Shortness of breath THEME

Spirometry: an
essential clinical
measurement 2OB0IERCE
-$&2!#0
IS0ROFESSOR
OF2ESPIRATORY
-EDICINE5NIVERSITY

"!#+'2/5.$ Respiratory disease is common R ESPIRATIONISTHEPROCESSBYWHICHOXYGENAND#/

OF-ELBOURNEAND
$IRECTOR2ESPIRATORY
and amenable to early detection and management AREEXCHANGEDBETWEENTHEATMOSPHEREANDTHEMIXED AND3LEEP-EDICINE
in the primary care setting. Spirometric evaluation VENOUS BLOOD TO MEET THE METABOLIC DEMANDS OF THE AND)NSTITUTEFOR
BODY4HIS IS ACHIEVED BY THE INTEGRATED PHYSIOLOGICAL "REATHINGAND3LEEP
of ventilatory function plays a critical role in
!USTIN(EALTH6ICTORIA
the diagnosis, differentiation and management
of respiratory illness such as asthma, chronic
obstructive pulmonary disease and restrictive lung
disorders, and is important in the assessment
of lung health in smokers and those exposed to
occupational and environmental hazards.
/"*%#4)6% This article covers the basic theory,
PROCESSES OF VENTILATION PULMONARY BLOOD FLOW AND RPIERCE MEDICINE
GASEOUSDIFFUSION UNIMELBEDUAU
3PIROMETRYISTHEMOSTWIDELYUSEDNONINVASIVETEST
OF VENTILATORY FUNCTION AND ASSESSES THE MECHANICAL
OR BELLOWS PROPERTIES OF THE PULMONARY SYSTEM BY
MEASUREMENTOFTHEDYNAMICORRESPIREDLUNGVOLUMES
ANDCAPACITIES7HENCOMBINEDWITHTHEMEASUREMENT
fundamentals of test indications, performance OF ARTERIAL GAS TENSIONS OR PULMONARY GAS EXCHANGE
and equipment, the interpretation of results and IT PROVIDES AN OVERALL ASSESSMENT OF LUNG FUNCTION
the nuances behind the spirogram and the flow- SUITABLE FOR THE DETECTION DIFFERENTIATION AND DIAGNOSIS
volume curve.
$)3#533)/. The use of spirometry by
primary care physicians, practice nurses and
physiotherapists is now practicable and supported
by a comprehensive range of devices, training
courses and reference materials. Systematic use of
ventilatory assessment both in the clinic and with
patient self monitoring of peak flow and FEV1
has the capacity to improve patient understanding,
confidence in self management, and quality of
life for those with lung disease. Spirometry may
OFVARIOUSRESPIRATORYDISEASESANDANOBJECTIVEMETHOD
FOR FOLLOWING DISEASE PROGRESSION OR IMPROVEMENT AND
THERAPEUTICRESPONSEOVERTIME
What is spirometry?
3PIROMETRY IS THE TIMED MEASUREMENT OF DYNAMIC LUNG
VOLUMES AND CAPACITIES DURING FORCED EXPIRATION AND
INSPIRATION TO QUANTIFY HOW EFFECTIVELY AND QUICKLY THE
LUNGS CAN BE EMPTIED AND FILLED LEFT PANEL &IGURE  
-EASUREMENTSUSUALLYMADEARE
also provide a useful modality for following the s THE VITAL CAPACITY EITHER FORCED &6# ANDOR
progress of those with neuromuscular disease and UNFORCED6#
incipient respiratory muscle weakness and for the s FORCEDEXPIRATORYVOLUMEINONESECOND&%6 AND
promotion of respiratory health in the community s THERATIOOFTHESETWOVOLUMES&%6&6# 
setting, although further research in all these areas !DDITIONALLY ONE CAN MEASURE THE MAXIMUM EXPIRATORY
is required. FLOWOVERTHEMIDDLEOFTHEVITALCAPACITY&%&n
 WHICHISASENSITIVEINDEXOFSMALLAIRWAYFUNCTION
#ORRESPONDINGMAXIMALINSPIRATORYMEASURESARETHE&)6
ANDTHE&)6#
4HE &%66# RATIO IS THE MOST SENSITIVE AND SPECIFIC

Reprinted from Australian Family Physician Vol. 34, No. 7, July 2005 4
Theme: Spirometry: an essential clinical measurement

