * Nausea * Vertigo ## Footnote These conditions can hinder the ability to perform the test effectively.
46
What condition may be aggravated by the **FVC maneuver** during spirometry?
Hemoptysis of unknown origin ## Footnote This condition poses a risk during the test due to potential underlying issues.
47
Name a **respiratory condition** that is a contraindication for spirometry.
Pneumothorax ## Footnote This condition can be dangerous during the test due to the risk of worsening the situation.
48
What type of recent surgery is a contraindication for spirometry?
* Abdominal surgery * Thoracic surgery ## Footnote These surgeries can affect the ability to perform the test safely.
49
Why is **recent eye surgery** a contraindication for spirometry?
Increases in intraocular pressure ## Footnote This pressure change can be harmful after eye surgery.
50
What cardiovascular events are contraindications for spirometry?
* Recent myocardial infarction * Unstable angina ## Footnote These conditions pose significant risks during the test.
51
What vascular condition poses a risk of rupture during spirometry?
Thoracic aneurysms ## Footnote Increased thoracic pressure during the test can lead to serious complications.
52
What is required for **spirometry** results to be valid?
Considerable patient effort and cooperation ## Footnote Inadequate patient effort can lead to misdiagnosis and inappropriate treatment.
53
Why is the **clinical context** of the spirometry test important?
Parameters in patients with mild disease can overlap with values in healthy persons ## Footnote This overlap can complicate the interpretation of results.
54
What factors can cause **normal spirometry values** to vary?
* Height * Weight * Age * Sex * Racial or ethnic background ## Footnote These factors influence the interpretation of spirometry results.
55
Predicted values for lung volumes may be inaccurate in which types of patients?
* Very tall patients * Patients with missing lower extremities ## Footnote These inaccuracies can affect the assessment of lung function.
56
Which groups have greater **FEV1 and FVC** values?
* Whites compared with blacks * Whites compared with Asians ## Footnote This highlights the importance of considering racial and ethnic background in spirometry interpretation.
57
How do **FVC and VC values** vary?
They vary with the position of the patient ## Footnote This can lead to differences in spirometry results based on patient positioning.
58
Fill in the blank: **Inadequate patient effort** can lead to _______.
misdiagnosis and inappropriate treatment ## Footnote Validity of spirometry results is crucial for accurate diagnosis.
59
What does the **FEV1/FVC ratio** distinguish in spirometry patterns?
Obstructive from restrictive ## Footnote The FEV1/FVC ratio is a key metric in pulmonary function tests to differentiate between types of lung diseases.
60
FVC is about **2 percent greater** in patients who are ______ compared with patients who are supine.
standing ## Footnote This indicates the impact of body position on forced vital capacity measurements.
61
To determine the **validity of spirometric results**, how many acceptable spirograms must be obtained?
At least three ## Footnote Each test requires specific criteria to ensure accurate results.
62
In each spirometry test, patients should exhale for at least ______ seconds.
six ## Footnote The test should stop when there is no volume change for one second.
63
The test session is finished when the difference between the two largest **FVC measurements** and between the two largest **FEV1 measurements** is within ______.
0.2 L ## Footnote If both criteria are not met after three maneuvers, the test should not be interpreted.
64
Repeat testing should continue until the criteria are met or until ______ tests have been performed.
eight ## Footnote This ensures thorough assessment of lung function.
65
What should the flow-volume curve look like in a valid spirometry test?
Free of glitches and irregularities ## Footnote This indicates proper technique and valid results.
66
The volume-time curve in a valid spirometry test should extend longer than ______ seconds.
six ## Footnote There should be no signs of early termination or cutoff.
67
If the spirometry test is valid, the next step is to determine whether an **obstructive or restrictive** ______ pattern is present.
ventilatory ## Footnote This classification helps in diagnosing respiratory conditions.
68
What is the **percent increase** in FVC for patients who are standing compared to those who are supine?
About 2 percent ## Footnote This indicates that body position can affect spirometric measurements.
69
To determine the **validity of spirometric results**, how many acceptable spirograms must be obtained?
At least three ## Footnote Each test should have patients exhaling for at least six seconds.
70
What is the criterion for finishing a spirometry test session regarding the **FVC and FEV1 measurements**?
The difference must be within 0.2 L ## Footnote If both criteria are not met after three maneuvers, the test should not be interpreted.
71
What indicates a **valid spirometry test** in terms of the flow-volume and time-volume curves?
* Flow-volume curve: free of glitches and irregularities * Volume-time curve: extends longer than six seconds ## Footnote There should be no signs of early termination or cutoff.
72
When both FVC and FEV1 are decreased, how is the distinction between an **obstructive and restrictive ventilatory pattern** determined?
By the absolute FEV1/FVC ratio ## Footnote A normal or increased ratio suggests restrictive ventilatory impairment.
73
What is the **TLC percentage** that indicates a restrictive pattern when diagnosing restrictive lung disease?
Less than 80 percent ## Footnote Conditions to consider include pleural effusion, pneumonia, pulmonary fibrosis, and congestive heart failure.
74
What does a **reduced FEV1 and absolute FEV1/FVC ratio** indicate?
An obstructive ventilatory pattern ## Footnote Bronchodilator challenge testing is recommended to detect reversible airway obstruction.
75
What is the criteria for a **positive bronchodilator response** during testing?
* FEV1 increases by at least 12 percent * FVC increases by at least 200 mL ## Footnote Patients should not use any bronchodilator for at least 48 hours before the test.
76
What is the **mid-expiratory flow rate (FEF25-75%)**?
The average forced expiratory flow rate over the middle 50 percent of the FVC ## Footnote It helps in diagnosing an obstructive ventilatory pattern.
77
What does a reduction in **FEF25-75%** of less than 60 percent of that predicted indicate?
Airway obstruction ## Footnote This is considered in conjunction with an FEV1/FVC ratio in the low to normal range.
78
What is the **maximal voluntary ventilation (MVV)** maneuver used for?
To confirm obstructive and restrictive conditions ## Footnote The result is extrapolated to 60 seconds and reported in liters per minute.
79
What is the typical relationship between **MVV** and **FEV1**?
MVV is approximately equal to FEV1 × 40 ## Footnote A low MVV can occur in obstructive disease but is more common in restrictive conditions.
80
What is the **final step** in interpreting spirometry?
Determine if additional testing is needed ## Footnote This step is crucial to further define the abnormality detected by spirometry.
81
Measurement of **static lung volumes** is required to make a definitive diagnosis of __________.
restrictive lung disease ## Footnote This includes measuring FRC (Functional Residual Capacity) among other volumes.
82
What is **basic spirometry** used for?
* Assessment of pulmonary function * Addressing major issues in clinical management * Health screening ## Footnote Basic spirometry can be performed in a family physician’s office with relative ease and inexpensive equipment.
83
True or false: **Office spirometry** provides an inadequate assessment of pulmonary function.
FALSE ## Footnote In most cases, office spirometry provides an adequate assessment of pulmonary function.
84
Where can **basic spirometry** be performed?
In the family physician’s office ## Footnote It can be done with relative ease and inexpensive equipment.
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