EXAMPLE 1: FIVC > 5% - SUBMAXIMAL INITIAL INHALATION
EXAMPLE 1: FIVC > 5% - SUBMAXIMAL INITIAL INHALATION
In this scenario if you use this trial in your final report the FVC would be underestimated thus giving inaccurate results. Please coach the applicant to take a deeper initial breath. The use of a nose clip often rectifies this issue as well.
EXAMPLE 2: HESITATION
EXAMPLE 2: HESITATION
In this scenario, the hesitation is indicated by the rise of the baseline of the curve in the flow volume curve. If you use this trial in your final report the FVC would be underestimated thus giving inaccurate results. Please coach the applicant to blast out faster.
EXAMPLE 3: NO PLATEAU
EXAMPLE 3: NO PLATEAU
In this scenario plateau has not been achieved which is indicated by the continued rise in the Flow volume curve. If you use this trial in your final report the FVC would be underestimated thus giving inaccurate results. Please coach the applicant to continue blasting air out until lungs are fully empty and plateau is achieved as determined by the clinician watching the flow volume curve.
EXAMPLE 4: VARIABLE PEF’s (PEAK EXPIRATORY FLOW)
EXAMPLE 4: VARIABLE PEF’s (PEAK EXPIRATORY FLOW)
In this scenario Purple trial PEF was approximately 5.8 litres/second and Red trial PEF was approximately 8litres/second. You would delete PURPLE trial as the applicant has shown they can achieve
8 litres/second and coach them to give maximum effort with each trial.
PEF’s give an indication on the reliability of the data. Once you feel you have 3 good quality curves for the final report, please ask yourself is the PEF within 10% of the best PEF trial?? The best approach to check this is use the overlay approach.
How to interpret your spirometry
How to interpret your spirometry
FVC – is it < LLN? (indicative of restrictive pattern)
FEV1 – is it < LLN? (indicative of obstructive pattern)
FEV1/FVC ratio – is it <LLN? (indicative of obstructive pattern)
How to grade the abnormality
How to grade the abnormality
Z scores are a grading system for the abnormal obstructive pattern determined by the above. You will need to have the Z scores activated on your report settings to see these. Do not rely on the system interpretation of the grading.
Normal – 1.645
Mild obstruction – 1.645 to -2.5
Moderate obstruction – 2.5 to -4.0
Severe obstruction <-4.0
When grading obstruction, ALWAYS look at the Z score in FEV1.
When grading obstruction, when only the ratio is <LLN, look at the Z score in the ratio.
Mandatory comments required on the spirometry report:
Mandatory comments required on the spirometry report:
Indication
Check of Contraindications
Any PMHx/Recent Medications (Significant to Spirometry) that should be documented.
If Ethnicity is Other - specify
Confirmation of quality of session - if not good, why? (Submaximal initial inhalation, poor initial blast, hesitant start, variable effort, cough in first 1 sec, tongue obstruction, unable to achieve plateau)
Are the trials valid - acceptable and reproducible?
Results of Spiro - Normal, Obstruction, Restriction
If abnormal - is Bronchodilator Responsiveness Testing required/completed/unable to be completed?
Results Post Ventolin spirometry - any significant changes? (A change of 10% of the predicted value in either the FVC or FEV1 is considered a clinically significant response)
Consultant name completing spirometry assessment.
Calculation required to determine the bronchodilator response:
Calculation required to determine the bronchodilator response: