Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
QU
ICK
GL
AN
CE
GU
IDE
TO
SP
IRO
ME
TR
Y
Mild
ly o
bstr
ucte
d �o
w lo
op
Mod
erat
ely
obst
ruct
ed �
ow lo
op
Seve
rely
obs
truc
ted
�ow
loop
Nor
mal
�ow
loop
Inte
rstit
ial p
ulm
onar
y �b
rosi
s �o
w lo
op (r
estr
ictiv
e lu
ng
dise
ase)
FVC
Peak
�ow
Exam
ples
of o
bstr
ucte
d an
d re
stric
ted
�ow
loop
s
Def
init
ion
s:
Fo
rced
Vit
al C
apac
ity
(FV
C):
the
volu
me
deliv
ered
dur
ing
an e
xpira
tion
mad
e as
fo
rcef
ully
and
com
plet
ely
as p
ossi
ble
star
ting
from
full
insp
iratio
n F
orc
ed E
xpir
ato
ry V
olu
me
in t
he
firs
t se
con
d (
FE
V1)
: the
vol
ume
deliv
ered
in
the
�rst
sec
ond
of a
n FV
C m
aneu
ver
Ob
stru
ctio
n: �
ow li
mita
tion
is o
bser
ved
durin
g sp
irom
etry
. If
the
obse
rved
FEV
1/FV
C
ratio
is d
own
10 o
r mor
e fr
om th
e pr
edic
ted,
obs
truc
tion
is p
rese
nt.
R
estr
icti
on
: Spi
rom
etry
with
low
FVC
(< 8
0%) c
an o
nly
sugg
est r
estr
ictio
n. F
urth
er
test
ing
is n
eede
d to
con
�rm
.
A
ctua
l
Pred
icte
d %
Pre
dict
ed
FVC
(L)
3.62
3.41
106
FEV1
(L)
4.00
4.03
99
A
ctua
l
Pred
icte
d %
Pre
dict
ed
FVC
(L)
3.64
3.41
107
FEV1
(L)
3.99
4.03
99
A
ctua
l
Pred
icte
d %
Pre
dict
ed
FVC
(L)
3.70
3.41
109
FEV1
(L)
4.07
4.03
101
Exam
ples
of u
nacc
epta
ble
test
s
Slow
sta
rt
of te
st
Roun
ded
peak
Ea
rly
term
inat
ion
Coug
h in
�r
st s
econ
d
Acc
epta
bilit
y cr
iter
ia fr
om th
e A
mer
ican
Tho
raci
c So
ciet
y: G
loba
l Lun
g Fu
nctio
n In
itiat
ive
(GLI
)-201
2 m
ulti-
ethn
ic re
fere
nce
rang
es a
re re
com
men
ded.
N
HA
NES
III r
efer
ence
val
ues
rem
ain
appr
opria
te w
here
mai
ntai
ning
con
tinui
ty is
impo
rtan
t. Fo
llow
ing
a gr
adin
g sy
stem
rang
e of
A-F
, spi
rom
etry
test
s w
ith g
rade
sof
A-C
are
clin
ical
ly u
sefu
l.
Spiro
met
ry m
ust e
stab
lish
a so
lid b
asel
ine
mee
ting
all c
riter
ia fo
r acc
epta
bilit
y an
d re
peat
abili
ty.
Use
GLI
-201
2 m
ulti-
ethn
ic re
fere
nce
rang
es w
hen
avai
labl
e. N
HA
NES
III r
efer
ence
val
ues
rem
ain
appr
opria
te fo
r pat
ient
s8-8
0, w
here
mai
ntai
ning
con
tinui
ty is
impo
rtan
t. Fo
r chi
ldre
n ag
es 5
-8,
Wan
g re
fere
nce
valu
es a
re re
com
men
ded
whe
n G
LI-2
012
is n
ot a
vaila
ble.
GLI
-201
2 ha
s a
grad
ing
syst
em ra
nge
of A
-F, s
piro
met
ry te
sts
with
gra
des
of A
-C a
re c
linic
ally
use
ful.
Follo
w a
ll O
SHA
and
JC
AH
O s
tand
ards
for i
nfec
tion
cont
rol.
Not
e: T
estin
g ch
ildre
n <
age
5 is
like
ly to
be
unsu
cces
sful
.
