interpreting spirometry: patient or data ?

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Interpreting Spirometry: Patient or Data ?. David Robiony-Rogers CRFS Service Leader Respiratory Medicine Capital & Coast District Health Board. The colours of disease. The colours of respiratory disease. For the movie conscious. For the spacer conscious. Medication type colour coding. - PowerPoint PPT Presentation

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Interpreting Spirometry: Patient or Data?

Interpreting Spirometry:Patient or Data?David Robiony-Rogers CRFSService Leader Respiratory MedicineCapital & Coast District Health Board

The colours of disease

The colours of respiratory disease

For the movie conscious...

For the spacer conscious...

Medication type colour coding...

Spirometry

Spirometry is the timed measurement of dynamic lung volumes during forced expiration and inspiration, and is used to quantify how effectively and how quickly the lungs can be emptied.Spirometry: Graphic Displays Volume time curveFlow volume loop

Spirometry Test

Spirometry InterpretationAcceptability

minimum of 3 acceptable manoeuvresgood start and satisfactory effortno artefacts induced by coughing or glottic closure in 1st second, or equipment problemsminimum of 6 seconds exhalation and/or plateau in the volume time curveMaximal inspiration prior to blowArtefacts

No artefactCough within 1st second of forced exhalationIncomplete exhalation/early termination (glottic closure)Slow start/submaximal forced effort at start of blowHesitant start

SpirogramsNormal and problematic

Flow Volume LoopsNormal and problematic

ReproducibilityReproducibility

two largest FVC within 0.150 L (150ml) of each othertwo largest FEV1 within 0.150 L (150ml) of each othermust meet criteria for acceptability

If the reproducibility criteria is not met after a total of 8 tests, stop testing.

Disease PatternsObstructive patternA disproportionate reduction of maximal airflow from the lung in relation to the maximal volume

Restrictive patternCharacterised by a normal FEV1/VC ratio and reduction in FVC below the 5th percentile of the predicted

Mixed patternCharacterised by the coexistence of obstruction and restriction, and is defined physiologically when both FEV1/FVC and FVC are below 5th percentiles of the predicted valueSpirometric overlap between Asthma and COPDCOPD has been described as a disease characterized by fixed airflow obstruction because in many patients FEV1 values improve little after bronchodilator challenge.

Current guidelines on diagnosis and management describe COPD as a condition that is partially reversible because some patients exhibit substantial improvements in FEV1 (despite an FEV1-FVC ratio that remains below 0.70) that compares in magnitude to what is observed in some asthma patients.

Tashkin et al (2008) have shown that about 54% of a large COPD cohort (N = 5756) exhibited an improvement in FEV1 values > 12% and 200 mL, while about 65% of patients had FEV1 increases > 15%. This substantial overlap in FEV1 reversibility between asthma and COPD underscores an important limitation of using this measurement to distinguish between asthma and COPD.Can Fam Physician. Oct 2011; 57(10): 11481152.The overlap of Asthma and COPD

Disease Patterns

The presence and site of disease have various effects on the volume-time and maximal expiratory flow volume curveVitalograph Ltd 1986 &2000Normal Ventilatory Function

The pattern of the lung and spirogram show a pattern of normalityVitalograph Ltd 1986 &2000Age: 22, Gender: Female; Height: 166 cm, Weight: 69.3 kg; BMI: 25.15 Spirometry measureBestReferenceRef CIFVC, L3.633.953.2 4.7FEV1, L3.023.432.8 4.0FEV1/FVC, %8376.3 95.9

Age: 23; Gender: Male; Height: 175 cm; Weight: 67.6 kg; BMI: 22.07Spirometry measureBestReferenceRef CIFVC, L5.495.394.5 6.3FEV1, L4.294.483.7 5.2FEV1/FVC, %7873.6 93.0

Reversible Obstruction

The lungs and spirogram show a pattern of airway obstruction (black), with the spirogram showing a marked improvement after the administration of a bronchodilator (red) Vitalograph Ltd 1986 &2000Age: 75; Gender: Male; Height: 175 cm; Weight: 97.2 kg; BMI: 31.74Spirometry measureBestReferenceRef CIFVC, L3.284.093.2 5.0FEV1, L2.072.972.2 3.7FEV1/FVC, %6363.1 82.5

Age: 29; Gender: Female; Height: 162 cm; Weight: 98.6 kg; BMI: 37.57Spirometry measurePre bronchodilator bestPost bronchodilator best% improvementReferenceRef CIFVC, L2.223.51583.753.1 4.4FEV1, L1.492.68803.182.6 3.8FEV1/FVC, %677674.9 94.4

Irreversible Obstruction

The lungs and spirogram show a pattern of airflow obstruction, with the spirogram showing little or no improvement after the administration of a bronchodilatorVitalograph Ltd 1986 &2000Age: 74; Gender: Female; Height: 161 cm; Weight: 70.9 kg; BMI: 27.35Spirometry measurePre bronchodilator bestPost bronchodilator best% improvementReferenceRef CIFVC, L1.461.72182.782.1 3.5FEV1, L0.570.53-72.081.5 2.7FEV1/FVC, %393165.3 84.9FEV6, L1.421.5162.642.0 3.3

