Interpretation Normal Spirometry Obstructive pattern Restrictive pattern Mixed pattern Small airway...
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Transcript of Interpretation Normal Spirometry Obstructive pattern Restrictive pattern Mixed pattern Small airway...
Interpretation
Normal Spirometry Obstructive pattern Restrictive pattern Mixed pattern Small airway obstruction Non-specific ventilatory pattern Probably normal pattern Upper airway obstruction pattern Neuromuscular diseases
Normal Spirogram
All parameters are normal
Normal shape in VT and FV loop
A. Normal:A. Normal: both the FVC and the both the FVC and the FEVFEV11/VC ratio are normal./VC ratio are normal.
““KneeKnee””
Obstructive pattern
Obstructive pattern
The severity of the abnormality is graded:The severity of the abnormality is graded:
- % Pred FEV- % Pred FEV11 > 100 > 100 = = May be a physiological May be a physiological variantvariant
- % Pred FEV- % Pred FEV11 < 80 and > 70 < 80 and > 70 MildMild
- % Pred FEV- % Pred FEV11 < 70 and > 60 < 70 and > 60 ModerateModerate severesevere
--% Pred FEV% Pred FEV11 < 60 and > 50 < 60 and > 50 ModeratelyModerately
- % Pred FEV- % Pred FEV11 < 50 and > 35 < 50 and > 35 SevereSevere
- % Pred FEV- % Pred FEV11 < 35 < 35 Very severeVery severe
Severe obstructive pattern
Restrictive pattern
Restrictive pattern
The severity of the abnormality might be The severity of the abnormality might be graded as follows:graded as follows:
-- % Pred FVC < LLN and > 70 % Pred FVC < LLN and > 70 mildmild- - % Pred FVC < 70 and > 60% Pred FVC < 70 and > 60 ModerateModerate--% Pred FVC < 60 and > 50% Pred FVC < 60 and > 50 ModeratelyModerately
severesevere--% Pred FVC < 50 and > 34% Pred FVC < 50 and > 34 SevereSevere- - % Pred FVC < 34 % Pred FVC < 34 Very severeVery severe
Mixed pattern
Small airway obstruction
Early small airway obxEarly small airway obx
FV curve :upward concavityFV curve :upward concavity
FVC, FEV1, FEV1/FVC :NLFVC, FEV1, FEV1/FVC :NL FEF 25-75 ???FEF 25-75 ??? ATS states that FEF25-75% should not be used to
diagnose small airway disease or to assess respiratory impairment
Probably normal
Isolated decrease in FEF25-75
Isolated decrease in FEV1/FVC
Probably normal spirogramProbably normal spirogram
Only Only FEF 25-75 FEF 25-75 No small airway disease (ATS)No small airway disease (ATS)
Only Only FEV1/FVC FEV1/FVC
FEV1> 100% Probably NormalFEV1> 100% Probably Normal
FVC>100%FVC>100%
Nonspecific ventilatory pattern
Similar to restrictive pattern
Normal TLC, RV & DLco
Obesity Asthma COPD Normal variant
Upper airway obxUpper airway obx
Upper airway obstruction pattern
Indications for referral
FEV1/FVC less than %75 and FEV1 less than %80 FEV1/FVC more than %75 and FVC less than %80 Significant reduction across time Pulmonary symptoms or signs even with normal spirogram
Screening Spirometry
General health Occupational health screening
Screening Spirometry in General Healthy Population
Baseline spirogram in all at 20-25 Periodic spirogram depends on risk factors
such as smoking each 1-5 yrs.
Occupational screening spirogram In certain occupational exposures
Asbestos, silica, cadmium, cotton, coal, beryllium, wood dust,….
Usually each 1-2 yrs
Comparison of periodic spirogram Significant change in FEV1 or FVC
Cross-shift Week-to-week Year-to-year
Definition
Considerations in periodic spirogram Using:
Similar reference values Similar patient position Similar time Standard spirometer Standard technique
Change in spirometric indices over timeChange in spirometric indices over time
malemale femalefemale malemale femalefemale
30 ml/yr30 ml/yr 25 ml/yr25 ml/yr 25 ml/yr25 ml/yr 25 ml/yr25 ml/yr
FEV1FEV1 FVCFVC
NIOSHNIOSH : :
(0.85 .initial FEV1 or FVC) – (number of yr . 0.025)(0.85 .initial FEV1 or FVC) – (number of yr . 0.025)
(value on time 1 – value on time 2 / value on time 1) × 100
In an ongoing annual surveillance of asbestos workers, a 24 year old woman is found to have an FVC of 3.59 liters. Her previous FVC was 4.17 liters. What is your interpretation?
Absolute change: 4.17-3.59 = .58 liters She showed a loss of .58 liters.
Percent change: ((4.17-3.59)/4.17) x 100 = 13.9% She showed a loss of 13.9% in her FVC.
