Easy Spirometry Interpretation Guide

5. A normal volume-time curve

The most important tools

for diagnosing COPD
and asthma are medical
history, physical examination, and spirometry.
Interpreting your spirometry results correctly will
help assure an accurate
diagnosis and disease
classification (severity).

rises sharply from the baseline

and reaches a flat plateau. A
gradual curve that never plateaus
suggests airway obstruction.
Sample V/T curves
00

2. Look at the curve patterns

and
numbers
to8 help guide your
5
6
7
olume (L) interpretation.

1
FEV1=4.0 L

FEV1=1.8 L
2

Time (sec)

that the quality of the spirometry

test is good. Poor quality tests
can cause diagnostic misclassifications. For more information,
see 10 Steps to Good Results on
our website.

3. A normal flow-volume curve

looks like a sail, rising rapidly to a

peak then descending at about a
45-degree angle.

4. A concave flow-volume curve

5
FVC=4.2 L

FVC=5.0 L

6
Volume (L)

suggests mild to moderate airways obstruction, while a prolonged finish rats tail shape
suggests severe obstruction.

Note: If the effort stops before 6

seconds in adults (3 seconds in
children) the FVC may be underestimated.

Normal
Moderate Obstruction
Severe Obstruction

Sample F/V curves

14
13
12
11
10
9
8
7
6

respiratory symptoms and normal

spirometry, consider performing a
post-BD test to identify intermittent or mild asthma which is confirmed by a >12% improvement
in FEV1, despite normal pre-BD
spirometry results.

9. Adult onset airway obstruction

in the long-term smoker (>10 to
20 pack year history) is usually
due to COPD.
10. Once a diagnosis of asthma

or COPD has been determined,

disease classification and approTo view additional curve samples,
priate
treatment can be easily
1
2
3
4
5
6
7
8
00
see Sample Spirometry
Tracings
established by utilizing the
Normal
on our website.
Severe Obstruction
corresponding tables on the
1
6. A low (< 70%
pred) FEV1%
following page.
FEV1=4.0 L
(FEV1/FVC) indicates
FEV1=1.8 L airway
If a diagnosis is still uncertain,
obstruction. A low
(< 80% pred)
2
consider referral to a specialist
FVC and FEV1 with a normal
for consultation or co-manageFEV1% suggests restriction with3
ment.
out obstruction. However, to
make a definitive diagnosis of
restrictive lung 4disease, the
patient should be referred to a
pulmonary lab for
additional lung
5
Jones Medical Instrument Company
volume testing.
FVC=5.0 L
200 Windsor Drive, Oak Brook, IL 60523
FVC=4.2 L
Time (sec)

airway obstruction should receive

a post-BD (bronchodilator)
spirometry test. After administration of a bronchodilator (i.e.,
albuterol, 2-4 puffs of 90
mcg/puff), allow 10-15 minutes
prior to performing the post BD
spirometry test. An increase of
12% (and more than 0.2 liters) in
the measured FEV1 suggests
reversible airways disease, such
as asthma. COPD can be as
much as 5-6% reversible, but not
much more. For more information, see Differential Diagnosis on
our website.

8. In patients with intermittent

Flow (L/sec)

Normal
Severe Obstruction

1. The first step is to make sure

4
3
2
1
0

7. Patients with symptoms and

4
Volume (L)

(800) 323-7336 www.jonesmedical.com

6

2008 Jones Medical Instrument Company. All Rights Reserved.

Volume (L)

Classification: First, identify the appropriate classification chart below. Then simply reference the
patients post-BD spirometry results to determine an accurate classification and treatment regimen.
CLASSIFYING ASTHMA SEVERITY IN CHILDREN 5 - 11
YEARS OF AGE

STEPWISE APPROACH FOR MANAGING ASTHMA IN

CHILDREN 5 - 11 YEARS OF AGE

Assessing severity and initiating therapy in children who are not currently taking long-term control medication

Classification of Asthma Severity

(5 - 11 years of age)

