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• FEV1/FVC ratio:
The fraction of air exhaled in the first second relative to the total
volume exhaled
Additional Spirometric Indicies
• VC - Vital capacity:
A volume of a full breath exhaled in the patient’s own time
and not forced. Often slightly greater than the FVC,
particularly in COPD
Residual volume
Spirogram Patterns
• Normal
• Obstructive
• Restrictive
Predicted Normal
Values
Predicted Normal Values
Affected by:
Age
Height
Sex
Ethnic Origin
Criteria for Normal
Post-bronchodilator Spirometry
5 FVC
4
Volume, liters
FEV1 = 4L
3
FVC = 5L
2 FEV1/FVC = 0.8
1 2 3 4 5 6
Time, sec
SPIROMETRY
OBSTRUCTIVE
DISEASE
Spirometry: Obstructive Disease
Normal
5
4
Volume, liters
3
FEV1 = 1.8L
2
FVC = 3.2L Obstructive
1 FEV1/FVC = 0.56
1 2 3 4 5 6
Time, seconds
Diseases Associated With
Airflow Obstruction
• COPD
• Asthma
• Bronchiectasis
• Cystic Fibrosis
• Post-tuberculosis
• Lung cancer (greater risk in COPD)
• Obliterative Bronchiolitis
Spirometric Diagnosis of COPD
RESTRICTIVE
DISEASE
Criteria: Restrictive Disease
5
Normal
4
Volume, liters
3
Restrictive
2 FEV1 = 1.9L
FVC = 2.0L
1
FEV1/FVC = 0.95
1 2 3 4 5 6
Time, seconds
Diseases Associated with a Restrictive Defect
Pulmonary Extrapulmonary
• Fibrosing lung diseases • Thoracic cage deformity
• Pneumoconioses • Obesity
• Pulmonary edema • Pregnancy
• Parenchymal lung tumors • Neuromuscular disorders
• Lobectomy or • Fibrothorax
pneumonectomy
Mixed Obstructive/Restrictive
Flow Volume
Flow Volume Curve
• Standard on most desk-top spirometers
Expiratory
flow rate
L/sec
TLC
FVC RV
Inspiratory
flow rate
L/sec
Volume (L)
Flow Volume Curve Patterns
Obstructive and Restrictive
Obstructive Severe obstructive Restrictive
Volume
Volume
Volume
Time Time Time
Performing Spirometry
Spirometry Training
• Training is essential for operators to learn correct performance
and interpretation of results
• Training for competent performance of spirometry requires a
minimum of 3 hours
• Acquiring good spirometry performance and interpretation skills
requires practice, evaluation, and review
• Spirometry performance (who, when and where) should be
adapted to local needs and resources
• Training for spirometry should be evaluated
Obtaining Predicted Values
• Independent of the type of spirometer
• Choose values that best represent the
• tested population
• Check for appropriateness if built into
• the spirometer
Optimally, subjects should rest 10 minutes
before performing spirometry
Performing Spirometry - Preparation
1. Explain the purpose of the test and demonstrate
the procedure
2. Record the patient’s age, height and gender and
enter on the spirometer
3. Note when bronchodilator was last used
4. Have the patient sitting comfortably
5. Loosen any tight clothing
6. Empty the bladder beforehand if needed
Performing Spirometry
• Breath in until the lungs are full
• Hold the breath and seal the lips tightly
around a clean mouthpiece
• Blast the air out as forcibly and fast as
possible. Provide lots of encouragement!
• Continue blowing until the lungs feel
empty
Performing Spirometry
• Watch the patient during the blow to
assure the lips are sealed around the
mouthpiece
• Check to determine if an adequate trace
has been achieved
• Repeat the procedure at least twice
more until ideally 3 readings within
100ml or 5% of each other are
obtained
Reproducibility - Quality of Results
Volume, liters
Time, seconds
Normal
Volume, liters
Time, seconds
Unacceptable Trace – Stop Early
Normal
Volume, liters
Time, seconds
Unacceptable Trace – Slow Start
Volume, liters
Time, seconds
Unacceptable Trace - Coughing
Normal
Volume, liters
Time, seconds
Unacceptable Trace – Extra Breath
Normal
Volume, liters
Time, seconds
Spirometry
• Mrs PZ 47 yrs
• FEV-1 = 0.8L (35% of pred)
• FVC = 2.4L (85% of pred)
• FEV-1/FVC Ratio = 30%
Spirometry
• Answer:
Spirometry
• Mr PY 83
• FEV-1 =0.6L (28%pred)
• FVC = 1.9 L (81% pred)
• FEV-1/FVC ratio =31.5%
Spirometry
• Answer:
Spirometry
• Mr BY 63
• FEV-1 = 1.6 L (63% pred
• FVC = 2.1 L (67% pred)
• FEV-1/FVC ratio = 76%
Spirometry
• Answer-
Spirometry
• Mrs TZ 56
• FEV-1 =1.1L (41% pred)
• FVC = 2.3 L (63%pred)
• FEV-1/FVC ratio =48%
Spirometry
• Answer?
Some Spirometry Resources
• Global Initiative for Chronic Obstructive Lung
Disease (GOLD) - www.goldcopd.org