SPIROMETRY

Blow to know

Dr.Johan Buffels Belgian Primary Care Respiratory Group

BPCRG    

Belgian Primary Care Respiratory Group

Domus Medica (wetenschappelijke vereniging van vlaamse huisartsen) Société Scientifique de Médecine Générale University Departments of General Practice

What is Spirometry?

      a simple and safe test that measures lung volumes with a graphical display gives an estimation of lung function Allows for diagnosis of

airflow obstruction

Permits good follow-up for asthma and COPD

Hand-held spirometer

Spirometer in the fifties..

In the lung function lab

Many types are available..

Simplicity Spirobank MicroLoop SpiroStar SpiroPro Datospir 70

What do we measure with a spirometer?

Normal spirogram: Volume / time

8 6 4 2 FVC FEV 1 Man 176 cm 76 kg 5 Time (s) 10 15

Two important parameters

 

FVC - Forced Vital Capacity. This is the total amount of air that you blow out in one breath. FEV1 - Forced Expiratory Volume in one Second. This is the amount of air you can blow out within one second. With normal lungs and airways you can normally blow out most of the air from your lungs within one second.

0 3 4 5 1 2 Spirometry: Normal and COPD

Normal COPD FEV 1 4.150

2.350

FVC 5.200

3.900

FEV 1 / FVC 80 % 60 % FEV 1

1

FEV 1

2

Normal

3 4

FVC

5

COPD FVC

6

Seconds

Normal spirogram: Flow/Volume

PEF 12 8 4 -4 -8 0 Volume (L) Man 176 cm 76 kg

Spirometry and ageing

10 8 25 yrs 175 cm male 75 yrs 171 cm male 6 4 2 0 0 1 2 3 Vol (l) 4 5 6

Spirometry allows for

   Early detection of airflow obstruction (often late signs and symptoms) Better diagnosis (helps to distinguish between asthma and COPD) Correct follow-up (compare with blood pressure meter in hypertension patients)

Reversibility Testing  If airflow obstruction is present, the test person is given a bronchodilator (inhalation device)

Reversibility testing

Short acting



2 agonist

2 6 10

Bronchodilators

FEV 1 FVC Pre 2.61

5.25

PEF 6.49

Post 3.95



51% 6.08

16% 9.64

49% 2 4 Vol ( L ) 6 + 12-15 % in FEV1 > 200ml improvement is considered significant

Reversibility Testing   Airflow obstruction disappears: REVERSIBLE OBSTRUCTION (probably asthma) Airflow obstruction remains: IRREVERSIBLE OBSTRUCTION (probably COPD)

A children’s game?

But needs a maximal effort

Where can I get spirometry?



Hospital services



Pneumologist



Many general practitioners

 new technique for primary care 

Lung function lab

Telemedicine?

Know your numbers!

 Blood pressure  Cholesterol and glycemia 

FEV1 [= ESW = VEMS]



and FVC [= (geforceerde) vitale capaciteit ] [= capacité vitale (forcée)]

SPIROMETRY

 Is a safe and simple test  Provides useful data 

Is underused until now… Blow to know !