Spirometry is the name of the test, whilst a spirometer is the device that is used to make the

measurements.

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There are many types of spirometer, classified as:
Volume-sensing; for example, the vitalograph, based on a bellows mechanism.
Flow-sensing; for example, the pneumotachograph, which is much more portable.
Which are measured using spirometry?
Spirometers are used to take many different lung measurements, broadly classified as:
Static lung volumes. The patient breathes in and out of a spirometer, first with tidal volume breaths and then
with vital capacity breaths. all static lung volumes and capacities can be measured,
with the exception of RV, FRC and TLC.
Dynamic spirometry. Lung measurements that depend on the rate (i.e. volume per unit time) at which air flows
in and out of the lungs are called dynamic. Dynamic PFTs include:
FEV1.
Forced vital capacity (FVC).
Peak expiratory flow rate (PEFR).
VC- The VC is the volume of gas measured from a
slow, complete expiration after a maximal inspiration,
without forced or rapid effort & and reported at body temperature
pressure,and saturation (BTPS).
VC is sometimes
referred to as the slow vital capacity (SVC),

Forced Vital Capacity

Is the volume of air in liters that can be forcefully and maximally
exhaled after a maximal inspiration.
slow vital capacity (SVC) also called the vital capacity
(VC) is similar to the FVC, but the exhalation is slow rather
than being as rapid as possible as in the FVC. In a normal subject,
the SVC usually equals the FVC, 3 while in patients with
an obstructive lung disorder (see Table 1.1 for definition), the
SVC is usually larger than the FVC

Forced Expiratory Volume in the 1st Second

Is the volume of air in liters that can be forcefully and maximally
exhaled in the 1st second after a maximal inspiration. In other
words, it is the volume of air that is exhaled in the 1st second of
the FVC, and it normally represents ~ 80% of the FVC.

While the ratio of FEV1/VC defines obstruction,

the severity of obstruction is defined by the
degree to which the FEV1 is reduced
Mild FEV1 > 70% predicted
Moderate FEV1 = 60%-69% predicted
Moderately severe FEV1 = 50%-59% predicted
Severe FEV1 = 35%-49% predicted
Very severe FEV1 < 35% predicted

grading severity based on FEV1

applies best when the VC is in the normal range.
Once the VC is below normal, a concomitant
restrictive defect may also be present, and this can
be determined only by further measurement of
lung volumes, in particular TLC.

FEV 6 is similarly defined as the volume of air exhaled in the first

6 s of the FVC and its only significance is that it can sometimes
substitute the FVC in patients who fail to exhale completely. 6

reported FEV1/VC ratio is calculated from the highest

FEV1 and the highest FVC. The FEV1/VC ratio decreases with increasing age, presumably because of
a gradual loss of lung elasticity. For example, older
healthy adults may have FEV1/VC ratios in the 65% to
70% range. Thus, the 5th percentile should be taken
as the lower limit of normal when interpreting the
FEV1/VC, just as with the FEV1 and VC separately

normal FEV1/VC ratio but a low VC and a normal

TLC. This pattern has been hypothesized to be the
result of small airways disease with resulting small
airways closure and gas trapping.
The presence of
a restrictive disorder may be suggested by a reduced
VC and a normal or increased FEV1/VC ratio. Further
studies (e.g., measurement of TLC) should be used to
confirm the diagnosis of restriction.

PEFR-
An isolated peak flow reading has no value in diagnosing the
cause of respiratory insufficiency

Greater than 20% difference between the highest and lowest

daily readings in the appropriate clinical setting is diagnostic
of asthma.

Diurnal variation in PEF is a cardinal feature of asthma

Lack of variability of PEF in a smoker with an obstructive

defect supports a diagnosis of chronic obstructive
pulmonary disease (COPD).

In a patient with asthma, a PEF of less than 50% predicted

(or the patients normal best, whichever is less) is a feature
of acute severe asthma. A patient with a PEF of this order,
particularly when this persists after bronchodilator therapy,
will need hospital admission.
A peak flow of 33% predicted (or patients best) is a feature
of life-threatening asthma.

A patient who has been

admitted to hospital with acute asthma should not be
discharged until the diurnal variation of PEF is
less than 25%.

many causes of low PEF other than asthma. Peak

flow is not a diagnostic test, and a low reading should
prompt further investigation.

FEF50 is the flow after 50% of the FVC has been exhaled, and FEF75 is the
flow after 75% of the FVC has been exhaled.

lesions of the major airway cause the MVV

to be reduced out of proportion to the FEV 1. The same result can occur in patients
who have muscle weakness, as in neuromuscular diseases (amyotrophic lateral
sclerosis, myasthenia gravis, and polymyositis).

volume-time tracings from a patient with severe obstruction.

Spirometric measurements from a group of healthy subjects
with a given sex, age, height, and race usually exhibit a normal
distribution curve;

The 5th percentile (1.65 standard

deviations) is, then, used to define the lower limit of the reference
range for that given sex, age, height, and race;
The predicted values for a group of normal subjects at a given
height, age, and sex form a normal distribution curve. Applying 1.65 standard
deviations (the 5th percentile) to define the lower limit of normal will
include 95% of that population. Values outside this range are then below the limit of normal(LLN).
look at the patients
results as percentage of the predicted values for that particular
patient (written in the report as % pred.). If the patient is normal,
then his/her values should roughly lie within 80120% of
predicted values.*