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Spirometry: Dr. Dora Florian

Spirometry measures lung function by determining the volume and speed of air inhaled and exhaled using an instrument called a spirometer. It is used to diagnose and monitor lung diseases like asthma and COPD. Key metrics include FEV1, FVC, and their ratio. Obstructive lung diseases reduce airflow while restrictive diseases reduce total lung volume. Spirometry helps differentiate these and assess response to treatment.

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167 views15 pages

Spirometry: Dr. Dora Florian

Spirometry measures lung function by determining the volume and speed of air inhaled and exhaled using an instrument called a spirometer. It is used to diagnose and monitor lung diseases like asthma and COPD. Key metrics include FEV1, FVC, and their ratio. Obstructive lung diseases reduce airflow while restrictive diseases reduce total lung volume. Spirometry helps differentiate these and assess response to treatment.

Uploaded by

Dora
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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SPIROMETRY

DR. DORA FLORIAN


Introduction

 It measures lung function, specifically the volume and or speed (flow) of air that can be
inhaled and exhaled by a subject
 It is an objective, noninvasive, sensitive to early change and reproducible method
 It is essential for the diagnosis and monitoring of many diseases of the RS
 It is performed with an instrument called “spirometer” in order to:
 detect the presence or absence of a lung disease (asthma, COPD, cystic fibrosis, pulmonary
fibrosis)
 quantify lung impairment
 monitor the effects of occupational/environmental exposures
 determine the effects of medications
Spirometer

 Spirometer is an instrument that measures


and records the volume of inhaled and
exhaled air, used to assess pulmonary
function
 The computer connected to spirometer
converts the signal into numerical values
and graphical images called a spirogram
Why do we do it?

 To diagnose or manage asthma


 To measure response to treatment of conditions which spirometry detects
 To dg and differentiate between obstructive lung disease and restrictive lung disease
 To identify those at risk from pulmonary barotrauma while scuba diving
 To conduct pre-op risk assessment bf anesthesia or cardiothoracic surgery
 Health promotion (smoking cessation)
Contraindications

 Hemoptysis of unknown origin


 Pneumothorax
 Unstable cardiovascular status (angina, recent myocardial infarction, etc.)
 Thoracic, abdominal, or cerebral aneurysms
 Cataracts or recent eye surgery
 Recent thoracic or abdominal surgery
 Nausea, vomiting, or acute illness
 Undiagnosed hypertension
Patient positioning

 Sit upright: there should be no difference in the amount of air the patient can exhale from
a sitting position compared to a standing position as long as they are sitting up straight
and there are no restrictions.
 Feet flat on floor with legs uncrossed: no use of abdominal muscles for leg position.
 Loosen tight-fitting clothing: if clothing is too tight, this can give restrictive pictures on
spirometry (give lower volumes than are true).
 Dentures normally left in: it is best to have some structure to the mouth area unless
dentures are very loose.
 Use a chair with arms: when exhaling maximally, patients can become light-headed and
possibly sway or faint.
Procedure

 Slow maneuver (VC):


 Quiet breathing
 Full inspiration
 Complete exhalation
 Forced maneuver (FVC):
 Quiet breathing
 Maximal inspiration
 Rapid and complete expiration
 Rapid and deep inspiration
Static Lung Volume

 tidal volume (TV): the volume of air inhaled


and exhaled during each breath = 500mL
 Inspiratory reserve volume (IRV): the
maximum amount of air that can be inspired at
the end of normal inhalation = 2500 mL
 Expiratory reserve volume (ERV): the
maximal volume of air that can be exhaled
from the end-expiratory position = 1500 mL
 Residual volume (RV): the volume of air
remaining in the lungs after a maximal
exhalation = 1000-1500 mL
Lung capacities

 Total lung capacity (TLC): the volume of air


contained in the lungs at the end of maximal
inspiration (TLC = TV + IRV + ERE + RV) = 5500-
6000mL air
 Vital Capacity (VC): the volume of air breathed out
after the deepest inhalation (VC = TV + IRV + ERV) =
4500mL
 Inspiratory Capacity (IC): maximum amount of air
that can be breathed in (IC = TV + IRV) = 3000 Ml
 Functional Residual Capacity (FRC): the volume in
the lungs at the end-expiratory position (FRC = ERV +
RV) = 3000mL
Dynamic lung volumes

 Forced expiratory volume in one second (FEV1): the volume of air exhaled during the
first second of a forced expiration.
Percentage of predicted FEV1 value Result
80% or greater normal
70%–79% mildly abnormal
60%–69% moderately abnormal
50%–59% moderate to severely abnormal
35%–49% severely abnormal
Less than 35% very severely abnormal
Dynamic lung volumes

 Forced vital capcity (FVC): the determination of the vital capacity from a maximally forced
expiratory effort

Percentage of predicted FVC value Result


80% or greater normal
less than 80% abnormal

 The Tiffneau Index (ratio of FEV1/FVC * 100); NV >= 75%


Reading spirometry

 ASSESSMENT OF FVC: <80% of the theoretical


value => restrictive defect
 EVALUATION OF FEV: <80% of the theoretical
value => obstructive defect
 EVALUATION Tiffeneau INDEX: <70 -75% of
the absolute value => obstructive deficit
Restrictive pulmonary disease

 Restrictive disorders -> loss in lung volume:


pulmonary fibrosis, pleural disease, chest wall
disorders (kyphoscoliosis), neuromuscular
disorders, pneumonectomy, pulmonary oedema
and obesity
 Restriction is characterised by:
 reduced FVC
 normal-to-high FEV1/FVC ratio;
 normal looking shape on spirometry trace
 possibly a relatively high PEF (peak expiratory
flow: the highest forced expiratory flow measured
with a peak flow meter)
Obstructive pulmonary disease

 Obstruction -> airflow limitation => decreased airway calibre (smooth muscle
contraction, inflammation, mucus plugging or airway collapse in emphysema)
 Eg: COPD, asthma, tumors of the lung/pleura, aspiration of foreign objects
 Obstructive disorders are characterised by:
 reduced FEV1
 normal (or reduced) VC
 normal or reduced FVC
 reduced FEV1/FVC ratio
 concave flow–volume loop

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