INDEX TO IDENTIFY AIRFLOW OBSTRUCTION4HE LOWER LIMIT OF THERIGHTPANELOF&IGURE)TSCHARACTERISTICSHAPERESULTS

NORMALITYFORTHISINDEXCENTRESAROUNDBUTDECLINES FROMTHEFACTTHATDURINGEXPIRATIONSOONAFTERPEAKFLOW
SLIGHTLY WITH AGE !LTERNATIVELY THE &%6&%6 FROM ISACHIEVEDMAXIMALFLOWBECOMESINDEPENDENTOFEFFORT
A  SECOND FORCED EXPIRATION CAN BE USED4HE &%6 AND DECLINES LINEARLY WITH LUNG VOLUME /N THE OTHER
PERCENTPREDICTEDISUSEDTOGRADESEVERITYOFVENTILATORY HANDDURINGINSPIRATIONMAXIMALFLOWISEFFORTDEPENDANT
DEFECTS!LOW&6#WITHANORMALORHIGHRATIOIDENTIFIESA AND INFLUENCED BY THE STRENGTH OF CONTRACTION OF THE
RESTRICTIVEVENTILATORYDEFECT DIAPHRAGM AND CHEST WALL MUSCLES AND THE PATENCY OF
-EASURES OF FORCED MAXIMAL FLOW DURING EXPIRATION THEUPPERAIRWAY
AND INSPIRATION CAN BE ALSO MADE EITHER ABSOLUTELY EG ! FURTHER SPIROMETRIC MEASURE UNDERGOING RENEWED
PEAK EXPIRATORY FLOW RATE 0%&2  OR AS A FUNCTION OF INTEREST IS THAT OF INSPIRATORY CAPACITY )# WHICH IS THE
VOLUMETHUSGENERATINGAFLOW VOLUMECURVETHESHAPE MAXIMUM VOLUME OF AIR THAT CAN BE INSPIRED FROM THE
OF WHICH ALSO CONTAINS INFORMATION OF DIAGNOSTIC VALUE END OF QUIET EXPIRATION FUNCTIONAL RESIDUAL CAPACITY
4HE FLOW VOLUME CURVE OF A NORMAL SUBJECT IS SHOWN IN ;&2#= TO TOTAL LUNG CAPACITY 4,#  )NSPIRATORY CAPACITY
IS REDUCED WHEN HYPERINFLATION IS PRESENT OR DEVELOPS
DYNAMICALLYEGDURINGEXERCISEINPATIENTSWITHCHRONIC
3PIROGRAM &LOW VOLUMECURVE OBSTRUCTIVEPULMONARYDISEASE#/0$ &IGURE 
6EXP
0%&2
Fundamentals for obtaining useful results
%XPIRED
4OACHIEVEOPTIMALRESULTSTHE&6#MANOEUVREMUSTBE
VOLUME
, PERFORMED WITH MAXIMAL EFFORT )MMEDIATELY FOLLOWING
&LOW
&)6 ,SEC
A FULL INSPIRATION THE PATIENT SEALS HISHER LIPS AROUND
&6#
4,# &6# 26 THEMOUTHPIECEANDBLASTSTHEAIROUTASFASTANDASFAR
6OLUME
&%6 , AS POSSIBLE UNTIL THE LUNGS ARE ABSOLUTELY EMPTY THEN
BREATHES IN AGAIN AS FORCIBLY AND FULLY AS POSSIBLE NOT
6IN
ALLSPIROMETERSWILLMEASUREINSPIRATION $EMONSTRATION
      0)&2
TO THE PATIENT OF THE PROCEDURE AND THE MAXIMAL EFFORT
4IMESEC
REQUIREDISHELPFULBEFORESTARTING&ORTHEMEASUREMENT
OF )# SCRUTINY OF THE STABILITY OF &2# DURING A SHORT
Figure 1. Normal spirogram and flow-volume curve showing the conventional measurements made
PERIOD OF TIDAL BREATHING BEFORE FULL INSPIRATION IS
FEV1 = forced expiratory volume in 1 second FVC = forced vital capacity NECESSARY &OR 0%&2 ONLY THE FIRST  OR  SECONDS OF
FIV1 = forced inspiratory volume in 1 second TLC = total lung capacity
FVC = forced vital capacity RV = residual volume MAXIMALEXPIRATIONISREQUIRED
PEFR = peak expiratory flow rate PIFR = peak inspiratory flow rate 2EMEMBER THAT PARTICULARLY IN AIRFLOW OBSTRUCTION IT
IRV = inspiratory residual volume ERV = expiratory residual volume
MAY TAKE MANY SECONDS FOR THE PATIENT TO EXPIRE FULLY
Vt = tidal volume
2ESTFORRECOVERYBETWEENREPEATTESTSANERECTSEATED
POSITION AND THE USE OF A NOSE CLIP ARE RECOMMENDED
#/0$ #AREFUL EXAMINATION OF EACH SPIROGRAM OR FLOW VOLUME
CURVE FOR ACCEPTABILITY REPRODUCIBILITY AND CORRECTION OF
.ORMAL )26
RESULTS TO BODY TEMPERATURE AND PRESSURE SATURATED
)#
CONDITIONSISNEEDED
6T
)26 -EASUREMENT OF SPIROMETRY IN CHILDREN REQUIRES
)#
%26
ANIMATION TO CAPTURE THE CHILDS ATTENTION AND EFFORT AND
4,#
6T
CANUSUALLYBEACHIEVEDINTHOSEYEARSOFAGEANDOVER
4,#
%26 &2# Indications for spirometry
&2# 26 s4HE DETECTION OF RESPIRATORY DISEASE IN PATIENTS
26 PRESENTING WITH SYMPTOMS OF BREATHLESSNESS EITHER
AT REST OR ON EXERTION WHEEZE COUGH STRIDOR OR
CHESTTIGHTNESS3PIROMETRYISUSEFULINDISTINGUISHING
Figure 2. Lung volumes and capacities in normal and hyperinflated (COPD) lungs. RESPIRATORY FROM CARDIAC DISEASE AS THE CAUSE OF
The IC is the volume that can be inspired from FRC up to TLC BREATHLESSNESS AND CAN BE USED TO SCREEN FOR

