Basic Interpretation of Spirometry. Chris Crocker COPD Team
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1 Basic Interpretation of Spirometry Chris Crocker COPD Team
2 Aims When to do spirometry When not to do spirometry Definition of terms Different patterns in spirometry Problems Interpreting Time/Volume graphs
3 Spirometry Spirometry is a method of assessing lung function by measuring the volume of air a patient can expel from the lungs after maximal inspiration
4 WHY WE DO IT! Diagnosis confirmation COPD classification Disease progression Response to treatment Health Promotion (Smoking Cessation) Targets
5 FINDING THE MISSING MILLIONS National Clinical Strategy recommends A diagnosis of COPD should be confirmed by quality assured spirometry..
6 When not to perform spirometry Inadequate training Inadequate equipment Lack of quality control Contra-indications During or immediately after an exacerbation
7 Contra-indications Haemoptysis Pneumothorax Unstable cardiac status Aneurysm Recent eye surgery Recent thoracic or abdominal surgery Acute disorders: D&V, Exacerbations
8 How we do it! Equipment / spirometers /syringes Cleaning Temperature Calibration/Verification checks Filters
9 Patient preparation Pre-test information Documentation Patient comfort Explanation/demonstration Seated, chair with arms
10 Definition of terms FEV 1 FVC VC (RVC,SVC,EVC) Ratio FEV 1 /FVC or FEV 1 /VC
11 FEV 1 (Forced Expiratory Volume in 1 second) FEV 1 Time in seconds
12 FVC The maximum volume of air exhaled as rapidly, forcefully and completely from maximum inspiration FVC
13 Relaxed Vital Capacity The maximum volume of air expelled during a relaxed exhalation from maximum inspiration
14 FEV 1 % or Ratio of FEV 1 to FVC FEV 1 /FVC x 100 The proportion of air exhaled in one second This percentage is important in identifying airways obstruction
15 Airflow Obstruction Definition of airflow obstruction: FEV 1 <80% predicted and FEV 1 /FVC <70%
16 Definition of Chronic Obstructive Pulmonary Disease (COPD) COPD is predominantly caused by smoking and is characterised by airflow obstruction that is not fully reversible. The airflow obstruction does not change markedly over several months but is usually progressive in the long term. (NICE 2010)
17 COPD Classification NICE Guidelines Mild COPD FEVı 80% >predicted Moderate COPD FEVı 80-50% predicted Severe COPD FEVı 50-30% predicted Very Severe COPD FEVı <30% predicted
18 Different Patterns in Spirometry Normal Obstructed Restricted Combined/Mixed
19 Normal spirometry trace education for
20
21 Restrictive Spirometry Restrictive: due to conditions in which the lung volume is reduced, eg fibrosing alveolitis, scoliosis. The FVC and FEV1 are reduced proportionately.
22 Reporting Spirometry Results should be the greatest values achieved from 3 technically acceptable blows. (FEV 1 within 5%) Poorly performed spirometry is worse than no spirometry!
23 QUALITY? National strategy cites an example: 31% of spirometry measurements in 38 practices in Rotherham met the required standard of 3 readings within 5% ( in contravention of BTS and GOLD spirometry standards)
24 New Guide to Spirometry!!! A Guide to Performing Quality Assured Diagnostic Spirometry
25 Problems! Slow start Short Blow Cough Leaks around mouthpiece Sub-maximal effort Unable to achieve 3 acceptable results Inadequate rest between attempts
26 Parameters of Lung Function Normal Obstructive Restrictive Combined FVC >80% Normal Reduced Reduced FEV1 >80% Reduced Reduced Reduced FEV1/ FVC >70% Reduced Normal/ High Reduced
27 Reading the tracing Is the spirometry valid? Check sex/age/height/weight/bmi Check tracing for problems Identify ACTUAL ratio? obstruction Identify FEV1 and % predicted Check VC and FVC? Air trapping? Reduced volumes Remember to use largest measurement from valid blows, (these may not all be from one blow) Do the figures fit with the tracing? Interpret together with history, symptoms and medication
28
29
30 Training Do not perform spirometry without training ARTP ( EQUIP ( Education for health ( health.org.uk)
31 Thank you for listening Any Questions?
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