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Pulmonology 2 > Spirometry > Flashcards

Spirometry Flashcards

1
Q

DLCO

A

diffusing capacity of the lung, capacity of lung to transfer CO2

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2
Q

ERV

A

expiratory reserve volume, max volume of air that can be exhaled from end-expiratory tidal position

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3
Q

FET

A

forced expiratory time - amt of time pt exhales during FVC

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4
Q

FEV1

A

forced expiratory volume in 1 second

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5
Q

FRC

A

functional residual capacity, volume of air in the lungs following tidal volume exhalation

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6
Q

FVC

A

forced vital capacity, total volume can be forcefully expired from max inspiratory effort (all the way full to all the way empty except residual air in lungs)

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7
Q

IC

A

inspiratory capacity, max volume of air can be inhaled from tidal volume end-experiatory level

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8
Q

IRV

A

inspiratory reserve volume

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9
Q

LLN

A

lower limit of normal

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10
Q

PEF

A

peak expiratory flow, fastest rate of flow

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11
Q

RV

A

residual volume, air remaining in lungs after max exhalation

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12
Q

TLC

A

total lung capacity, total volume in lungs at full inhalation

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13
Q

TV (or VT)

A

tidal volume

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14
Q

VC

A

vital capacity - max air that can be exhaled starting from max inspiration

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15
Q

spirometer def

A

device that measures the volume of air inspired or expired and records the time over which volume change occurs

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16
Q

What are four main reasons to use spirometry

A
  1. diagnostic
  2. public health (epidemiology studies, reference calcs, etc.)
  3. monitoring
  4. disability/impairment evaluations
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17
Q

Diagnostic reasons to use spirometry

A
  • eval sx
  • eval abnormal lab reports
  • measure effect of disease on pulm fn
  • assess pre-op risk
  • screen people at risk for pulm dx
  • assess prognosis
  • assess health status prior to start of strenuous activity
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18
Q

monitoring reasons to use spirometry

A
  • assess therapeutic intervention
  • describe course of disease that affects lung fn
  • monitor people exposed to injurious agents
  • monitor for adverse reactions to drugs with well known pulm toxicity
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19
Q

role of spirometry in primary care

A
  • provide objective measure of airflow restriction/obstruction
  • assess reversibility of airflow obstruction
  • provide objective measurements for asthma assessment and monitoring
  • assist with initial dx of asthma and assessment of asthma control
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20
Q

what age can start using spirometry to dx asthma

A

=>5 usually

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21
Q

how is asthma reversibility determined using spirometry

A

After administering short acting bronchodilator:

  1. increase in FEV1 > 12% from baseline
  2. increase that is at least 200mL

*2-3 week steroid tx might be required to demonstrate reversibility

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22
Q

Methods to establish dx of asthma

A
  1. med history with detailed sx (cough, wheezing, SOB with exercise)
  2. PE assess respiratory tract, chest, skin
  3. Spirometry to demonstrate obstruction and assess reversibility
  4. additional studies as needed to exclude other dx
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23
Q

NAEPP recommends spirometry in five situations (5)

A
  1. initial assessment
  2. after tx to determine “normal” airway fn
  3. during periods of loss of control
  4. when assessing change in pharmacotherapy
  5. every 1-2 years to assess maintenance of airway function (Kaitlin… hahaha)
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24
Q

Spirometry results that demonstrate obstruction

A
  1. FEV1 <80% predicted

2. FEV1/FVC below LLN of individual’s predicted value

25
Q

what is the gold standard of objective asthma (other breathing disorders?) measurements

A

spirometry

26
Q

What does spirometry require from the pt

A
  • effort
  • coordination
  • cooperation

careful coaching/instruction from medical professional

27
Q

what is required for consistently accurate test results

A
  • correct technique
  • calibration of machines
  • maintenance of equipment
28
Q

what is essential for accurate assessment

A

reproducibility of efforts

29
Q

Spirometry maneuvers

A
  • nose clip preferred
  • normal breathing prior to test
  • max forced exhalation during test
  • repeated until acceptability and reproducibility are achieved
30
Q

coaching for best technique

A
  • fill lungs completely
  • seal lips - no leaks!
  • blast out as hard and fast as possible
  • blow until lungs are completely empty
31
Q

Criteria for acceptability

A
  • lack of artifact (cough, glottic closure, equipment problems)
  • start without hesitation
  • satisfactory exhalation with 6 sec smooth continuous exhalation or reasonable duration with a plateau
  • 3 acceptable spirograms, 2 largest FVC within 200 mL
32
Q

Look at slides for pictures of acceptable and unacceptable efforts

33
Q

Once three acceptable spirograms are obtained, what tests must be done?