3Reprinted from Australian Family Physician Vol. 34, No. 7, July 2005
 Theme: Spirometry: an essential clinical measurement

RESPIRATORYDISEASEINCERTAINHIGHRISKSITUATIONSEG THE REFERENCE RANGE )NTER RELATIONSHIPS OF THE VARIOUS

PRE
EMPLOYMENT IN INDUSTRIES IN WHICH OCCUPATIONAL MEASUREMENTS ARE ALSO IMPORTANT DIAGNOSTICALLY &OR
ASTHMA IS PREVALENT )T IS ALSO USED TO MEASURE
BRONCHIAL RESPONSIVENESS IN PATIENTS SUSPECTED OF
HAVING ASTHMA AND TO IDENTIFY THOSE AT RISK FROM
PULMONARYBAROTRAUMAWHILESCUBADIVING
s 4HEDIAGNOSISOFRESPIRATORYDISEASEANDDIFFERENTIATION
EXAMPLE A REDUCTION OF &%6 IN RELATION TO THE FORCED
VITALCAPACITYRESULTINGINALOW&%6&6#PERCENT
CONSTITUTESANOBSTRUCTIVEVENTILATORYDEFECTASOCCURSIN
ASTHMAANDEMPHYSEMA&IGURE 
)NRESTRICTIVEVENTILATORYDEFECTSASOCCURININTERSTITIAL
OFOBSTRUCTIVEVERSUSRESTRICTIVEVENTILATORYDEFECTSTHE LUNGDISEASERESPIRATORYMUSCLEWEAKNESSANDTHORACIC
IDENTIFICATIONOFUPPERAIRWAYOBSTRUCTIONANDDISEASES
ASSOCIATEDWITHWEAKNESSOFTHERESPIRATORYMUSCLES
s &OLLOWING THE NATURAL HISTORY AND PROGRESSION
OF RESPIRATOR Y AND SOMETIMES SYSTEMIC AND
NEUROMUSCULARDISEASES
s !SSESSMENT OF RESPONSE TO TREATMENT IN THESE
CONDITIONS
s!SSESSMENT OF IMPAIRMENT FROM RESPIRATOR Y
DISEASE IN THE WORKPLACE AND IN THE SETTINGS OF
PULMONARY REHABILITATION AND COMPENSATION FOR
OCCUPATIONALDISEASE
s 0RE
OPERATIVE RISK ASSESSMENT BEFORE ANAESTHESIA AND
ABDOMINALORTHORACICSURGERY
Interpretation of results
CAGEDEFORMITIESSUCHASKYPHOSCOLIOSIS THE&%6&%6#
PERCENT RATIO REMAINS NORMAL OR HIGH TYPICALLY 
WITHAREDUCTIONINBOTH&%6AND&6#!REDUCED&6#
TOGETHER WITH A LOW &%6&6# PERCENT RATIO MAY OCCUR
AS A FEATURE OF A MIXED VENTILATORY DEFECT IN WHICH A
COMBINATION OF BOTH OBSTRUCTIVE AND RESTRICTIVE TYPES
COEXIST!LTERNATIVELYITMAYOCCURINAIRFLOWOBSTRUCTIONAS
ACONSEQUENCEOFAIRWAYCLOSURERESULTINGINGASTRAPPING
RATHER THAN AS A RESULT OF SMALL LUNGS -EASUREMENT
OF STATIC LUNG VOLUMES SUCH AS THE PATIENTS4,# ARE
NECESSARYTODISTINGUISHBETWEENTHESEPOSSIBILITIES
)T IS ROUTINE PRACTICE TO QUANTIFY THE DEGREE OF
REVERSIBILITY OF AN OBSTRUCTIVE DEFECT BY MEASURING
SPIROMETRY BEFORE AND AFTER THE ADMINISTRATION OF A
BRONCHODILATOR'ENERALLYANIMPROVEMENTIN&%6OF
4HE DYNAMIC LUNG VOLUMES EG &%6&6# AND M,ORMOREINFERSSIGNIFICANTREVERSIBILITYIFTHEBASELINE
MAXIMUMFLOWSEG0%&2 OFANYINDIVIDUALNEEDTOBE
COMPAREDWITHREFERENCEVALUESOBTAINEDFROMANORMAL
POPULATION USING SIMILAR TEST PROTOCOLS AND CAREFULLY
CALIBRATEDINSTRUMENTS
4HE PRESENCE OF VENTILATORY ABNORMALITY CAN BE
&%6 IS  , AS DOES AN IMPROVEMENT OF  IF
THE &%6 IS  , .ORMAL SUBJECTS GENERALLY EXHIBIT A
SMALLERINCREASEIN&%6OFUPTO)TSHOULDALSOBE
NOTEDTHATNORMALSPIROMETRYINAWELLPATIENTDOESNOT
EXCLUDETHEDIAGNOSISOFASTHMA
IMPLIEDIFANYOF&%6&6#0%&2OR&%66#AREOUTSIDE )MPROVEMENT IN )# MAY OCCUR DUE TO INCREASE IN

