SPIROMETRY

DR. SALMA ELAGEL

SPIROMETRY

DEFINITION
Spirometry is a method of assessing lung function by
measuring the volume of air a patient can expel from
the lungs after maximal inspiration.

Types of spirometer

INDICATION
1. detecting pulmonary disease.
2. assessing severity or progression disease.
a. COPD, ILD, Sarcoidosis
b. neuromuscular disorders: MND, GBS, MG.
3.pre-op risk assessment
4. evaluating disability.

CONTRAINDICATIONS
Haemoptysis of unknown origin.
Pneumothorax
Unstable cardiac status (recent MI or unstable angina)
Thoracic Aneurysm (risk of rupture b/c of inc intra
thoracic pressure )
Recent eye surgery (inc intraocular pressure)
Recent thoracic or abdominal surgery
During Exacerbations
Acute disorders affecting test performance (N/V, Vertigo).

HOW TO PERFORM SPIROMETRY

Patient preparation
1. Pre-test information
2. Documentation (sex, age and height of the pt)
3. Patient comfort
4. Explanation/demonstration
5. Seated, chair with arms

DEFINITION OF TERMS
FEV1
FVC
VC (RVC,SVC,EVC)
Ratio FEV1/FVC or FEV1/VC

DEFINITIONS
FVC: Forced vital capacity; the total volume of air that can be
exhaled during a maximal forced expiration effort.
FEV1: Forced expiratory volume in one second; the volume of air
exhaled in the first second under force after a maximal inhalation.
FEV1/ FVC ratio : The percentage of the FVC expired in one
second.
FEV6: Forced expiratory volume in six seconds.
FEF25-75%: Forced expiratory flow over the middle one half of the
FVC; the average flow from the point at which 25 percent of the
FVC has been exhaled to the point at which 75 percent of the FVC
has been exhaled.

DEFINITIONS

Lung volumes & Capacities:

ERV: Expiratory reserve volume; the maximal volume of air exhaled from end
expiration.
IRV: Inspiratory reserve volume; the maximal volume of air inhaled from end
inspiration.
RV: Residual volume; the volume of air remaining in the lungs after a maximal
exhalation.
VT: Tidal volume; the volume of air inhaled or exhaled during each respiratory
cycle.
FRC: Functional residual capacity; the volume of air in the lungs at resting end
expiration.
IC: Inspiratory capacity; the maximal volume of air that can be inhaled from
the resting expiratory level.
TLC: Total lung capacity; the volume of air in the lungs at maximal inflation.
VC: Vital capacity; the largest volume measured on complete exhalation after
full inspiration.

LUNG VOLUMES AND CAPACITIES

NORMAL VALUES OF
SPIROMETRY

Obstructive &Restrictive
pattern

REVERSIBILITY TEST
1. stop all the following Medication before the test day
(Inhaler or nebuliser B agonist , Inhaler or nebuliser
Ipratropium bromide , Tablet Theophylline , Inhaler
Tiotropium).
2. Refrain from smoking 24 hours before the test.
3. Avoid eating a large meal for 2 hours before the test.
4. Avoid vigorous exercise for 30 minutes before the test.
5. Avoid alcohol on the day before the test.
INTERPRETATION: significant increase in FEV1 >12% from
baseline OR > 200 ml increase in FVC is diagnostic of
reversible airway disease (Asthma).

How to interpret the spirometry results?

Normal

Normal, Obstructive, Restrictive

patterns:

EXAMPLES
1. 60 Y/F. heavy active smoker since age of 20, c/o smokers
cough and SOB
Spirometry:
FEV1 = 1.39 (56% Predicted) = reduced
FVC = 2.53 (86% Predicted) = N
FEV1/FVC Ratio = 0.55 = reduced
Dx:
Rx:

EXAMPLES
2. 70Y/M, heavy active smoker 40pack/year. c/o decrease ET, SOB,
Chronic productive cough, and received multiple courses pf antibiotics
over the last one year. his symptoms interfere with daily activity and was
not able to do gardening anymore, seen by GP : He looks cyanosed
Spirometry:

FEV1 = 0.89 (26% Predicted) = reduced

FVC = 2.74 (67% Predicted) = reduced
FEV1/FVC Ratio = 0.32 = sever obstruction
Dx:
Rx:

EXAMPLES
3. 42Y/M, has history of recurrent resp symptoms since childhood
(wheezing &SOB increase with exercise). started smoking at age of 24,
H/O frequent episodes of URTI symptoms a/w wheezing. Recently start to
C/O persistent chesty cough with wheezing leading to sleep disturbance.
Spirometry:
Baseline: FEV1 = 3.24 (76% Predicted) = Slightly reduced.
FVC = 4.82 (91% Predicted) = N
FEV1/FVC Ratio = 0.67 = Slightly reduced.
Post-bronchodilator: FEV1 = 4.17 (+ 930 & 29%) = Significant reversibility.
Dx:
Rx:

EXAMPLES
4. 65Y/M, Non-Smoker C/O dry cough and SOB, he thought medical advice
TRO asthma as recently there was ongoing construction at nearby area to
his house.
Spirometry:
FEV1 = 1.67 (57% Predicted) = reduced
FVC = 2.07 (55% Predicted) = reduced
FEV1/FVC Ratio = 0.81
DLCO = 40%
Dx:
Rx:

=N

How to perform spirometry test

(Video)
https://www.youtube.com/watch?v=6kbgZWS5wH0

THANK YOU