Spirometry: How To Do The Test
Spirometry: How To Do The Test
Spirometry: How To Do The Test
Spirometry
Miranda A Paraskeva
Brigitte M Borg
Matthew T Naughton
This article forms part of our ‘Tests and results’ series for 2011 which aims to provide information • not smoke or perform strenuous exercise on
about common tests that general practitioners order regularly. It considers areas such as indications,
the day of the test
what to tell the patient, what the test can and cannot tell you, and interpretation of results.
• not consume alcohol or eat a large meal
within 4 hours of the procedure
Spirometry measures the flow and volume of air entering and leaving the lungs. It is used • wear unrestrictive, loose clothing during the
to assess ventilatory function and differentiates between normality and diseases causing procedure.
obstructive and possibly restrictive defects.
Keywords: asthma; respiratory tract diseases; pulmonary disease, chronic obstructive; How to do the test
respiratory tract diseases With the patient sitting upright on a chair or
in standing position, and with their lips sealed
tightly around a spirometer mouthpiece, the
Spirometry should be performed patient is asked to exhale as hard and as fast as
early in the assessment of a patient they can from a position of maximal inhalation
presenting with symptoms of ventilatory until they cannot blow out any more.
dysfunction. Common indications are
listed in Table 1.
How does the test work?
Spirometry provides three measurements:
Precautions • Forced vital capacity (FVC) is the maximal
While spirometry is generally considered to be volume of air that can be forcibly expelled
safe, high airway and intrathoracic pressures from the lungs from a position of maximal
are generated during the test, hence it is not inhalation. It indicates lung volume
recommended in the following settings:1 • Forced expiratory volume in 1 second (FEV1) is
• if the patient is unable to cooperate or sit the maximal volume of air exhaled in the first
upright second of an FVC manoeuvre. In individuals
• recent pneumothorax (within 6 weeks) with normal lung function this is 75–80% of
• unstable angina or recent myocardial FVC. FEV1 reflects the mechanical properties
infarction (within 4 weeks) of the large and medium sized airways
• haemoptysis (within 48 hours) • Forced expiratory ratio (FEV1/FVC or FER%)
• recent abdominal, thoracic or eye surgery is the ratio of FEV1 to FVC, expressed as a
(within 6 weeks) percentage. It assists with distinguishing
• thoracic, aortic or cerebral aneurysm obstruction from possible restriction when
• suspected or confirmed communicable FEV1 is reduced. If restriction is suspected,
infectious disease (eg. tuberculosis or further testing with static lung volumes may
influenza). be required.
216 Reprinted from Australian Family Physician Vol. 40, No. 4, April 2011
Spirometry clinical
Bronchodilator reversibility
Table 2. Causes of obstructive and restrictive impairment on spirometry
Significant bronchodilator reversibility is defined
Restrictive lung disease Obstructive lung disease
by a 12% and greater than 200 mL increase in
Pulmonary fibrosis Chronic obstructive pulmonary disease (COPD)
either FEV1 or FVC (or both).3 It is assessed by the
Neuromuscular disorders Asthma
administration of a short acting beta 2 agonist and
Congestive cardiac failure Bronchiectasis/cystic fibrosis
repeating spirometry after around 10 minutes.4
Sarcoidosis Cystic fibrosis
Failure to respond does not preclude clinical
Obesity Bronchiolitis
α1 – antitrypsin deficiency benefit from bronchodilators.
8 8
6
6 6
4
4 4
2
2 2
Flow (L/sec)
Flow (L/sec)
Flow (L/sec)
0 0 0
2 4 2 4 2 4
–2 –2
–2
–4 –4
–4
–6 –6
–6
–8 –8
–8
–10 –10
Figure 1. Normal flow volume loop Figure 2. Flow volume loop showing an Figure 3. Flow volume loop showing a
obstructive ventilatory defect restrictive ventilatory defect
Reprinted from Australian Family Physician Vol. 40, No. 4, April 2011 217
clinical Spirometry
218 Reprinted from Australian Family Physician Vol. 40, No. 4, April 2011
Spirometry clinical
and validity of
Report: test results
6
0
Positive flows
bronchodilator.# Results are consistent with a
2 4
represent expiration, –2
represent inspiration. –6
Red – baseline –8
* Baseline FEV1/FVC is below the lower limit of normal (normal range >71%). FVC is
within normal limits (>3.13); indicates obstruction
# There was a >12% increase in FEV1 (23%) that was also >200 mL (700 mL).
Therefore the response to inhaled bronchodilator is significant
^ Fully reversible obstructive pattern on spirometry is consistent with suboptimally
controlled asthma
Figure 5. Spirometry results of Case study patient
References
1. Cooper BG. An update on contraindications for lung 2005;26:948–68.
function testing. Thorax 2010 [Epub ahead of print]. 4. Miller MR, Hankinson J, Brusasco V, et al.
2. Miller MR, Crapo R, Hankinson J, et al. General Standardisation of spirometry. Eur Respir J
considerations for lung function testing. Eur Respir J 2005;26:319–38.
2005;26:153–61.
3. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative
strategies for lung function tests. Eur Respir J
Reprinted from Australian Family Physician Vol. 40, No. 4, April 2011 219