A
  1. 2 largest FVC must be within 0.150 L of each other
  2. 2 largest FEV1 must be within 0.15 L of each other

OR

  1. 8 tests have been performed
  2. pt can’t continue
    * then save best 3
34
Q

PEFR

A

peak expiratory flow rate - max air flow rate during forced exhalation

35
Q

How assess spirometry results

A

based on

  • FVC
  • FEV1
  • FEV1/FVC

relative to reference or predicted values

36
Q

what do the predicted values depend on

A

age
gender
height
race

37
Q

how are predicted values used

A

as percentage of average expected, called “percent predicted”

38
Q

how are FEV1 and FCV expressed on spirogram

A
  • absolute number
  • percent predicted

> 80% predicted are normal

39
Q

what happens to FEV1/FVC as we age

40
Q

what 4 reduce FVC

A
  1. lung disease (resection, collapse, obstructive dz)
  2. probs with pleural cavity (enlarged heart, pleural fluid, tumor)
  3. chest wall restriction
  4. respiratory muscle issues don’t allow inflation and deflation of lungs
41
Q

What is the most reproducible measure in spirometry

A

FEV1

  • most commonly obtained
  • most powerful measurement
42
Q

what is interesting about children FEV1/FVC ratio

A

high flow for size so ratios often higher, up to 90%

43
Q

What is the significance of FEV1/FVC ratio

A
  1. IDs people with airway obstruction in people with reduced FVC
  2. IDs the cause of low FEV1 (restrictive or obstructive)
44
Q

FEV1/FVC in restrictive disease

A

decrease proportionately, ratio is normal. May even be increased bc of elastic recoil of lungs

45
Q

FEV1/FVC in obstructive disease

A

reduced ratio vs. predicted value

46
Q

Obstructive defect def

A

process that causes a decrease in max expiratory flow so that can’t rapidly empty lungs

  • emphysema, chronic bronchitis, asthma
  • generally see associated decrease in FVC
47
Q

restrictive defect

A

lung volume is reduced by any process except obstruction

- total lung capacity must be less than normal!

48
Q

what does a reduced FVC with a normal FEV1/FVC suggest

A

restrictive pattern

49
Q

what does a reduce ratio of FEV1/FVC indicate

A

obstruction

50
Q

Pattern appearance on flow loop

  • normal
  • obstructive
  • restrictive
A
  • normal: rapid peak, gradual decline to zero
  • obstructive: rapid peak, scooped decline
  • restrictive: normal shape just smaller, witch hat
51
Q

What to do when get abnormal test result

A
  1. confirm demographic data (m vs. f makes a big difference)
  2. was test acceptable and reproducible
  3. look at appearance of flow/volume curve
  4. look at FEV1/FVC ratio
52
Q

FEV1/FVC ratio

  • low value
  • normal value
A
  • low: obstructive

- normal: restrictive or normal

53
Q

Obstructive and Restrictive pattern

- FVC

A
  • Obstructive: decreased or normal

- Restrictive: decreased

54
Q

Obstructive and Restrictive pattern

- FEV1

A
  • Obstructive: decreased

- Restrictive: decreased or normal

55
Q

Obstructive and Restrictive pattern

- FEV1/FVC

A
  • Obstructive: decreased

- Restrictive: normal

56
Q

Obstructive and Restrictive pattern

- total lung capacity

A
  • Obstructive: normal or increased

- Restrictive: decreased

57
Q

FEV1 abnormality severity

A
  • mild >70%
  • moderate 60-69%
  • moderately severe: 50-59%
  • severe: 35-49%
  • very severe: <35
58
Q

Discussing spirometry results with pts

A
  • acknowledge info, combined with hx and PE, will help establish dx
  • spirometry alone does not make the dx
  • add’l tests might be necessary for further assessment
  • spirometry might improve with effective asthma management

Pulmonology 2 (17 decks)

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