3PIROMETRYPERFORMED

!BNORMALVENTILATORYFUNCTION
.ORMAL

/BSTRUCTION 2ESTRICTION -IXED

6OLUME

6OLUME

6OLUME

4IME 4IME 4IME

&LOW

&LOW

&LOW

6OLUME 6OLUME 6OLUME

Figure 3. Types of ventilatory defect with typical spirograms and flow-volume curves

Reprinted from Australian Family Physician Vol. 34, No. 7, July 2005 4
Theme: Spirometry: an essential clinical measurement

4,# ANDOR TO A REDUCTION IN &2# WITH LESSENING MORNING HOURS &IGURE  AND FALL IN 0%&2 DURING THE
OF HYPERINFLATION )NSPIRATORY CAPACITY MAY IMPROVE WEEK WITH IMPROVEMENT ON WEEKENDS AND HOLIDAYS
SIGNIFICANTLY WITHOUT CHANGE IN &%6 IN PATIENTS WITH WHICH OCCURS IN OCCUPATIONAL ASTHMA )SOLATED FALLS IN
@IRREVERSIBLE AIRFLOW OBSTRUCTION IN #/0$ &URTHERMORE 0%&2 IN RELATION TO SPECIFIC ALLERGENS OR TRIGGER FACTORS
CHANGES IN )# FOLLOWING BRONCHODILATOR CORRELATE BETTER CAN HELP IDENTIFY AND QUANTIFY THESE FOR THE DOCTOR AND
THAN OTHER SPIROMETRIC INDICES WITH IMPROVEMENT IN PATIENT! DOWNWARD TREND IN 0%&2 AND AN INCREASE IN
DYSPNOEAANDEXERCISEPERFORMANCE ITS VARIABILITY CAN IDENTIFY WORSENING ASTHMA AND CAN BE
3IMILARLY THE SHAPE OF THE EXPIRATORY FLOW
VOLUME USEDBYTHEDOCTORORPATIENTTOMODIFYTHERAPYEGTHE
CURVE &IGURE  VARIES BETWEEN OBSTRUCTIVE VENTILATORY PATIENT INCREASES HISHER TREATMENT AS PER AN @ASTHMA
DEFECTSWHEREMAXIMALFLOWRATESAREDIMINISHEDANDTHE ACTIONPLAN0EAKEXPIRATORYFLOWMONITORINGISPARTICULARLY
EXPIRATORYCURVEISSCOOPEDOUTORCONCAVETOTHE8AXIS USEFUL IN ASTHMATICS WHO HAVE POOR PERCEPTION OF THEIR
ANDRESTRICTIVEDISEASESWHEREFLOWSMAYBEINCREASEDIN OWN AIRWAY CALIBRE FOR FOLLOWING RESPONSE TO TREATMENT
RELATIONTOLUNGVOLUMES2EDUCTIONOFMAXIMALEXPIRATORY ANDTOIMPROVESELFMANAGEMENTINCONJUNCTIONWITHAN
FLOW AS RESIDUAL VOLUME IS APPROACHED IS SUGGESTIVE ACTION PLAN 2ESPONSE TO ASTHMA TREATMENT IS USUALLY
OF OBSTRUCTION IN THE PERIPHERAL AIRWAYS ! PLATEAU OF CHARACTERISEDNOTONLYBYANINCREASEIN0%&2BUTALSOBY
INSPIRATORY FLOW MAY RESULT FROM A COLLAPSIBLE EXTRA
