Spirometry use: detection of chronic obstructive pulmonary disease in the primary care setting

Figures & data

Figure 1 Three-step method to identify people with a high pre-test probability for moderate to severe COPD.²⁹

Abbreviations: COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in the first second; PEF, peak expiratory flow measurement.

Table 1 Precautions to be taken during spirometry

Consider spirometry contraindications, eg, hemoptysis of unknown origin (forced expiratory maneuver may aggravate the underlying condition); pneumothorax; unstable cardiovascular status (forced expiratory maneuver may worsen angina or cause changes in blood pressure), or recent myocardial infarction, or pulmonary embolus; thoracic, abdominal, or cerebral aneurysms (danger of rupture due to increased thoracic pressure); recent eye surgery; presence of an acute disease process that might interfere with test performance (nausea, vomiting); recent surgery of thorax or abdomen. Ask the patient to sit in a comfortable chair (prevent falls and fatigue). Wash your hands, keep hands away from your nose and mouth, and stay home if you have a cold or the flu. Wipe the spirometer with an alcohol pad.

Table 2 A procedure for spirometry

Wash hands (staff person and patient). Reassure the patient. Review pre-test questionnaire. Carefully enter data into the spirometer. “Demonstrate” the maneuver. Coach and observe body language. Obtain three good maneuvers.

Table 3 Common problems during office spirometry and the appropriate solutions

Problem	Solution
Hesitant starts	For the next maneuver, watch the patient inhale deeply, then shout “blast” before they start to exhale.
Poor blast effort	Need more aggressive coaching (not due to lung disease).
	Enthusiastically demonstrate the FVC maneuver again. Yell “blast” after the deep inhalation and before they start to exhale.
Short maneuvers	Need more aggressive coaching (not due to lung disease).
	The patient needs to be encouraged to blow out longer.
Submaximal inhalation	Dramatically demonstrate a deep breath and encourage maximal inhalation before the breath.
Extra breaths	Caused by nasal inhalations during exhalation.
	Reject these maneuvers and then use nose clips.

Abbreviation: FVC, forced vital capacity.

Table 4 Overall spirometry test session quality goals

Three good FVC maneuvers (minimal start hesitation and forced exhalation >6 seconds) Two best FEV1 Quality grades Eight maneuvers maximum

Abbreviations: FEV₁, forced expiratory volume in the first second; FVC, forced vital capacity.

NelsonSBThomashawBMEnrightPA tiered, economical approach for COPD case-finding in the general populationAm J Respir Crit Care Med2010181A5949

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