CHAPTER 1

PRELIMINARY

Spirometry is a physicological test that measures how an individual inhalesor exhales

volumes of air as a function of time. The primary signal measured in spirometry may be
spirometry volume or flow.

Number of disorders can cause harmful changes in the lungs andrespiratory tractus.
The most important effect is on the airways and elasticity lungs . Spirometry testing is
important in detecting some abnormalities associated with respiratory disorders . Spirometry
is a screening tool for lung disease and most often performed to test lung function and detect
abnormalities in the respiratory tractus . Spirometry is a pulmonary function test most
commonly used to screen ( screening ) lung disease . Another indication spirometry use to
determine the strength and function of the chest, detect various respiratory diseases primarily
due to environmental pollution and cigarette smoke .

Spirometry examination is not only important to determine the diagnose but also
important to assess the severity of obstruction, severe restriction and the effects of treatment.
The most important aspects of spirometry are the forced vital capacity (FVC), which is the
volume delivered during an expiration mades forcefully and completly as possible starting
from full inspiration, and the forced expiratory volume (FEV) in 1 seconds, which is the
volume delivered in the first second of an FVC manoever. Other spirometry variables derived
from the FVC manoeuvre are also addressed.

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 CHAPTER II
LITERATURE

2.1 DEFINITION

Spirometry is the measure of the volume of air that is breathed in or out of the lungs.
a spirometer is a volume recorder consisting of a double-walled cylinder in which an inverted
bell is immersed in water to form a seal. A pulley attaches the bell to a marker that writes on
a rotating drum. When air enters the spirometer from the lungs, the bell rises. Because of the
pulley arrangement, the marker is lowered. Therefore, a downward deflection represents
expiration and an upward defrlection represents inspiration. The recording is known as a
spirogram.

Spirometry is used to measure static and dynamic volome except reisidu volume, total lung
capacity and functional residual capacity:

Static volume:

 Tidal volume (VT)

 Inspiratory reserve volume ( IRV )
 Expiratory reserve volume ( ERV )

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  Residual Volume ( RV)
 Vital capacity ( VC )
 Forced vital capacity ( FVC )
 functional Residual capacity ( RFC )
 Total lung capacity (TLC)

Volume dinamic:

 Forced expiratory volume 1 (FEV1)

 voluntary Ventilation maximal ( VVM)

ABBREVIATIONS AND DEFENITIONS USED IN PULMONARY FUNCTION

Abbreviation Term Definition Normal

value
EPP Equal pressure point The point at which the pressure
inside the airway equals the pressure
outside of the airway
ERV Expiratory reserve The maximum volume of air exhaled 1.2 L
volume at the end of the tidal volume
FEF25-75 Forced expiratory The maximum midexpiratory flow 5L/ sec
flow rate, measured by drawing a line
between points representing 25% and
75% of the forced vital capacity
FEV1 Forced expiratory The maximum volume of air forcibly 4.0 L
volume exhaled in 1 second
FEV1/FVC% Forced expired The percentage of FVC forcibly 80%
volume/forced vital exhaled in 1 second
capacity ratio
FRC Functional residual The volume of air remaining in the 2.4 L
capacity lungs at the end of a normal tidal
volume
FVC Forced vital capacity The maximum volume of air forcibly 4.8 L

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 exhaled after a maximum inhalation
IC Inspiratory cacacity The maximum volume of air inhaled 3.6 L
after a normal expiration
IRV Inspiratory reserve The maximum volume of air inhaled 3.1 L
volume at the end of a normal inspiration
PEF Peak Expiratory flow The maximal expiratory flow during
a FVC maneuver
RV Residual volume The volume of air remaining in the 1.2 L
lungs after maximum expiration
RV/TLC Residual volume/total The percentage of total lung capacity 20%
lung capacity ratio made up of residual volume
TLC Total lung capacity The volume of air in the lungs at the 6.0 L
end of a maximum inspiration
VC Vital capacity The maximum volume of air that can 4.8 L
be exhaled (not that the values for
FVC and VC are the same). VC is
calculated from static lung volumes
(VC=ERV+VT+IRV). FVC is
determined from direct spirometry.
V0/VT Dead space-tidal The fraction of tidal volume made up 30%
volume ratio of dead space
VT Tidal Volume The volume of air inhaled or exhaled 0.5 L
with each breate

