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Spirometry: step by step

V.C. Moore
Breathe 2012 8: 232-240; DOI: 10.1183/20734735.0021711
V.C. Moore
Occupational Lung Disease Unit, Dept of Respiratory Medicine, Birmingham Heartlands Hospital, Birmingham, UK
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  • Figure 1
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    Figure 1

    Expanded version of the early part of a subject's volume–time spirogram, illustrating back-extrapolation through the steepest part of the curve, where flow is peak expiratory flow (PEF), to determine the new time zero. Forced vital capacity (FVC): 4.291 L; back extrapolated volume (EV): 0.123 L (2.9% FVC). -----: back extrapolation line through PEF. Reproduced from [1] with permission from the publisher.

  • Figure 2
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    Figure 2

    Flow–volume loop of a normal subject. Forced expiratory volume in 1 s (FEV1): 105% predicted; forced vital capacity (FVC): 103% pred; FEV1/FVC ratio: 89%. The plot shows the predicted flow–volume loop (-----) and predicted ranges for the peak and mid-expiratory flow rates and the FVC.

  • Figure 3
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    Figure 3

    Moderate airflow limitation in a subject with asthma. Forced expiratory volume in 1 s (FEV1): 73% predicted; forced vital capacity (FVC): 109% pred; FEV1/FVC ratio: 53%.

  • Figure 4
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    Figure 4

    Example of a typical restrictive defect. Forced expiratory volume in 1 s (FEV1): 82% predicted; forced vital capacity (FVC): 85% pred; FEV1/FVC: 84%; peak expiratory flow: 157% pred.

  • Figure 5
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    Figure 5

    Serial peak flow plot showing occupational asthma in a worker exposed to formaldehyde. The top part of the plot shows the diurnal variation (DV), the middle section shows the highest peak expiratory flow (PEF), mean PEF and lowest PEF each day. Shaded areas are work days and white areas are days away from work. The Oasys complex scores (a complex is either a rest–work–rest or work–rest–work pattern) are shown and the predicted PEF line of 519 L·min−1. The bottom section shows the date, number of readings per day and number of hours worked. The overall Oasys score is 3.93 (≥2.51 is positive for occupational asthma). The area between curves score is 80.4 L·min−1·h−1 (≥15 L·min−1·h−1 is positive for occupational asthma) and time-point analysis is positive for occupational asthma.

Tables

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  • Table 1 Checklist of factors that the patient should avoid prior to spirometry
    ActivityLength of time to stop before spirometry
    Drinking alcohol4 h
    Eating a large meal2 h
    Vigorous exercise30 min
    Smoking>1 h
    Medication useDocument treatment and when last taken
    For reversibility testing
     Taking short-acting bronchodilators6 h
     Taking long-acting bronchodilators (including combination inhalers) or twice-daily preparations24 h
     Taking tiotropium or once-daily preparations48 h
  • Table 2 Assessment of severity of airflow obstruction in chronic obstructive pulmonary disease according to forced expiratory volume 1 s (FEV1) % predicted (% pred)
    FEV1 % predCategory#
    ≥80Mild
    50–79Moderate
    30–49Severe
    <30Very severe
    • #: values are post-bronchodilator and used in combination with an FEV1/FVC ratio of <0.7.

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Vol 8 Issue 3 Table of Contents
Breathe: 8 (3)
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Spirometry: step by step
V.C. Moore
Breathe Mar 2012, 8 (3) 232-240; DOI: 10.1183/20734735.0021711

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Spirometry: step by step
V.C. Moore
Breathe Mar 2012, 8 (3) 232-240; DOI: 10.1183/20734735.0021711
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  • Article
    • Abstract
    • Introduction
    • The measures
    • Performing spirometry
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