ADECREASEINITSVARIABILITY&IGURE 
THORACIC AIRWAY WHEREAS INSPIRATORY AND EXPIRATORY FLOW
AREBOTHLIMITEDFORFIXEDLESIONS-AXIMALEXPIRATORYFLOW
Normal values for spirometry
ISSELECTIVELYREDUCEDFORCOLLAPSIBLEINTRA
THORACICAIRWAY 4HEREAREANUMBEROFREFERENCEVALUESTUDIESTHATHAVE
OBSTRUCTION&IGURE  GENERATED PREDICTIVE EQUATIONS FOR VENTILATORY FUNCTION
Spirometric monitoring in airways disease
7HEN PEAK EXPIRATORY FLOW IS MEASURED REPEATEDLY AND
PLOTTED AGAINST TIME EG MORNING AND EVENING VALUES
BY ASTHMATIC PATIENTS THE PATTERN OF RESULTS CAN BE OF
GREATVALUEINIDENTIFYINGPARTICULARASPECTSOFAPATIENTS
DISEASE4YPICAL PATTERNS ARE THE @MORNING DIPPER
PATTERN OF SOME ASTHMATICS DUE TO A FALL IN THE EARLY
6OLUMEDEPENDENT
.ORMAL
OBSTRUCTION
THAT TAKE INTO ACCOUNT GENDER HEIGHT AGE AND ETHNICITY
SEE2ESOURCES .ORMALVALUESFOR0%&2MAYNOTBEAS
USEFUL TO THE INDIVIDUAL PATIENT AS HISHER OWN @PERSONAL
BESTTARGETFORMANAGEMENTOFASTHMA
Equipment, calibration and quality assurance
#ONVENTIONAL VOLUME DISPLACEMENT SPIROMETERS PROVIDE
A DIRECT MEASURE OF EXPIRED VOLUME FROM DISPLACEMENT
/BSTRUCTIONWITH 0RESSUREDEPENDENT
REVERSIBILITY OBSTRUCTION
EGASTHMA EGLOSSOFRECOIL
#/0$ EMPHYSEMA

&IXEDINTRA OR 6ARIABLEEXTRA THORACIC 4ESTEDVIATRACHYTUBE 4ESTVIATRACHYTUBE

EXTRA THORACIC OBSTRUCTION AIRWAYOBSTRUCTION AIRWAYOBSTRUCTION
OBSTRUCTION EGLARYNGEAL UNLIKELY ISEVIDENT
PARALYSIS

/BSTRUCTIONTOONE 6ARIABLEINTRA THORACIC ,UNGRESTRICTION

BRONCHUSEG#A $,4X
OBSTRUCTIONMAJOR EGPULMONARY

OR3,4X AIRWAY FIBROSIS
EMPHYSEMA

Figure 4. Examples of how various respiratory diseases affect the shape of the flow-volume curve

3Reprinted from Australian Family Physician Vol. 34, No. 7, July 2005
 Theme: Spirometry: an essential clinical measurement

OF A BELLOWS PISTON ROLLING SEAL OR BELL WATER SEALED 


AND ARE ROBUST ACCURATE AND RELIABLE4HEY ARE HOWEVER 4REATMENT
DIFFICULTTOCLEANANDDISINFECTANDNOTVERYPORTABLE&LOW 
0REDICTED0%&

