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Medical Notes
Respiratory Medicine Articles
Revision Notes
/ Medical Notes
/ Heart Lungs & Blood
/ Respiratory Medicine
What is spirometry?
Spirometry is a form of pulmonary function test. Patients blow into a tube as strongly as
possible, expiring until they have no breath left.
What do all the acronyms mean?
FEV1: forced expiratory volume in one second
VC: vital capacity - how much air you can breath out after as deep a breath as possible.
Crucially it is not 'forced'...
FVC: forced vital capacity. Essentially the vital capacity but blowing out as strongly as possible.
*In normal young people VC and FVC are most likely to be equal. However, in emphysematous
lungs elasticity of the airways is lost. This elasticity is what normally keeps the airways patent
during expiration. If the elasticity is not present the airways can become closed on forceful
expiration and so not all the air is expelled. The key word to describe this phenomenon in
OSCEs is 'trapping'. It is important to be aware of this disparity between VC and FVC in
emphysematous patients.
Most general practices have their own spirometer. In secondary care formal request may be
necessary but many thoracic departments have a spirometer in each ward. If this is the case in
your teaching hospital take the opportunity to do patients' pulmonary function. It is not
uncommonly requested by the consultant. It is a basic piece of equipment so you only need to
do it once to be covered for any potential OSCE station.
Interpretation - Part 1
1. Details
Name
Age
Sex
Height
Ethnicity
2. Reproducibility
Look at the variability (Var). BTS states that there must be at least two values within 3% of each
other for the result to be reliable.
3. Is it technicaly acceptable?
Did they cough during the expiration?
Did they take an extra breath during expiration?
Maybe they had a slow start?
Was it a sub-maximal effort?
All of these produce dents and artefacts in the cruve produced. It may be difficult to achieve a
perfectly accurate graph but the result should be as smooth as possible.
Interpretation - Part 2
Is the ratio FEV1/FVC <70%?
Yes: obstructive lung disease
Our patient above appears to have an obstructive pattern. Another clue towards this is the shape
of the curve, which will have a flatter gradient the more obstruction there is.
Our patient's FEV1 increased from 1.21L to 1.63L, a difference of greater than 400ml. His airway
Our 72 year old Caucasian man with reversible obstructive disease has a % predicted FVC of
91%. This is greater than 80% and so there is no additional restrictive element.
Clearly, in other situations there will be patients with no obstructive disease but a restrictive
pattern. These can be divided into pulmonary problems and non-pulmonary causes:
1. Pulmonary: fibrosis; pneumoconiosis; pulmonary oedema; parenchymal lung tumours;
lobectomy/pneumectomy.
2. Non-pulmonary: neuromuscular disorders; postural problems (e.g. thoracic cage deformity or
kyphoscoliosis); obesity; pregnancy.
Additional example
Stage 1 - Mild
FEV1 50-79%
Stage 2 - Moderate
FEV1 30-49%
Stage 3 - Severe
Skills
ABG Sampling and Interpretation
Metered Dose Inhaler (MDI) Usage
Nebuliser Usage
Oxygen Therapy
PEFR Measurement and Spirometry
Respiratory Examination
Conditions
Asthma
Bronchiectasis
Chronic Obstructive Pulmonary Disorder (COPD)
Interstitial Lung Disease
Lung Cancers
Pleural Effusion
Pneumonia
Pneumothorax
Pulmonary Embolism
Tuberculosis
Presentations
Chest Pain
Cough
Cyanosis
Haemoptysis
Shortness of Breath
Basic Principles
Control of Breathing
Gas Exchange
Ventilation
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