2.2 INDICATION FOR SPIROMETRY

Diagnostic

 To evaluate symptoms, signs or abnormal laboratory tests

 To measure the effect of disease on pulmonary function
 To screen individuals at risk of having pulmonary disease
 To assess pre-operative risk
 To assess prognosis
 To assess health status before beginning strenuous physical activity programmes

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Monitoring

 To assess therapeutic intervention

 To describe the course of diseases that affect lung function
 To monitor people exposed to injurious agents
 To monitor for adverse reactions to drugs with known pulmonary toxicity

Disability/impairment evaluations

 To assess patients as part of a rehabilitation programme

 To assess risks as part of an insurance evaluation
 To assess individuals for legal reasons

Public health

 Epidemiological surveys
 Derivation of reference equations
 Clinical research

2.3 CONTRAINDICATION

 haemoptisis
 pneumothoraks
 heart disease
 angina pectoris
 aneurisme of thoraks,abdominal, cranial
 trombotic condition
 thoraks or abdominal surgery
 nausea and vomite

2.4 PROCEDURE

The basic forced volume vital capacity (FVC) test varies slightly depending on the
equipment used.

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 Generally, the patient is asked to take the deepest breath they can, and then exhale
into the sensor as hard as possible, for as long as possible, preferably at least 6 seconds. It is
sometimes directly followed by a rapid inhalation (inspiration), in particular when assesing
possible upper airway obstruction. Sometimes, the test will be preceded by a period of quiet
breathing in and out from the sensor (tidal volume), or the rapid in (forced inspiratory part)
will come before the forced exhalation.

During the test, soft nose clips may be used to prevent air escaping through the nose.
Filter mouthpieces may be used to prevent the spread of microorganisms.

2.5 PULMONARY DISEASE STATES

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 Flow volume curves seen with obstructive and restrictive pulmonary disease. This
figure ilustrates the flow- volume curves observed for normal adults, obstructive, restrictive,
and mised disease. Flow volume curve number 1 represents baseline spirometry. Flow-
volume number 2, if present, is a repeat of the spirometry after bronchodilator is
administered(refer to bronchodilator studies under airway reactivity test). The curve with the
vertical lines represents the predicted normal values. In these examples,there is no
improvment in the flow- volume curves after bronchodilator administration. The normal
flow- volume curve shows that the curve is large than expected based on predicted values and
is therefore normal. Concavity of the expiratory portion of the curve, consistent with
limitation in flow compared to the predicted, is illustrated in the obstruction flow- volume
curve. The restriction flow- volume curve shows a forced vital capacity that is smaller than
expected. The predicted volume is approximately 3L;however, the patient’s forced vital
capacity is 2L. In restriction, although the forced expiratory flows are often decreased there is
no concavity such as seen in the obstructioncurve. It is important to note that spirometry does
not diagnose restriction. The flow- volume loop will demonstrate findings such as this
consistent with restriction, however , lung volumes are needed to difine restriction. Concavity
in the expiratory phase and a decresed forced vital capacity volume is consistent with
combination of an obstruction and restriction flow- volume curve.

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 CHAPTER III

CONCLUTION

Spirometry is a physiological test instrument that measures the volume of air which is
blown air and exhaled by time. with spirometry examination can know the number of lung
volume except residual volume, all except lung capacity lung capacity component containing
residual volume that FRC and tlc.

indication of the use of spirometry is any shortness, stable asthmatics, patients with
stable COPD, asthma patient evaluation of COPD patients each year and every 6 months,
patients will in general anesthesia.

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 REFERENCE LIST

Djojodibroto, R. Darmanto. Respiratory Medicine . Jakarta : EGC

Miller M.R. et al. 2005. European Respiratory Journal: ERS Journals Ltd

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