Peak flow / Spirometry

Question 1

What is peak flow?

Answer 1

Measures how quickly you can blow air out of your lungs

Question 2

What counselling is given to a patient when taking a peak flow reading?

Answer 2

Take your peak flow before using the preventer inhaler

Always use the same peak flow meter

Question 3

What factors can cause variation in a normal peak flow?

Answer 3

Age
Height
Gender

Question 4

What would diurnal variation suggest?

Answer 4

Asthma
Poor control of pre-existing condition

Question 5

What would a low score avg suggest?

Answer 5

Narrowed airways

Question 6

What is spirometry?

Answer 6

Method to assess lung function

Measures the vol of air a person is able to expire after maximal inspiration

Measures functional lung volumes.

Question 7

What is spirometry used for?

Answer 7

To diagnose and monitor certain lung diseases

Distinguishing between obstructive and restrictive lung disease

Question 8

What is FEV1?

Answer 8

Vol exhaled in 1sec after deep inspiration + forced expiration

FORCED EXPIRATION IN 1 SEC

Question 9

What does FEV1 depend on?

Answer 9

Age
Sex
Height
Mass
Ethnicity

Question 10

What is FVC?

Answer 10

Total vol of air that a person can forcibly exhale in 1 breath

FORCED VITAL CAPACITY

Question 11

What are the predicted % based on?

Answer 11

Predicted normal for a person of the same sex / gender, age, ethnicity and height

Question 12

What would an obstructive picture on spirometry look like?

Answer 12

FEV1 < FVC
FEV1/FVC < 0.7
FEV1 < 80% predicted.
FVC is lower but not as low as FEV1

Question 13

Why does obstructive spirometry have that pattern?

Answer 13

Takes a long time to exhale (wheeze) so not much breathed out at 1 second but volumes not bad overall.

Question 14

Give examples of Obstructive lung diseases that are :
a) Reversible
b) Irreversible
c) other causes?

Answer 14

a) Asthma
b) COPD
c) CF, emphysema, bronchiectasis, inhaled foreign body and
tumour

Question 15

What would an restrictive picture on spirometry look like?

Answer 15

FEV1/FVC > 70% w/ FEV1 + FVC being <80% predicted

Question 16

Why does restrictive spirometry have that pattern?

Answer 16

Restriction, lung volumes are small and most of breath is out in the first second.

Question 17

True or False:
- restrictive lung diseases are usually diseases of the interstitial affecting chest wall movement and elasticity

Answer 17

True

Question 18

Give some pulmonary causes of restrictive lung disease

Answer 18

Pulmonary fibrosis
Pneumoconiosis
Pulmonary oedema
Lobectomy / Pneumonectomy
Parenchymal lung tumours

Question 19

Give some non pulmonary causes of restrictive lung disease

Answer 19

Skeletal abnormality - Kyphosis
NMD - MND / Myasthenia gravis / Guillain-Barre syndrome
Connective tissue disorders
Obesity
Pregnancy

Question 20

What focused questions would you ask about medications?

Answer 20

Adherence to tx
current meds
inhalers they use and how often
other medications?
any beta blockers?
SE?
check inhaler technique
check inhaler use has been assessed by the nurse.

Question 21

What focused questions would you ask about SHx?

Answer 21

Any (new) pets?
Recent travel anywhere?
- Particularly to places that are polluted.
Housing situation(damp)?
Hayfever.
Smoking? Alcohol? Impact of condition on life.

Question 22

What red flags would you ask about?

Answer 22

worsening wheeze
Affecting ADLS
waking up at night w/ sx (SOB, cough)
using reliever inhaler more than usual

Question 23

Any other questions you would ask?

Answer 23

recent illnesses / infection
SOB?
worse at any specific time?

Question 24

What advice would you give a patient?

Answer 24

Stop / reduce smoking
Avoid precipitants
Vaccinations - flu / COVID 19
Exercise
Eating
Support