SPIROMETRY

• Wash hands• Introduce, identify patient, gain consent• Establish height, sex, age and ethnicity (if African/Asian query whether ‘normal’

values are appropriate)• Assemble equipment - remember to place Vitalograph sheet upside down, with the

stylus on the ‘0’ point. Ensure sheet is clipped in• Attach clean mouth piece• Turn on power and reset the carriage (to the left)• If available, turn switch to ‘neutral’ mode

• General explanation: “Spirometry will involve you taking some long deep breaths and exhaling for as hard and as long as you can, while breathing into this machine. You’ll have a nose-piece on during this. Some people feel a little light-headed afterwards but you’ll be sat down, and this feeling passes quickly. Are you happy to go ahead with this today?”

• Check contraindications with patient - “Are you feeling well today?”- Abdominal or eye surgery (recently)- Pneumothorax- Tuberculosis- Haemoptysis- Vomitting (or generally unwell)- Unstable CV status (recent MI, ACS etc)- “Has anyone ever said you should not have spirometry performed?”

• Position patient: “I’ll need you sat down with a nice straight back and shoulders back.”

• VC*: “So first, I’ll put this nose clip on - now take a deep breath in through your mouth and breath out into this tube - you don’t need to force it this time, just breath out normally”. Reset carriage.• FVC/FEV1: “Now, I want you take a deep breath in, but this time breath out as hard and as fast

as you can. Don’t stop breathing out until I say so. You may have to go beyond the point where you feel ‘empty’ but keep going”. Give lots of verbal encouragement. Repeat 3 times or until there are 3 readings all within 100ml of each other (up to 9, then take best).• Record best FEV1 and FVC

• FEV1/FVC x 100 = ratio.

• Meas. FEV1/Pred. FEV1 x 100 AND Meas. FVC/Pred. FVC x 100

• Establish normal, obstructive or restrictive patten:Obstructive Restrictive

FEV1:FVC ratio < 70% normal

FEV1 % of predicted < 80% < 80%

FVC % of predicted reduced < 80%

• Record all information on the spirometry chart• Thank the patient• Summarise: “Mrs. Thompson is a 45 year old lady who, on spirometry, demonstrated an obstruc-

tive pattern of breathing deficit. If no diagnosis has been reached yet, I would re-test her lung function fol-

* This can be omitted in a time-pressured situation.

lowing treatment with an inhaled bronchodilator (such as salbutamol) to ascertain whether this is re-versible”.

* This can be omitted in a time-pressured situation.