SPIROMETERS MEASURE EXPIRATORY AND INSPIRATORY FLOW

0EAKFLOW,MIN
PRIMARILYASPRESSUREDROPACROSSAGRIDORORIFICECOOLING 

OFAHOTWIREROTATIONOFAVANEORTURBINEORTRANSMISSION 

OF ULTRASOUND AND ARE PORTABLE AUTOMATICALLY CALCULATE
RESULTSANDNORMALVALUESANDPRINTOUTTHESPIROGRAMOR 

FLOW
VOLUMECURVE

3TANDARDS FOR EQUIPMENT CALIBRATION AND QUALITY

CONTROLASPECTSOFSPIROMETRYAREGIVENBYTHE!MERICAN
       
4HORACIC 3OCIETY STATEMENT ON @3TANDARDISATION $AYS
OF SPIROMETRY 'UIDELINES FOR BOTH SPIROMETRY AND
Figure 5. Peak expiratory flow chart in an asthmatic showing the typical morning dipper pattern
INFECTION CONTROL IN THE RESPIRATORY LABORATORY HAVE ALSO stabilising with increased treatment
BEENPUBLISHEDBYTHE!USTRALIAN.EW:EALAND3OCIETYOF
2ESPIRATORY 3CIENCE &OR SPIROMETERS REGULAR CALIBRATION
BY INJECTING A KNOWN VOLUME OF AIR FROM A CALIBRATED
SYRINGEATVARYINGSPEEDSTOCHECKLINEARITY ANDUSEOFA
Resources
s-ANY LARGE TEACHING HOSPITAL RESPIRATORY LABORATORIES NOW
PROVIDE SHORT COURSES IN SPIROMETRY FOR CLINICIANS WITH
PRACTICAL@HANDSONFAMILIARISATION
@BIOLOGICCONTROLSUBJECTWITHSTABLEKNOWNLUNGVOLUMES s*OHNS $0 0IERCE 2 0OCKET GUIDE TO SPIROMETRY ST ED
ARE RECOMMENDED!CCURACY OF TIMING DEVICES USED FOR -C'RAW
(ILL)3".



s3PIROMETRY#$
2/--EDI7/2,$)NTERNATIONAL
TIMEDVOLUMESEG&%6 SHOULDALSOBEASSESSED
Conclusion
-EASUREMENTS OF VENTILATORY CAPACITY ARE FUNDAMENTAL
TO THE ASSESSMENT OF RESPIRATORY HEALTH AND SHOULD
BE ROUTINELY APPLIED IN THE PRIMARY CARE SETTING IN
PATIENTS WITH KNOWN OR SUSPECTED RESPIRATORY DISEASE
3PIROMETRIC MEASUREMENT IS CRITICAL TO THE DIAGNOSIS
s'ROSSELINK23TAN'EDITORS/FFICESPIROMETRYFORGENERAL
PRACTITIONERS LUNG FUNCTION TESTING %UROPEAN 2ESPIRATORY
3OCIETYn
s3 PIROMETER USERS AND BUYERS GUIDE !VAILABLE AT WWW
NATIONALASTHMAORGAU(4-,MANAGEMENTSPIRO?GUIDESP?
GDASP
#ONFLICTOFINTERESTNONEDECLARED
AND MANAGEMENT OF ASTHMA #/0$ AND RESTRICTIVE LUNG References
DISEASE 2ESPIRATORY DISEASE IS COMMON AND THE EARLY 
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s 3PIROMETRY SHOULD BE PERFORMED IN ALL PEOPLE OVER 

YEARSOFAGEWHOHAVEEVERSMOKEDANDINTHOSEWITH
ANYSYMPTOMOFPOSSIBLERESPIRATORYORIGIN
s#/0$ IS EASILY DETECTED BEFORE SYMPTOMS DEVELOP
ANDSMOKINGCESSATIONATTHISPOINTISOFMAJORBENEFIT
s 3PIROMETRY IS VITAL IN THE MANAGEMENT OF ASTHMA
TO ASSESS SEVERITY AND RESPONSE TO TREATMENT AND TO
GUIDEMANAGEMENT
s !N INCREASE IN &%6 OF  OR  M, SUGGESTS
ASTHMA ALTHOUGH NORMAL SPIROMETRY IN A WELL PATIENT
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DOESNOTEXCLUDEIT

Reprinted from Australian Family Physician Vol. 34, No. 7, July 2005 4