Family Physician Son Pisa Primary Health Care Centre Palma de Mallorca Spain Spanish Primary Care Respiratory Group Jaime Correia de Sousa MD MSc PhD Family Physician Associate Professor School of Medicine Minho University Portugal ID: 1048394
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1. Miguel Román-RodríguezFamily PhysicianSon Pisa Primary Health Care Centre, Palma de Mallorca. SpainSpanish Primary Care Respiratory GroupJaime Correia de Sousa, MD, MSc, PhDFamily PhysicianAssociate Professor, School of Medicine, Minho University, PortugalPresident of the International Primary Care Respiratory GroupSpirometry made easyIPCRG workshop on respiratory diseases
2. ObjectivesTo know the important spirometry parametersTo identify a “good quality” spirometryTo identify the different spirometry patternsTo accurately “read” the results of the test
3. Forced spirometrySpirometry measures airflow and lung volumes, and is the preferred lung function test for COPD and asthma in primary careForced exhalation from a maximal inspiration
4. Tidal Volume (TV)Total Lung Capacity (TLC)Vital Capaciity (VC)Inspiratory Capacity (IC)Residual Functional Capacity (RFC)Residual Volume (RV)Expiratory Reserve Volume (ERV)Inspiratory Reserve Volume (IRV)
5. FEV1Exhaled volume in the first second of a forced expiration after a maximal inspiration.
6. Total volume of exhaled air in a forced expiratory manoeuvre after a maximal inspiration.FVCThe less total volume /capacity the less FVC
7. Bronchial obstruction generates less volume in the first second
8. % of forced vital capacity expelled during the first secondFEV1 / FVCBest obstruction measurementFLOWFLOWFLOW
9. Important measurementsFVC: Forced Vital Capacity Volume of air exhaled after full inspiration and full exhalationFEV1: Forced Expiratory Volume in 1 second Volume of air exhaled in the first second of forced exhalation. FEV1 / FVC: Ratio of vital capacity exhaled in 1 second expressed as a percentage of the total volume of air exhaled after full inspiration and full exhalation
10. Does anyone blow the same?HeightTall people have larger lungsAge Respiratory function declines with ageSex Lung volumes smaller in femalesEthnicity Peculiarly studies show Black and Asian people as a whole, have smaller lung volumes (12-20 %). No studies for Pacific People.Posture Little difference between sitting and standing. Reduced in supine position.
11. When to perform a spirometry?Asthma and COPD diagnosis and follow upTo asses chronic respiratory symptomsTo identify smokers at risk of COPD
12. Absolute contraindicationsRecent pneumothoraxPulmonary Embolism (before anticoagulation)Active respiratory infectionRecent myocardial infarction or unstable angor pectorisRetinal detachmentAortic AneurismsRecent abdominal surgeryIntracranial hypertensionRelative contraindications TraqueostomyProblems holding the mouthpieceFacial hemiparesisPoor mental condition. When NOT to perform a spirometry?
13. The most important matter: curvesAny test is only as good as its accuracyTime/volumeFlow/volume
14. The most important matter: curvesFEV1: Volume of air exhaled in the first second of a forced exhalation after complete inspirationFVC: Total volume of air exhaled after full inspiration and full exhalation1234561234Volume, litersTime, secondsFVC51FEV1 = 4LFVC = 5LFEV1/FVC = 0.8
15. The most important matter: curvesPeak-flow: Maximum airflow during the manoeuvreFVC FEV1
16. FEV1
17. Spirometry Interpretation
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19. Spirometry InterpretationIs it acceptable and reproducible? The traces’ shape Measurements assessment
20. Reasons for unacceptable /unreliable readings:Inadequate or incomplete inhalationSlow start to the forced exhalationLack of blast effort during exhalationCoughingAdditional breath taken during manoeuvreLips not tight around the mouthpieceExhalation stops before complete expiration
21. Airflow [L/s] CoughEarly endingVolume [L] Inadequate initial effortHesitationReasons for unacceptable /unreliable readings:
22. Please be careful with the curves !!
23. Doubtful start: extrapolated volume
24. Flow problem: cough
25. Weak effort: no shouting, no peak
26. Variable effort
27. Early ending: short encouragement
28. Mínimum of 3 and máximum of 8 manouversLess tan 5% or 100 ml difference in FEV1 and FVCBest test= best parameters sumReproducibility
29. Reproducibility
30. Is there an obstruction?1234561234Volume, litersTime, secondsFVC51FEV1 = 4LFVC = 5LFEV1/FVC = 0.8
31. Spirometric patternsObstructiveRestrictiveMixedNormal
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34. Obstruction
35. Restriction
36. Mixed
37. FEV1/FVCFVCFEV1ObstructionRestrictionMixedObstruction and hyperinflationNNNSpirometric patterns
38. FEV1/FVCFVCFEV1ObstructionRestrictionMixedObstruction and hyperinflationNNNSpirometric patterns
39. Mild ObstructionFEV1 80%Moderate ObstructionFEV1 < 80% 50% Severe ObstructionFEV1 < 50% 35% Very Severe ObstructionFEV1 < 35% Any other assesment?GOLD classificationSeverity of obstruction
40. Quick spirometry assesmentFEV1 /FVC ≥ 70%Normal< 70%ObstructionFVC ≥ 80% ref value< 80% ref. value≥ 80% ref value< 80% ref valueNORMALMixed patternOBSTRUCTION+ HYPERINFLATION (↑VR)OBSTRUCTION+RESTRICTION(VR normal)RESTRICTIONOBSTRUCTIONFVC
41. Reversibility TestPositive: Increase in FEV1 ≥ 12% and 200 ml from basal values PRÉPostBronchodilationEXFlow (L/s)INVolume (L)Second full spirometry 15 minutes after inhalation of 400µg of salbutamol or equivalentEssential for the diagnosis of respiratory diseases
42. Bronchial provocation testUseful to identify bronchial hyperreactivity Useful when asthma is suspected and normal spirometryProgressive increasing inhalation doses of Histamine, methacholine, allergens, hypertonic solution, or exercise Positive test: 20% decrease in FEV1 or more
43. Bronchial provocation test
44. Contraindications to methacholine challenge testing
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46. Let’s practice
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51. Non acceptable
52. Acceptable
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57. Non acceptable
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59. Non acceptable
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61. Respiratory Health: Adding Value in a Resource Constrained WorldIn collaboration with:GRESP PortugalGRESP Brazil GRAP SpainGRAP Chile
62. Now you are ready for that...Go home and try!Thank you for your attention!
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