Co
ntr
ain
dic
atio
ns:
•
Rece
nt s
urge
ry
•W
ithin
one
mon
th o
f a m
yoca
rdia
l inf
arct
ion
•Re
cent
pne
umot
hora
x •
Una
ble
to u
nder
stan
d di
rect
ions
or i
nabi
lity
to s
eal m
outh
piec
e
CP
T c
od
es f
or
spir
om
etry
: 94
010
spiro
met
ry 9
4060
spi
rom
etry
with
bro
ncho
dila
tor (
pre-
and
pos
t-te
st)
Whe
n us
ing
thes
e CP
T co
des,
bet
ter r
eim
burs
emen
t hap
pens
whe
n cu
rren
t sym
ptom
s ar
e as
soci
ated
with
the
appr
opria
te IC
D9
code
for a
sthm
a or
CO
PD.
Ref
er t
o a
sp
ecia
list:
•If
patie
nt h
as s
ever
e o
bst
ruct
ion
•If
patie
nt h
as a
res
tric
tive
pat
tern
•
If pa
tient
do
es n
ot
resp
on
d t
o m
edic
atio
ns
Co
ach
ing
pat
ien
ts t
hro
ug
h s
pir
om
etry
: In
stru
ct p
atie
nt to
bre
athe
nor
mal
ly. W
h en
pat
ient
is re
ady,
hav
e hi
m/h
er ta
ke h
is/
her d
eepe
st b
reat
h an
d bl
ow a
s ha
rd a
s he
/she
can
as
long
as h
e/sh
e ca
n. T
here
is a
le
arni
ng c
urve
for s
piro
met
ry. U
se p
ositi
ve re
info
rcem
ent t
o bu
ild o
n th
e pa
tient
’s
succ
esse
s. (F
or
ex
ampl
e, “T
hat w
as re
ally
goo
d; th
is ti
me
take
an
even
dee
per
brea
th.”)
Alw
ays
dem
onst
rat
e th
e sp
irom
etry
man
euve
r, es
peci
ally
if la
ngua
ge is
a
barr
ier o
r com
mun
icat
ion
issu
es a
rise.
Ap
pro
pri
ate
bro
nch
od
ilato
r u
se:
If te
stin
g fo
r rev
ersi
bilit
y, g
ive
patie
nt 4
puf
fs o
f bro
ncho
dila
tor w
ith a
spa
cer o
r a
stan
dard
neb
uliz
ed d
ose.
Wai
t 15
min
utes
aft
er la
st d
ose
to p
erfo
rm p
ost-
bron
chod
ilato
r man
euve
r. If
a pa
tient
can
not p
erfo
rm a
ccep
tabl
e ba
selin
e m
aneu
vers
acc
ordi
ng to
Am
eric
an T
hora
cic
Soci
ety
crite
ria o
r the
re is
no
evid
ence
of
airf
low
obs
truc
tion,
do
NO
T gi
ve a
bro
ncho
dila
tor.
Refe
renc
es:
1. R
epea
tabi
lity
crite
ria fo
r the
Am
eric
an T
hora
cic
Soci
ety:
Thr
ee (3
) acc
epta
ble
test
s m
ust b
e pe
rfor
med
with
two
(2) t
ests
hav
ing
FEV1
and
FV
C w
ithin
.15L
or 1
50m
L of
eac
h ot
her.
2.M
iller
M, H
anki
nson
J, B
rusa
sco
V, e
t al.
Stan
dard
isat
ion
of s
piro
met
ry. E
urop
ean
Res
pira
tory
Jou
rnal
. 200
5;26
:319
–338
. 3.
Pelle
grin
o R,
Vie
gi G
, Bru
sasc
o V,
et a
l. In
terp
reta
tive
stra
tegi
es fo
r lun
g fu
nctio
n te
sts.
Eur
opea
n R
espi
rato
ry J
ourn
al. 2
005;
26:9
48–9
68.
4.G
loba
l Str
ateg
y fo
r the
Dia
gnos
is, M
anag
emen
t, an
d Pr
even
tion
of C
hron
ic O
bstr
uctiv
e Pu
lmon
ary
Dis
ease
. U
pdat
ed 2
007.
Ava
ilabl
e at
ht
tp://
ww
w.g
oldc
opd.
com
.5.
Nat
iona
l Hea
rt, L
ung
and
Bloo
d In
stitu
te N
atio
nal A
sthm
a Ed
ucat
ion
and
Prev
entio
n Pr
ogra
m.
Exp
ert P
anel
Rep
ort 3
: Gui
delin
es fo
r th
e D
iagn
osis
and
Man
agem
ent o
f Ast
hma.
200
7. A
vaila
ble
at h
ttp:
//w
ww
.nhl
bi.n
ih.g
ov.