Further investigation recommended Further investigation recommended
for follow-up results iffor follow-up results if::
1. Decline in FEV1 or FVC > 15% in longitudinal screening. If the period is > 5 years, adjust for the decline due to aging (25 ml/year)
2. FEV1, FVC or FEV1/FVC < LLN at any time
3. >10% decline between pre and post shift screening
Case 1Case 1
A 71 yrs maleA 71 yrs male HeightHeight :175 , :175 ,weightweight :88 :88 FVC:45%FVC:45% FEV1: 31%FEV1: 31% FEV1/ FVC :53%FEV1/ FVC :53% FEF25-75 :15%FEF25-75 :15% TLC :142%TLC :142% very severe obxvery severe obx
Case 2Case 2
A 36 yrs femaleA 36 yrs female
HeightHeight :162 , :162 ,weightweight :83 :83
FVC:89%FVC:89%
FEV1: 94%FEV1: 94%
FEV1/ FVC :89%FEV1/ FVC :89%
FEF25-75 :131%FEF25-75 :131%
TLC :92%TLC :92%
normalnormal
Case 3Case 3
A 29 yrs femaleA 29 yrs female HeightHeight :165 , :165 ,weightweight :129 :129 FVC:78%FVC:78% FEV1: 79%FEV1: 79% FEV1/ FVC :86%FEV1/ FVC :86% FEF25-75 :85%FEF25-75 :85% TLC :82%TLC :82% non specific ventilatorynon specific ventilatory
Case 4Case 4
A 43 yrs femaleA 43 yrs female HeightHeight :61, :61,weightweight :167 :167 FVC:33%FVC:33% FEV1: 17%FEV1: 17% FEV1/ FVC :42%FEV1/ FVC :42% TLC :114%TLC :114% variable inthratoracicvariable inthratoracic obxobx
Case 5Case 5
A 30 yrs maleA 30 yrs male HeightHeight :186, :186,weightweight :68 :68 FVC:19%FVC:19% FEV1: 21%FEV1: 21% FEV1/ FVC :93%FEV1/ FVC :93% FEF25-75% :48%FEF25-75% :48% TLC :28%TLC :28% very severe restrictionvery severe restriction
Case 6Case 6
A 30 yrs maleA 30 yrs male
HeightHeight :175 , :175 ,weightweight :70 :70
FVC: 88%FVC: 88%
FEV1: 69%FEV1: 69%
FEV1/ FVC :66%FEV1/ FVC :66%
FEF25-75 :38%FEF25-75 :38%
VEXT : 90VEXT : 90
moderate obxmoderate obx
Case 7Case 7
A 29 yrs maleA 29 yrs male
HeightHeight :179 , :179 ,weightweight :83 :83
FVC: 95%FVC: 95%
FEV1: 84%FEV1: 84%
FEV1/ FVC :67%FEV1/ FVC :67%
FEF25-75 :51%FEF25-75 :51%
VEXT : 120VEXT : 120
Mild obxMild obx
Case 8Case 8
A 26 yrs maleA 26 yrs male
HeightHeight :177 , :177 ,weightweight :67 :67
FVC: 97%FVC: 97%
FEV1: 77%FEV1: 77%
FEV1/ FVC :66%FEV1/ FVC :66%
FEF25-75 :48%FEF25-75 :48%
VEXT : 60VEXT : 60
mild obxmild obx
Post bronchodilator spirometry(reversibility testing)
Short-acting inhaled drugs should not be used Short-acting inhaled drugs should not be used within within 4h4h of testing of testing
Long-acting should be stopped for Long-acting should be stopped for 12h12h prior test prior test Smoking should be avoided for Smoking should be avoided for ≥ 1h≥ 1h Salbutamol Salbutamol 400 µg400 µg (4 puffs) at 30 (4 puffs) at 30s intervalss intervals → ≥ → ≥
10 min and up to 15 min10 min and up to 15 min Ipratropium bromide Ipratropium bromide 160 µg160 µg (4 puffs)→30 min (4 puffs)→30 min
later
Positive reversibility testing
Percent change from baseline & absolute change in FEV1 and/or FVC :
>12% AND 200 CC
Other criteria include:
At least 20% increase in FEF25-75%
A 24 yrs maleA 24 yrs male HeightHeight :170 , :170 ,weightweight :82 :82
FVC:80%FVC:80% FEV1: 70%FEV1: 70% FEV1/ FVC :69%FEV1/ FVC :69% FEF25-75 :50%FEF25-75 :50%
pre post %change pre post %change
FVC 4 4.26 +7FVC 4 4.26 +7
FEV1 2.91 3.32 +14 FEV1 2.91 3.32 +14
FEV1/ FVC 72.8 77.9 +7 FEV1/ FVC 72.8 77.9 +7
FEF25-75 2.32 3.09 +31 FEF25-75 2.32 3.09 +31
Case Case
A 70 yrs male, A 70 yrs male, HeightHeight :172 , :172 ,weightweight :65 :65
pre %pred post %chgpre %pred post %chg
FVC 3.13 83 3.52 +12 FVC 3.13 83 3.52 +12
FEV1 2.02 70 2.49 +23FEV1 2.02 70 2.49 +23
FEV1/ FVC 64.5FEV1/ FVC 64.5
Case Case
A 28 yrs male , A 28 yrs male , HeightHeight :192 , :192 ,weightweight :92 :92
pre %pred post %chgpre %pred post %chg
FVC 5.68 95 5.81 +2FVC 5.68 95 5.81 +2
FEV1 4.02 81 4.28 +6FEV1 4.02 81 4.28 +6
FEV1/ FVC 68.2FEV1/ FVC 68.2
Thank you
Thank you