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Asthma Spirometry

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3. Evaluating the use of a portable spirometers in a study of pediatric asthma. Chest. ... Spirometers. SDI Diagnostics, Spirolab II ... – PowerPoint PPT presentation

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Title: Asthma Spirometry


1
AsthmaSpirometry Devices
  • BUMED Asthma Action Team

2
Objectives
  • To understand the basic mechanics of respiration
  • To have a basic understanding of how to properly
    administer spirometry to pediatric asthma
    patients.
  • To understand the value of spirometry in the
    asthma clinic setting
  • To provide patient education relating to testing
    and treatment

3
Dynamics of Breathing
  • Inspiration Negative intrathoracic pressure
    relative to atmosphere. Diaphragm and
    inspiratory muscles contract, lungs fill
    passively.
  • Expiration Passive process resulting from
    elastic recoil of expanded lung walls. During
    rapid breathing, internal intercostal and
    abdominal muscles contract to force air out of
    lungs.

4
Spirometry
  • The measurement of the flow and volume of air
    entering and leaving the lungs.

5
Pulmonary Function Testing
  • Dependent upon
  • Age
  • Body Size (height and weight)
  • Gender
  • Pulmonary Health
  • Altitude
  • Irritants
  • Effort dependant, (patient tech)

6
Dynamic Lung Volumes
  • Valuable in spirometry for following the progress
    of a patient with asthma
  • Can be used to assess response to treatment
    (pre/post bronchodilator)
  • Help assess lung health
  • Does not provide the diagnosis, but can
    demonstrate if lung function is consistent with a
    diagnosis

7
Dynamic Lung Volumes
  • Forced Vital Capacity (FVC) Volume expired by a
    forced maximal expiration after maximal
    inhalation, also known as FEV6.
  • Forced Exp. Volume in 1 second (FEV1) Volume of
    air forcefully expired in the first 1 second from
    a position of maximal inspiration.

8
  • FVC
  • The largest volume of air
  • that can be forcefully
  • expired from
  • the lungs

exp

insp
9
  • FEV1
  • The largest
  • volume of air that can be forcefully
  • expired in the first second
  • Indication of long-term risk in asthma

exp

1sec
insp
10
  • FEV1/FVC
  • The ratio of FEV1
  • to FVC expressed as
  • a percentage. It is
  • the most commonly
  • used measurement
  • of airway obstruction.
  • Provides severity classification level of
    asthma control.


11
  • FEFmax (PEFR)
  • The maximal
  • expiratory flow
  • generated during
  • a forced maneuver.
  • Referred to as the
  • effort or the blast.

FEF Max

12
Administering PFTs in Children
  • Requires pt cooperation (unlikely in children
    less than 5-6 yrs).
  • Requires a technician who is sensitive to the
    needs of children.
  • Practice makes perfect!
  • Calm, success-oriented
  • environment.

13
Administering PFTs in Children
  • Ask child to take a full breath (to maximal
    inflation), followed by a brief hold.
  • Next, perform a maximal forced exhalation for at
    least 3 seconds.
  • Blow out all your birthday
  • candles.

14
Standards for the Testing Environment
  • Torso and head should be erect in sitting or
    standing posture
  • Nose clip should be used
  • Special training is required for test
    administrators

15
Standards for the Testing Environment
  • All reports should include date of birth, date of
    test, weight/height, sex, race, absolute values
    of all measurements with percent of predicted
    values and conditions of test
  • VC should be reported as the largest value
    obtained from any of the respiratory maneuvers
  • Best of three
  • Best test is the one with the greatest sum of
    FEV1 and FVC

Data from Taussig LM, Chernick V, Wood R, et al
Standardization of lung function testing in
children. J Pediatr 97 668-676, 1980
16
Performing the Test
  • Obtain height and weight by physically taking the
    patient to the scales to measure height weight
  • Explain and demonstrate the testing maneuver to
    the patient and parents, practice, and get the
    child to feel comfortable with procedure
  • Perform testing, 3 consistent tests with
    repeatable results
  • Administer bronchodilator if indicated, retest

17
Coaching during testing
  • Perhaps the MOST important aspect of testing.
  • Deep breath in, BLAST it out, keep blowing,
    blowing, blowing, DEEP breath in, and that's
    done!
  • Techs should become competent by TAD training,
    civilian PFT labs, extend out a Medivac to
    include time in the PFT lab of a major MTF, or
    manufacturer inservice.