Restrictive Defect

The lung and spirogram show a pattern of volume restrictionVitalograph Ltd 1986 &2000Age: 74; Gender: Male; Height: 160 cm; Weight: 82.3 kg; BMI: 32.15Spirometry measureBestReferenceRef CIFVC, L2.013.152.4 3.9FEV1, L1.532.261.6 2.9FEV1/FVC, %7663.1 82.5

Combined Pattern

The lungs and spirogram show a pattern of combined airflow obstruction and volume restrictionVitalograph Ltd 1986 &2000Spirometry measureBestReferenceRef CIFVC, L2.834.023.2 4.9FEV1, L0.942.962.2 3.7FEV1/FVC, %3364.1 83.5Age: 69; Gender: Male; Height: 171 cm; Weight: 50.9 kg; BMI: 17.41

Age: 35; Gender: Male; Height: 168 cm; Weight: 90.6 kg; BMI: 32.10Spirometry measureBestReferenceRef CIFVC, L2.524.763.9 5.6FEV1, L1.693.873.2 4.6FEV1/FVC, %6771.2 90.5

Response to 2-agonist2-agonist bronchodilator

Dose: 4 puffs of 2-agonist delivered through a spacer deviceWait 15-20 minutes before repeating spirometrySignificant response defined as >12% and more than 200mL increase in either the FEV1 or FVC.Spirometry: Pre & Post 2-agonist

Severity classificationDegree of severityFEV1 % predictedMild>70Moderate60-69Moderately severe50-59Severe35-49Very severe LLNPre 2-agonist FEV1/FVC ratioModified from Primary Health Care Alliance of Canada spirometry interpretation algorithm 2011 Visual Interpretation

Age: 58; Gender: Female; Height: 156 cm; Weight: 61.1 kg; BMI: 25.11Spirometry measureBestReferenceRef CIFVC, L1.472.081.4 2.7FEV1, L0.991.521.0 2.1FEV1/FVC, %6763.0 82.5

Age: 68; Gender: Female; Height: 170 cm; Weight: 70.0 kg; BMI: 24.22Spirometry measureBestReferenceRef CIFVC, L2.903.432.7 4.2FEV1, L2.042.612.0 3.3FEV1/FVC, %7066.6 86.2

Age: 35; Gender: Male; Height: 168 cm; Weight: 90.6 kg; BMI: 32.10Spirometry measureBestReferenceRef CIFVC, L2.524.763.9 5.6FEV1, L1.693.873.2 4.6FEV1/FVC, %6771.2 90.5

Age: 50; Gender: Female; Height: 164 cm; Weight: 109.2 kg; BMI: 40.60Spirometry measureBestReferenceRef CIFVC, L3.163.612.9 4.3FEV1, L2.352.862.3 3.5FEV1/FVC, %7470.4 90.0

Age: 64; Gender: Male; Height: 162 cm; Weight: 60.5 kg; BMI: 23.05Spirometry measureBestReferenceRef CIFVC, L3.343.642.9 4.4FEV1, L2.582.722.1 3.4FEV1/FVC, %7765.2 84.5

Age: 70; Gender: Female; Height: 153 cm; Weight: 127.9 kg; BMI: 54.64Spirometry measureBestReferenceRef CIFVC, L1.912.551.9 3.2FEV1, L1.591.921.4 2.4FEV1/FVC, %8366.1 85.7

Age: 70; Gender: Female; Height: 144 cm; Weight: 81.8 kg; BMI: 39.45Spirometry measureBestReferenceRef CIFVC, L2.052.151.6 2.7FEV1, L1.751.611.2 2.1FEV1/FVC, %8566.1 85.7

Age: 52; Gender: Female; Height: 161 cm; Weight: 50.8 kg; BMI: 19.60Spirometry measureBestReferenceRef CIFVC, L3.843.422.7 4.1FEV1, L2.722.702.1 3.3FEV1/FVC, %7170.0 89.6

Age: 39; Gender: Female; Height: 157 cm; Weight: 100.1 kg; BMI: 40.61Spirometry measureBestReferenceRef CIFVC, L3.093.442.8 4.1FEV1, L1.752.832.3 3.4FEV1/FVC, %5672.7 92.3

Age: 67; Gender: Female; Height: 157 cm; Weight: 67.7 kg; BMI: 27.47Spirometry measureBestReferenceRef CIFVC, L2.672.832.2 3.5FEV1, L1.802.151.6 2.7FEV1/FVC, %6766.8 86.4

https://www.youtube.com/watch?v=yNDKD_xI684Spirometry EducationPulmonary Function Tests (PFT): Lesson 2 - Spirometry

Published on Feb 3, 2014A discussion of FEV1, FVC, FEV1/FVC ratio, and the flow volume loop, including how these are used in the diagnosis of various lung diseases, with a particular focus on the distinction between obstructive and restrictive lung disease. A summary of flow volume loop patterns in upper airway obstruction is covered as well.

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