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	What is spirometry?

Solution Spirometry is invaluable as a screening test of general respiratory health in the same way that blood pressure provides important information about general cardiovascular health. However, on its own, spirometry does not lead clinicians directly to an aetiological diagnosis. Some indications for spirometry are given in the ATS/ERS 2005 Standardisation of spirometry.

Diagnostic
To evaluate symptoms, signs or abnormal laboratory tests
To measure the effect of disease on pulmonary function
To screen individuals at risk of having pulmonary disease
To assess pre-operative risk
To assess prognosis
To assess health status before beginning strenuous physical activity
programmes

Monitoring
To assess therapeutic intervention
To describe the course of diseases that affect lung function
To monitor people exposed to injurious agents
To monitor for adverse reactions to drugs with known pulmonary toxicity

Disability/impairment evaluations
To assess patients as part of a rehabilitation programme
To assess risks as part of an insurance evaluation
To assess individuals for legal reasons

Public health
Epidemiological surveys
Derivation of reference equations
Clinical research

Spirometry is a noninvasive, medical screening test to study of air volume and flow rate within the lungs and to study various aspects of breathing and lung function. Spirometry is frequently used to evaluate lung function in people with obstructive or restrictive lung diseases such as asthma, chronic obstructive pulmonary disease (COPD) or cystic fibrosis.

Spirometry is performed by using a spirometer, a special device that registers the amount of air a subject inhales or exhales and the rate at which the air is moved into or out of the lungs. Spirograms are tracings or recordings of the information obtained from the test. The most common spirometric tests require that the subject exhale as forcefully as possible after taking in a full, deep breath. The subject's efforts are called forced expiratory and inspiratory manoeuvres.

The clinical value of spirometric measurements is critically dependent on the correct operation and accuracy of the spirometer, performance of the correct breathing manoeuvre and use of relevant predicted normal values.

National Lung Health Education Program recommends spirometry for all smokers, who are over 45 years old and for anyone with dyspnea on exertion, chronic cough, mucus hypersecretion, or wheeze (Ferguson GT, Enright PL, Buist AS, et al. Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program. Chest 2000; 117:1146–1161).

The National Asthma Education Program has recommended spirometry in the evaluation of asthmatics for more than a decade (National Asthma Education Program. Expert panel report: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Institutes of Health, 1991; publication No. 91–3042). Thus, spirometry has to become the standard of care.

The Framingham study has shown a causal link of reduced spirometry study results and sudden cardiac death linked to coronary artery disease (Sorlie P, Lakatos E, Kannel WB, et al. Influence of cigarette smoking on lung function at baseline and at follow-up in 14 years: The Framingham Study. J Chron Dis 1987;40:849-856).

During the past 30 years, pulmonary function testing has come into widespread use. This has been facilitated by several developments:

Miniaturization and advances in computer technology, microprocessor devices have become portable and automated with fewer moving parts.
Testing equipment, patient manoeuvres, and testing technique have become widely standardized throughout the world through the efforts of professional

Testing equipment, patient manoeuvres, and testing technique have become widely standardized throughout the world through the efforts of professional societies.

Widely accepted normative parameters have been established.

Over the past years it has become obvious that the spirometers and peak flow meters used to measure ventilatory function are as deserving of a place in the family practitioner's surgery as the sphygmomanometer. After all, who would dream of managing hypertension without measurement of blood pressure? No doctor would prescribe antiarrhythmics without evidence of cardiac rhythm disturbances, or insulin without measurements of blood sugar. Analogously, it is not appropriate to treat obstructive or restrictive lung diseases without spirometry. Spirometry is as fundamental to the diagnosis and management of pulmonary diseases as the sphygmomanometer is to the assessment and management of hypertension.

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28 Dec 2007 08:20 AM

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