Sp
iro
met
ry:
a m
easu
re o
f ai
rflo
w (
ho
w f
ast)
an
d v
olu
me
(ho
w m
uch
)
Supp
orte
d by
Boe
hrin
ger I
ngel
heim
Pha
rmac
eutic
als,
Inc.
Repe
atab
ility
cri
teri
a fo
r the
Am
eric
an T
hora
cic
Soci
ety:
Rec
omm
ende
d re
peat
abili
ty c
riter
ia o
f 150
ml.
SP
IRO
ME
TR
Y I
NT
ER
PR
ETA
TIO
N
Wha
t is
the
obse
rved
ratio
(FEV
1/FV
C)
com
pare
d to
pre
dict
ed?
Dow
n 10
or g
reat
er =
air�
ow o
bstr
uctio
n
AT
S/E
RS
* D
egre
e o
f se
veri
ty o
f o
bst
ruct
ion
bas
ed o
n F
EV
1
Deg
ree
of s
ever
ityFE
V1 %
pre
dict
edM
ild
>70
M
oder
ate
60-6
9 M
oder
atel
y se
vere
50
-59
Seve
re
35- 4
9 Ve
ry s
ever
e
<35
•Air�
ow o
bstr
uctio
n th
at is
not
sig
ni�c
antly
reve
rsib
le
does
NO
T ru
le o
ut a
sthm
a.
•To
help
di�
eren
tiate
CO
PD fr
om a
sthm
a w
ith a
irway
re
mod
elin
g/�x
ed o
bstr
uctio
n, fu
rthe
r tes
ting
optio
ns
incl
ude:
DL,
CO, c
hest
x-r
ay, a
nd c
hest
CT.
No
Yes
Is it
reve
rsib
le?
FE
V1
≥ 12
% a
nd
≥ 20
0 m
L in
you
ths
and
adul
ts 1
2+
≥ 15
% a
nd
≥ 20
0 m
L in
chi
ldre
n <
12
Sam
ple
writ
ten
asth
ma
inte
rpre
tatio
n:
The
FEV
1/F
VC ra
tio b
eing
dow
n m
ore
than
10
from
pre
dict
ed i
s co
nsis
tent
with
air�
ow o
bstr
uctio
n. T
he F
EV1
bei
ng 7
7%
of p
redi
cted
sug
gest
s a
mild
air�
ow o
bstr
uctio
n (b
ased
on
the
2005
ATS
/ERS
gui
de fo
r sev
erity
of o
bstr
uctio
n). T
he p
ost
bron
chod
ilato
r stu
dy re
veal
s a
sign
i�ca
nt re
spon
se to
alb
uter
ol w
ith th
e FE
V1 i
ncre
asin
g 15
% o
r 550
cc. T
his
�ndi
ng is
co
nsis
tent
with
dia
gnos
is o
f ast
hma
alth
ough
clin
ical
cor
rela
tion
is n
eede
d to
con
�rm
. (Ba
sed
on th
e 20
07 N
AEP
P gu
idel
ines
fo
r ast
hma
seve
rity)
, thi
s 28
yea
r old
mal
e w
ith a
bas
elin
e FE
V 1 o
f 77%
has
mod
erat
e pe
rsis
tent
ast
hma.
Sam
ple
writ
ten
COPD
inte
rpre
tatio
n:
The
FEV
1/FV
C ra
tio b
eing
dow
n m
ore
than
10
from
pre
dict
ed is
con
sist
ent w
ith a
ir�ow
obs
truc
tion.
The
FEV
1
bein
g 51
% o
f pre
dict
ed s
ugge
sts
a m
oder
atel
y-se
vere
air�
ow o
bstr
uctio
n (b
ased
on
the
2005
ATS
/ERS
gu
idel
ines
for s
ever
ity o
f obs
truc
tion)
. N
o si
gnif
ican
t res
pons
e to
alb
uter
ol w
as re
veal
ed a
s th
e FE
V1 o
nly
incr
ease
d 2%
. Fur
ther
test
ing
reve
aled
a d
i�us
ion
capa
city
of 5
0% o
f pre
dict
ed. T
he la
tera
l che
st �
lm s
how
ed
sign
s of
hyp
erin
�atio
n an
d �a
tten
ed d
iaph
ragm
and
the
ches
t CT
had
clas
sic
chan
ges
seen
in e
mph
ysem
a.
(Bas
ed o
n th
e 20
07 G
OLD
gui
delin
es fo
r CO
PD s
ever
ity),
this
74
year
old
fem
ale
with
a b
asel
ine
FEV 1
of 5
1%
has
Stag
e II
mod
erat
e CO
PD.
