SPIROMETRY BASICS

ROSEMARY STINSON MSN, CRNP

THE CHILDREN’S HOSPITAL OF PHILADELPHIA
DIVISION OF ALLERGY AND IMMUNOLOGY
PORTABLE COMPUTERIZED SPIROMETRY
WITH BUILT IN INCENTIVES
 WHAT IS SPIROMETRY?
 Use to obtain objective measures of lung function
 Physiological test that measures how an individual
inhales or exhales volume of air
 Primary signal measured–volume or flow
 Essentially measures airflow into and out of the
lungs
 Invaluable screening tool for respiratory health
compared to BP screening CV health
 Gold standard for diagnosing and measuring airway
obstruction.

ATS, 2005
SPIROMETRY AND ASTHMA
 At initial assessment
 After treatment initiated and symptoms and
PEF have stabilized
 During periods of progressive or prolonged
asthma control
 At least every 1-2 years: more frequently
depending on response to therapy
 WHY NECESSARY?
o To evaluate symptoms, signs or abnormal laboratory
tests
o To measure the effect of disease on pulmonary
function
o To screen individuals at risk of having pulmonary
disease
o To assess pre-operative risk
o To assess prognosis
o To assess health status before beginning strenuous
physical activity programs

ATS, 2005
 SPIROMETRY VERSUS PEAK FLOW
 Recommended over peak flow meter measurements in
clinician’s office.
 Variability in predicted PEF reference values.

 Many different brands PEF meters.

 Peak Flow is NOT a diagnostic tool.

 Helpful for monitoring control.

EPR 3, 2007
 WHY MEASURE?
o Some patients are “poor perceivers.”
o Perception of obstruction variable and spirometry
reveals obstruction more severe.
o Family members “underestimate” severity of
symptoms.
o Objective assessment of degree of airflow obstruction.
o Pulmonary function measures don’t always correlate
with symptoms.
o Comprehensive assessment of asthma.

ATS, 2005 ; EPR 3, 2007

EPR 3,1997
SPIROMETRY MYTHS
 Can’t be performed on children
 It takes a long time

 It can only be performed by respiratory

therapists
 The curves and numbers are hard to interpret
TEST PROCEDURE
Three Phases:
o Maximal inspiration- Deep breath in

o Exhalation- Blast of air: Takes at least 6 seconds to

fully empty air
o Continue completion to end of time

Vital Capacity:
o Maximum amount of air emptied from lungs

o Average 3-5 liters

o Dependent on age, sex, height

COMMONLY MEASURED VARIABLES
 Forced Vital Capacity (FVC)
 Forced Expiratory Volume in first second
(FEV1)
 FEV1/FVC

 Forced Expiratory Flow from 25-75% of FVC

(FEF25-75%)
 Peak Expiratory Flow (PEF)

 Flow volume loop/expiratory curve

FEV1
Defined: Forced expired volume in 1st second of FVC
maneuver; Normal > 80%

 Expressed as a percent of the predicted value

 A proportion of the forced vital capacity (FVC) or
FEV1 /FVC.
 Approximately 2.5 - 4 Liters
 Depends upon age, height, sex
 Measure of speed exhalation (volume/liters)
 Value most used to diagnose obstructive disease and
degree of improvement with bronchodilator
 The test most used for assessing the risk of future of
exacerbations

ATS, 2005; EPR 3 ,2007

FEV1
FVC
Defined: Forced vital capacity-Maximal volume of
air exhaled with maximum force

 Measures the amount of air blown out after full

inspiration
 Total lung capacity minus Residual Volume

 Their “umph” factor

FVC
FEV1/FVC RATIO
Defined: Amount of air expired in the 1st second/ Total
amount air expired during maneuver

o Decreased in obstructive, normal in restrictive

o Calculated result
o Measured FEV1 / Measured FVC
o Percentage
o Example: FEV1 3 L and FVC 4 L ; FEV1/FVC= 75%
o Compared to predicted normal value ( age, sex,
height)
PEFR
Defined: Peak expiratory flow rate- The maximum
flow attained during a FVC maneuver.

 Effort dependent!
 The top of the blast

 Value indicative of large airway function

 Used to determine baseline in peak flow meters

 Measure PEFR (in meters/second) x 60 = baseline
 Must have baseline minimum of ~ 240 Liters
FEF 25-75%
Defined: Measures the average amount of air in the
small airways during the middle half of test (From
1-3 seconds)

 Forced expiratory flow rate between 75% and

25% of FVC
 Flow in the middle of the curve
 Measures small airways function
 Effort dependent
 Useful in children over 10 yrs old
 Most sensitive test to detect the presence of early
small airways disease!
FEF 25-75%
 THE EXPERT PANEL RECOMMENDED
SPIROMETRY MEASUREMENTS:
• FEV1
• FEV6
Before AND after use of
• Forced expiratory volume in 6 seconds
short-acting
• FVC
bronchodilator
• FEV1/FVC

 Should be performed for patients where a

diagnosis of asthma is being considered
 Including children ≥ 5 years of age.

EPR 3- Guidelines, 2007

 TESTING METHOD
o Patient has 3 acceptable tests
o Pre bronchodilator
o Drug administered (Albuterol 4 puffs 90 mcg/puff)
o Testing repeated:
> 10 to 15 minutes post SABA
> 30 minutes post anticholinergic agents
o Significant reversibility an increase in FEV1 > 200
ml and 12 % from baseline
o Degree of airway reversibility- correlates with
airway inflammation

ATS 2005 ; EPR 3 ,2007

 TESTING…
o Aim of test –to determine whether patient lung
function can improve with therapy- in addition to
their regular medications.
o Baseline testing: when not taking any drugs
• SABA> 4 hours
• LABA, Theophylline> 12 hours
• No smoking> 1 hour prior to testing

ATS, 2005
SUMMARY
 Pulmonary functions are important
o Gold standard used to confirm diagnosis of
asthma (≥ 12% FEV1, ≥ 200 ml)
o Determine the degree of obstruction
o Determine severity
o To assess one aspect of response to therapy
o To monitor for future remodeling
SUPPLEMENTAL SLIDES
BRONCHODILATOR RESPONSE
 FEV1 may improve within about 10 minutes of
using inhaled bronchodilator
 If reverses by ≥ 12% “reversibility” or “bronchial
hyper-responsiveness” has been
demonstrated
 If reversible, suggests asthma

 If not reversible, does not exclude asthma

PRE- POST SPIROMETRY
REPORT