quality assured spirometry fileprior pneumothorax unstable vascular system (e.g. mi in last month,...

Quality Assured Spirometry

Laura Leeks

Specialist Respiratory Physiotherapist

Camden COPD and Home Oxygen Service

A Guide To Performing Quality Assured Diagnostic Spirometry

(Association for Respiratory Technology and Physiology (ARTP 2013)

Quality Assurance

“Refers to planned and systematic activities implemented to provide

adequate confidence that the results will fulfil requirements for

quality.”

Grant EL and Leavenworth RS (1988) Statistical Quality Control

Quality Assurance



quality.”


Consistent processes in

place

Quality Assurance



quality.”


Consistent processes in

placeResults are

valid and reliable

Spirometry is the recommended objective test performed to identify abnormalities in lung volumes and air flow

What is Spirometry?

Spirometry is the recommended objective test performed to identify abnormalities in lung volumes and air flow

What is Spirometry?

It is NOTPulmonary Lung Function

Testing

Includes transfer factor and other measures of

pulmonary function

Equipment

Person

Procedure

Interpretation

What do we need?

Equipment

3 litre syringe

Prior to every clinic / session or after every 10th patient

Calibration log maintained

Biological control

Calibration

Before the test STOP: Short acting bronchodilators for 4 hours

Long acting beta 2 agonist bronchodilators for 8 hours

Long acting muscarinic antagonist bronchodilators for 36 hours

Before the test AVOID: Smoking for at least 24 hours

Eating a large meal

Vigorous exercise

Wearing tight clothing

Pre-test advice

Contraindications

Absolute Active Infection Conditions that might cause

serious consequences if aggravated by forced expiration: Dissecting / unstable aortic

aneurysm Current pneumothorax Recent surgery – opthalmic,

abdominal, thoracic, neurosurgery

Relative Suspected respiratory infection

in last 4-6 weeks Undiagnosed symptoms e.g.

Haemoptysis Conditions that might be

aggravated by forced expiration: Prior pneumothorax Unstable vascular system

(e.g. MI in last month, uncontrolled hypertension, PE or haemorrhagic event)

Previous relevant surgery Patient too unwell Communication problems

Vital signs

Height (arm span if unable to stand)

Weight (BMI)

Age

Gender

Ethnicity

Pre-test measurements

Global Lung Function Initiative (GLI) reference values not the European Community of Coal and Steel (ECSS)

Hong Kong Chinese 100% (as per Caucasian)

Japanese American 11% Reduction

Polynesians 10% Reduction

North Indians and Pakistanis 10% Reduction

South Indians and African Descent 13% Reduction

Ethnicity and predicted values

Quanjer et al (2012) Multi-ethnic reference values for spirometry for the 3-85 year age range: The Global Lung Function 2012 Equations. Report of the Global Lung Function Initiative (GLI), ERS Task Force to establish improved Lung Function Reference Values. European Respiratory Journal 40(6) 1324 - 1343









Less accurate in ‘young’ (under

estimates) and ‘old’ (over estimate)









Less accurate in ‘young’ (under

estimates) and ‘old’ (over estimate)

Download software onto the desktop

spirometer so automatically calculates the

reduction when put in ethnicity

Vital Capacity (VC)

Forced Vital Capacity (FVC)

Forced Expiratory Volume in 1 second (FEV1)

FEV1/FVC

FEV1/VC

(Maximal inspiration for maximal exhalation)

Procedure

If baseline spirometry obstructive picture

Salbutamol

2.5mg via nebuliser

4 x 100mcg (as single puffs) via spacer

Perform spirometry 15 minutes after bronchodilation

Post-bronchodilator testing

If baseline spirometry obstructive picture

Salbutamol

2.5mg via nebuliser

4 x 100mcg (as single puffs) via spacer

Perform spirometry 15 minutes after bronchodilation

Post-bronchodilator testing

This is not reversibility testing

for asthma(although it is the same process)

“Operator trained and assessed to ARTP or equivalent standards” (expert clinician program – portfolio)

No more than 100ml variation

Within 5%

Observe technique

No more than 8 forced manoeuvres in one session

Appropriate rest time between manoeuvres

Repeatability

Recording results

Actual values

Largest FEV1

Largest VC or FVC

Percentage predicted values

FEV1

FVC

Lower limit of normal

FEV1/VC or FEV1/FVC

Levy et al (2009) Diagnostic Spirometry in Primary Care; proposed standards for general practice compliant with ATS and ERS. Primary Care Respiratory Journal 18(3) 130-147

Graphs

Interpretation

Flow Volume graph

Volume Time graph

Interpretation

Tongue or teeth obstructing mouthpiece

Leak around mouthpiece

Cough

Slow start

Early stop

Poor effort

Common technical errors

2nd Breath

Submaximal Effort

Coughing

Slow start

Early Stop

FEV1/FVC < 0.7

Lower limits of normal

Obstructive picture

© Global Initiative for Chronic Obstructive Lung Disease, Inc. (2017)www.goldcopd.org

1. Patient Demographics

2. Technical acceptance of blows

3. Number of blows

4. Quality of blows

5. Reproducibility

6. Airflow obstruction (FEV1/FVC)

7. Severity (FEV1 % predicted)

8. Limitations

9. Reversibility

10. Check the Clinical Picture

Top 10 tips for reporting results

quality assured spirometry fileprior pneumothorax unstable vascular system (e.g. mi in last month,...

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