PR
E-B
RO
NC
H
O
bser
ved
Pred
icte
d %
Pre
dict
ed
FVC
(L)
5.
25
5
.68
92
FE
V1 (L
)
3.59
4
.64
77
FE
V1/F
VC (%
)
68
82
PR
E-B
RO
NC
H
O
bser
ved
Pre
dict
ed
% P
redi
cted
FV
C (L
) 5.
25
5.
68
9
2 FE
V1 (L
) 3.
59
4.
64
7
7 FE
V1/F
VC (%
)
68
82
PO
ST
-BR
ON
CH
Obs
erve
d %
Pre
dict
ed P
ost
% C
hang
e FV
C (L
) 5.
35
94
2 FE
V1 (L
) 4.
14
89
15
FEV1
/FVC
(%)
77
1
3
PR
E-B
RO
NC
H
O
bser
ved
Pred
icte
d %
Pre
dict
ed
FVC
(L)
2.
09
2
.78
75
FE
V1 (L
)
1.06
2
.08
51
FE
V1/F
VC (%
)
50
75
PR
E-B
RO
NC
H
O
bser
ved
Pre
dict
ed
% P
redi
cted
FV
C (L
)
2.
09
2.
78
75
FEV1
(L)
1.0
6
2.
08
51
FEV1
/FVC
(%)
5
0
75
PO
ST
-BR
ON
CH
Obs
erve
d %
Pre
dict
ed P
ost
% C
hang
e FV
C (L
) 2.
03
7
3
-
3 FE
V1 (L
) 1.
07
5
2
2
FE
V1/F
VC (%
)
53
5
* A
mer
ican
Tho
raci
c So
ciet
y/Eu
rope
an R
espi
rato
ry S
ocie
ty
AS
TH
MA
C
OP
D
Is th
is a
goo
d te
st?
(Acc
epta
bilit
y an
d re
peat
abili
ty
crite
ria o
n re
vers
e)
Chec
k FV
C. I
f nor
mal
(≥8
0%),
rest
rictio
n ca
n be
rule
d ou
t. If
redu
ced,
furt
her
test
ing
is n
eede
d to
di�
eren
tiate
rest
rict
ion
from
obs
truc
tion
with
air-
trap
ping
.
5-11
yea
rs
12 +
yea
rs
Nor
mal
FEV
1/FV
C:
8-19
yr
85%
20-3
9 yr
80
%40
-59
yr
75%
60-8
0 yr
70
%
Nor
mal
FEV
1 b
etw
een
exac
erba
tions
FE
V 1 >
80%
pre
dict
ed
FE
V1 /F
VC >
85%
Nor
mal
FEV
1 bet
wee
n ex
acer
batio
ns
FEV
1 > 8
0% p
redi
cted
FE
V1/
FVC
norm
al
FEV1
> 8
0% p
redi
cted
FEV1
/FVC
> 8
0%
FEV
1 ≥
80%
pre
dict
ed
FEV
1/FV
C no
rmal
FEV 1
= 6
0-80
% p
redi
cted
FEV1
/FVC
= 7
5-80
%
FEV
1 60-
80%
pre
dict
ed
FEV
1/FV
C re
duce
d 5%
FEV
1 < 6
0% p
redi
cted
FE
V1/
FVC
< 75
%
FEV
1 < 6
0% p
redi
cted
FE
V1/
FVC
redu
ced
> 5%
Inte
rmitt
ent
Mild
M
oder
ate
Seve
re
Per
sist
ent
As
thm
a S
ever
ity
CO
PD
Sev
erit
y
Stag
e I:
mild
St
age
II: m
oder
ate
Stag
e III
: sev
ere
FEV
1/FV
C <
70%
FE
V1
≥ 80
% p
redi
cted
FE
V1/
FVC
< 70
%
FEV
1 50-
80%
pre
dict
ed
FEV
1/FV
C <
70%
FE
V1 3
0-50
% p
redi
cted
Stag
e IV
: ver
y se
vere
FEV
1/FV
C <
70%
FE
V1 <
30%
pre
dict
ed o
r FE
V1 <
50%
pre
dict
ed p
lus
chro
nic
resp
irato
ry fa
ilure
DM
6060
5C S
uppo
rted
by
Boeh
ringe
r Ing
elhe
im P
harm
aceu
tical
s, In
c.
Cons
iste
nt w
ith a
sthm
a di
agno
sis