Components of
Severity
Symptoms
Nighttime
awakenings
Short acting
beta2-agonist use for
symptom control (not
prevention of EIB)
Interference with
normal activity

Moderate

Severe

2 days/week

>2 days/week but

not daily

Daily

Throughout
the day

2x/month

3 - 4x/month

>1x/week but
not nightly

Often 7x/week

Daily

Several times
per day

>2 days/week
but not daily

2 days/week

None

Minor limitation

FEV1 >80%
predicted
FEV1/FVC >85%

FEV1 = >80%
predicted
FEV1/FVC >80%

0 - 1/year

Exacerbations
requiring oral
systemic
corticosteroids

Some limitation

FEV1 = 60-80%
predicted
FEV1/FVC = 75-80%

FEV1 <60%
predicted
FEV1/FVC < 75%

Step 3, medium- Step 3, medium-dose

dose ICS option
ICS option or Step 4
and consider short course of
oral systemic corticosteroids

Step 2

In 2 - 6 weeks, evaluate level of asthma control that is achieved,

and adjust therapy accordingly

CLASSIFYING ASTHMA SEVERITY IN YOUTHS 12 YEARS OF AGE

AND ADULTS

Preferred:

Step 3

Preferred:

High-dose ICS +
LABA

Step 2

Preferred:

Medium-dose
ICS + LABA

Alternative:

Preferred:

EITHER:

Alternative:

High-dose ICS +
either LTRA
or Theophylline

Step 1

Low-dose ICS

Preferred:

Alternative:

SABA PRN

Cromolyn, LTRA,
Nedocromil, or
Theophylline

Low-dose ICS +
either LABA,
LTRA, or
Theophylline
OR
Medium-dose
ICS

Medium-dose
ICS + either
LTRA or
Theophylline

Preferred:
High-dose ICS +
LABA + oral
systemic
corticosteroid
Alternative:
High-dose ICS +
either LTRA
or
Theophylline +
oral systemic
corticosteroid

Each Step: Patient education, environmental control, and management of comorbidities.

Steps 2 - 4: Consider subcutaneous allergen immunotherapy for patients who have allergic asthma.

Step up if
needed
(first, check
adherence,
inhaler
technique,
environmental
control, and
comorbid
conditions)

Assess
control
Step down if
possible
(and asthma is
well controlled
at least
3 months)

Quick-Relief Medication for All Patients

SABA as needed for symptoms. Intensity of treatment depends on severity of symptoms: up to 3 treatments
at 20-minute intervals as needed. Short course of oral systemic corticosteroids may be needed.
Caution: Increasing use of SABA or use >2 days a week for symptom relief (not prevention of EIB) generally
indicates inadequate control and the need to step up treatment.

STEPWISE APPROACH FOR MANAGING ASTHMA IN

YOUTHS 12 YEARS OF AGE AND ADULTS

Assessing severity and initiating treatment for patients who are not currently taking long-term control medications

Classification of Asthma Severity

12 years of age
Mild

Moderate

Severe

2 days/week

>2 days/week but

not daily

Daily

Throughout
the day

Nighttime
awakenings

2x/month

3 - 4x/month

>1x/week but
not nightly

Often 7x/week

Short acting
beta2-agonist use for
symptom control (not
prevention of EIB)

2 days/week

Daily

Several times
per day

Symptoms

Impairment
Normal FEV1/FVC:
8 - 19 yr 85%
20 - 39 yr 80%
40 - 59 yr 75%
60 - 80 yr 70%

Interference with
normal activity

None

Lung function

Normal FEV1
between
exacerbations
FEV1 >80%
predicted
FEV1/FVC normal

Risk

Minor limitation

FEV1 >80%
predicted
FEV1/FVC normal

Some limitation

FEV1 >60%, but

<80% predicted
FEV1/FVC
reduced 5%

Extremely limited

FEV1 <60%
predicted
FEV1/FVC
reduced >5%

Step 3
Step 1

Step 2

II: Moderate

FEV1 80% predicted

FEV1/FVC < 0.70

50% FEV1 < 80%
predicted

Step 2
Step 1

Step 4 or 5

and consider short course of

oral systemic corticosteroids

III: Severe

FEV1/FVC < 0.70

30% FEV1 < 50%
predicted

IV: Very Severe

FEV1/FVC < 0.70

FEV1 < 30% predicted
or FEV1 < 50%
predicted plus chronic
respiratory failure

Alternative:

SABA PRN

Cromolyn, LTRA,
Nedocromil, or
Theophylline

Low-dose
ICS + LABA
OR
Medium-dose
ICS
Alternative:

Preferred:

Step 4

Preferred:

Preferred:

High-dose ICS +
LABA

Medium-dose
ICS + LABA

AND

AND

Consider
Omalizumab for
patients who
have allergies

Consider
Omalizumab for
patients who
have allergies

Alternative:
Medium-dose
ICS + either
LTRA,
Theophylline,
or Zileuton

High-dose ICS +
LABA + oral
corticosteroid

Low-dose ICS +
either LTRA,
Theophyline, or
Zileuton

Steps 2 - 4: Consider subcutaneous allergen immunotherapy for patients who have allergic asthma.

(first, check
adherence,
environmental
control, and
comorbid
conditions)

Assess
control
Step down if
possible
(and asthma is
well controlled
at least
3 months)

SABA as needed for symptoms. Intensity of treatment depends on severity of symptoms: up to 3 treatments
at 20-minute intervals as needed. Short course of oral systemic corticosteroids may be needed.
Use of SABA >2 days a week for symptom relief (not prevention of EIB) generally indicates inadequate control and
the need to step up treatment.

Visit the Links page on our website for complete

versions of the asthma and COPD guidelines.
Note: This information is intended to augment,
not replace, a physicians independent
professional judgment.

NHLBI/WHO. GOLD COPD Guidelines; 2006 Revised

NHLBI. Guidelines for the Diagnosis and Management of Asthma:
Expert Panel Report 3: 2007

Add inhaled glucocorticosteroids if

repeated exacerbations
Add long-term oxygen if
chronic respiratory
failure.
Consider surgical
treatments

Step up if
needed

Quick-Relief Medication for All Patients

Add regular treatment with one or more long-acting bronchodilators

(when needed); Add rehabilitation

Preferred:

Step 6

Each Step: Patient education, environmental control, and management of comorbidities.

Active reduction of risk factor(s); influenza vaccination

Add short-acting bronchodilator (when needed)

Low-dose ICS

Preferred:

2/year

Consider severity and interval since last exacerbation.

Frequency and severity may fluctuate over time for patients in any severity category.
Relative annual risk of exacerbations may be related to FEV1.

COPD CLASSIFICATION AND TREATMENT

I: Mild

Step 5

Preferred:

In 2 - 6 weeks, evaluate level of asthma control that is achieved,

and adjust therapy accordingly

FEV1/FVC < 0.70

Consult with asthma specialist if Step 4 care or higher is required.

Consider consultation at Step 3.

Step 3

>2 days/week
but not daily, and
not more than
1x on any day

0 - 1/year

Exacerbations
requiring oral
systemic
corticosteroids

Recommended Step for

Initiating Therapy

Persistent Asthma: Daily Medication

Intermittent
Asthma

Persistent
Intermittent

Step 4

Step 6

2/year

Step 1

Components of
Severity

COPD

Step 5

Extremely limited

Consider severity and interval since last exacerbation.

Frequency and severity may fluctuate over time for patients in any severity category.
Relative annual risk of exacerbations may be related to FEV1.

Recommended Step for

Initiating Therapy

ASTHMA2

Mild

Normal FEV1
between
exacerbations

Lung function

Risk

Consult with asthma specialist if Step 4 care or higher is required.

Consider consultation at Step 3.

Persistent
Intermittent

Impairment

Persistent Asthma: Daily Medication

Intermittent
Asthma

Jones Medical Instrument Company

200 Windsor Drive, Oak Brook, IL 60523
(800) 323-7336 www.jonesmedical.com

2008 Jones Medical Instrument Company. All Rights Reserved.