18
  • ATS (American Thoracic Society) criteria
  • Acceptability and reproducibility criteria
    include
  • Expiration minimum of 6 seconds or until no
    volume change for at least 1 sec
  • Three acceptable efforts should be saved for
    interpretive purposes
  • The two largest FVC and FEV1values should agree
    within 150ml

19
  • ATS (American Thoracic Society) criteria
  • Acceptability and reproducibility criteria
    include
  • No hesitation at the start of the test
  • Back extrapolation should be less than 5 of the
    FVC or 150cc
  • Absence of coughing during test
  • No glottic closure, mouthpiece obstruction by
    tongue, and/or leaks

20
  • ATS (American Thoracic Society) criteria

Testing should continue until - Three
acceptable tests have been achieved, -
Patient just cant perform testing,
and/or - The patient just cannot continue.
21
The technicians job is to also be able to
recognize poor efforts
  • glottic closure
  • poor expiratory
  • flows
  • inconsistencies in
  • volumes flows
  • coughing

22
Interpreting Results
  • Spirometry allows comparison of patients lung
    function to reference values.
  • Technicians should refrain from diagnosing any
    test directly to the patient.
  • Should be interpreted by a pediatric asthma
    specialist until competencies are demonstrated
    for certification.

23
Example of Glottic Closure
Glottic closure
Normal
Flow ceased (red) Continuous flow (white)
24
Poor Expiratory Efforts, inconsistencies, and
coughing examples
Hesitation, causing back extrapolationloss of
volume in first 10 of flow
No effort heredid not blast
25
Poor Expiratory Efforts, inconsistencies, and
coughing examples
Stopped flow prematurely Glottic closure
By placing the flow loops on top of each other,
you can see the inconsistencies
26
Interpreting Results
  • Flow-volume loop highest point of curve is the
    peak flow rate
  • Volume expired versus time helpful in
    determining FEV1

27
Interpreting Results
  • Numerical data Patient values compared to
    predicted values for dynamic lung volumes

28
Interpreting Results
  • Assess quality of study!
  • Appropriate curve shape without artifact.
  • Sustained expiration for 3 seconds.
  • At least 3 FVCs within 150ccs of best effort
    (except in very young).
  • Satisfactory effort as determined by tester.
  • Response to bronchodilator gt12 increase in FEV1

29
Pattern Recognition
30
Recognizing Artifact
Poor Effort
Coughing
31
Recognizing Artifact
32
(No Transcript)
33
Quality Assurance for Interpretations
  • Studies should be entered into AHLTA
  • Results should be made available to Dr. Wojtczak
    or Dr. Lee for review pending asthma treatment
    certification

34
Literature for testing
  • Outcomes Associated With Spirometry for Pediatric
    Asthma in a Managed Care Organization, Pediatrics
    2006118151-156
  • Forced Expiratory Volume in 1 Second Percentage
    Improves the Classification of Severity Among
    Children With Asthma, Pediatrics
    2006118347-355
  • Office Spirometry in Primary Care Pediatrics,
    Pediatrics 2005 116792-797
  • Guidelines for the Diagnosis and Management of
    Asthma, NIH, Nov 1997

35
Spirometry in Asthma Care
  • Should be a tool for diagnosis and treatment.
  • Can be used to help determine appropriate
    medications

1. Office spirometry in primary care pediatrics
a pilot study. Pediatrics. 2005
Dec116(6)e792-7 2. The influence of pulmonary
function testing on the management of asthma in
children. J Pediatr. 2005 Dec147(6)797-801. 3.
Evaluating the use of a portable spirometers in a
study of pediatric asthma. Chest. 2003
Jun123(6)1899-907.
36
Summary
  • Spirometry is an important diagnostic tool which
    should be used in the primary care setting.
  • Requires proper training for physicians, nurses,
    techs.
  • Portable spirometry equipment produces quality
    studies and allows for testing in clinical
    setting.

37
Asthma Treatment Tools
38
Spirometers
  • Ferraris KoKo Spirometer
  • PC based, easy to use, ability to network, and a
    pediatric display.

39
Spirometers
  • Creative Biomedics DX-Portable Plus
  • Self-contained portable unit, pediatric display

40
Spirometers
  • SDI Diagnostics, Spirolab II
  • Small self-contained unit, no pediatric display,
    cant network
  • into AHLTA

41
Treatment Inhaler use
  • Shake Medication
  • Exhale
  • Inhale medication slowly
  • Hold your breath 10 seconds
  • Slowly Exhale

42
Treatment . . . Is my Inhaler empty?
  • Keep track of your puffs
  • Controller inhalers have between 60-120 puffs
  • Rescue inhalers have 200 puffs
  • Replace when EMPTY
  • Rinse mouth after using steroids!

43
Home Nebulizers
  • Most MTFs have units for home use.
  • Open unit, attach nebulizer, add medication, turn
    on, and breath till meds are done.

44
Treatment . . . Valved Holding
Chamber
  • Insert the inhaler into the back piece of the
    chamber
  • Shake, exhale, squirt, inhale slowly, hold 10
    seconds and then exhale slowly
  • Clean your spacer initially and weekly, warm
    soapy water, rinse well, air dry only.

45
Aerochamber with mask
  • If using a mask, spend time getting the child
    used to it, seal it well over face, watch for
    flapper valve movement, administer meds, hold on
    face for 15 seconds.

46
Monitoring Asthma
  • Peak flow meter
  • A simple test that can be completed at home or
    school
  • Follow package directions to determine zones
  • Deep breath in, blast out
  • Best of 3 efforts
  • Record results
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