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Spirometry Interpretation

This document provides guidance on interpreting spirometry tests. Spirometry measures lung function by assessing the volume of air a patient can exhale. It can differentiate between obstructive and restrictive lung diseases. The key spirometry measures are FEV1, FVC and their ratio. Obstructive patterns show reduced FEV1 and FEV1/FVC ratio, while restrictive patterns show reduced FEV1 and FVC but normal ratio. Causes of obstructive diseases include COPD and asthma, while restrictive diseases may be pulmonary or non-pulmonary in origin such as fibrosis or obesity. Reversibility testing can help identify asthma.

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183 views4 pages

Spirometry Interpretation

This document provides guidance on interpreting spirometry tests. Spirometry measures lung function by assessing the volume of air a patient can exhale. It can differentiate between obstructive and restrictive lung diseases. The key spirometry measures are FEV1, FVC and their ratio. Obstructive patterns show reduced FEV1 and FEV1/FVC ratio, while restrictive patterns show reduced FEV1 and FVC but normal ratio. Causes of obstructive diseases include COPD and asthma, while restrictive diseases may be pulmonary or non-pulmonary in origin such as fibrosis or obesity. Reversibility testing can help identify asthma.

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Spirometry Interpretation

geekymedics.com/spirometry-interpretation/

Ivan July 1, 2018


Kwek

What is spirometry?
Spirometry is a method of assessing lung function by measuring the volume of air that the patient
is able to expel from the lungs after a maximal inspiration. It is a reliable method of differentiating
between obstructive airways disorders (e.g. chronic obstructive pulmonary disease, asthma) and
restrictive diseases (e.g. fibrotic lung disease).

Aside from being used to classify lung conditions into obstructive or restrictive patterns, it can also
help to monitor disease severity. This guide aims to provide a basic approach to spirometry
interpretation.

Spirometry provides several important measures including:

Forced expiratory volume in 1s (FEV1): the volume exhaled in the first second after
deep inspiration and forced expiration, similar to PEFR.
Forced vital capacity (FVC): the total volume of air that the patient can forcibly exhale in
one breath.
FEV1/FVC: the ratio of FEV1 to FVC expressed as a percentage.

Values of FEV1 and FVC are expressed as a percentage of the predicted normal for a person of the
same sex, age and height.

Reference ranges
FEV1: >80% predicted
FVC: >80% predicted
FEV1/FVC ratio: >0.7

Patient details
Confirm the patient’s details:

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Name
Age
Gender
Height
Ethnicity

Age, gender, height and ethnicity are used to calculate predicted normal values for the patient.

Assess the quality of results


Three consistent volume-time curves are required, of which the best two curves should be
within 5% of each other.

The best of the three consistent readings of FEV1 and FVC should be used in your
interpretation.

The expiratory volume-time graph should also be smooth and free from abnormalities caused
by:

Coughing during expiration


Extra breath during expiration
Slow start to forced expiration
Sub-maximal effort

Obstructive spirometry pattern


Typical spirometry findings in obstructive lung disease include:

Reduced FEV1 (<80% of the predicted normal)


Reduced FVC (but to a lesser extent than FEV1)
FEV1/FVC ratio reduced (<0.7)

Spirometry: obstructive lung disease

Reversibility
It can be useful to assess reversibility with a bronchodilator if considering asthma as a cause of
obstructive airway disease.

Patients should be asked to stop bronchodilator therapy prior to spirometry, to ensure previous
treatments do not affect the results (if the patient has severe disease, this would not be advisable):
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Short-acting beta-2-agonists should be stopped 6 hours prior to testing.
Long-acting beta-2-agonists should be stopped 12 hours prior to testing.

To assess reversibility, administer 400 micrograms of salbutamol and repeat spirometry


after 15 minutes:

The presence of reversibility is suggestive of a diagnosis of asthma.


The absence of reversibility suggests fixed obstructive respiratory pathology such as chronic
obstructive pulmonary disease (COPD).
Partial reversibility may suggest a coexisting diagnosis of asthma and another obstructive
airway disease (e.g. COPD).

Aetiology of obstructive lung disease


Causes of obstructive lung disease include:

COPD
Asthma
Emphysema
Bronchiectasis
Cystic fibrosis

Restrictive spirometry pattern


Typical spirometry findings in restrictive lung disease include:

Reduced FEV1 (<80% of the predicted normal)


Reduced FVC (<80% of the predicted normal)
FEV1/FVC ratio normal (>0.7)

Spirometry: restrictive lung disease

Aetiology of restrictive lung disease


Causes of restrictive lung disease can be pulmonary or non-pulmonary in origin.

Pulmonary causes
Pulmonary causes of restrictive lung disease include:

Pulmonary fibrosis
Pneumoconiosis
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Pulmonary oedema
Lobectomy/pneumonectomy
Parenchymal lung tumours

Non-pulmonary causes
Non-pulmonary causes of restrictive lung disease include:

Skeletal abnormalities (e.g. kyphoscoliosis)


Neuromuscular diseases (e.g. motor neuron disease, myasthenia gravis, Guillan-Barre
syndrome)
Connective tissue diseases
Obesity or pregnancy

References
1. Spirometry in Practice: A Practical Guide to Using Spirometry in Primary Care 2nd Ed (2005).
British Thoracic Society COPD Consortium. Available from: [LINK].
2. Dr Colin Tidy. Spirometry. Patient.info. Published 2nd Dec 2016. Accessed on 12th Dec 2017.
Available from: [LINK].

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