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Office spirometry e spirometria domiciliare: i requisiti minimi e loro rispondenza nelle strumentazi

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Title: Office spirometry e spirometria domiciliare: i requisiti minimi e loro rispondenza nelle strumentazi


1
Office spirometry e spirometria domiciliare i
requisiti minimi e loro rispondenza nelle
strumentazioni attuali
  • Andrea Pelucchi Antonio Foresi
  • Servizio di Pneumologia e Fisiopatologia
    Respiratoria
  • Sesto San Giovanni
  • I Congresso AIPO di Telemedicina Bari 29-30
    Ottobre 2004

2
John Hutchinson, 18111861, inventor of the
spirometer. Reprinted with permission from
Wellcome Trust Medical Photographic Library.
3
Silhouette of John Hutchinson and his spirometer,
illustrating correct body positioning for
performance of the vital capacity maneuver
Petty, T. L. Chest 2002121219S-223S
4
Indication for Spirometry
  • Diagnosis
  • Early detection
  • Monitoring

5
Office spirometry, portable spirometr, handheld
electronic spirometer home spirometers,office-base
d spirometers, standard spirometers
6
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7
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8
  • TYPES OF SPIROMETERS
  • 2. Flow-Type spirometers
  • Indirectly measure airflow during exhalation
    integrate the flows to obtain expired volume
    (pneumotachometer, turbine, hot wire anemometer,
    vortex, ultrasound beam)
  • Large range of flows are measured during a forced
    expiration Flow sensors may perform better at
    high flow rates (early in maneuver) than at low
    flow rates (end of maneuver)
  • Often more variable (less precise) than
    volumetric spirometers
  • Integrity of sensors must be maintained for
    accurate spirometry measurements - if sensor is
    damaged, blocked, or has moisture condensation or
    obstruction by mucus, test results may be
    erroneous
  • Malfunctions in sensors, transducers, and
    electronics can go unnoticed - users must be
    alert for anomalous results
  • Lightweight and portable.

9
  • Factors to Consider when Choosing a Spirometer
  • A spirometer must
  • be simple to use
  • be safe and effective. Ensure compliance with
    spirometer and electrical safety standards
  • be capable of simple routine calibration checking
    and have stable calibration which allows
    adjustments by the operator
  • be robust and reliable, with low maintenance
    requirements
  • provide graphic display of the manoeuvre
  • utilise a sensor which is disposable or can be
    cleaned and disinfected
  • be purchased from a reputable supplier who can
    provide training and servicing/repair
  • be provided with a comprehensive manual
    describing its operation, routine maintenance and
    calibration
  • use relevant normal predicted values
  • be reasonably priced.

10
American Thoracic Society.
Standardization of spirometry, 1994 update. Am J
Respir Crit Care Med 1995152,1107-1136
11
MINIMAL RECOMMENDATIONS
12
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13
Early assessment of respiratory function in
people at risk for chronic respiratory diseases.
Office Spirometers Must Only Report Values for
FEV1, FEV6, and the FEV1/FEV6 Ratio
14
Technical Requirements for Office Spirometers
  • Advantages of the newly proposed category of
    office spirometers for this purpose include
  • lower instrument cost
  • smaller size
  • less effort to perform the test
  • improved ease of calibration checks
  • an improved quality-assurance program
  • Office spirometers should not be utilized for
    diagnostic testing, surveillance for occupational
    lung disease, disability evaluations, or
    research purposes.

Ferguson GT et al Chest. 20001171146-1161
15
Sample volume-time curve illustrating differences
between FVC- and FVC6-derived parameters
Chest. 20031241805-1811.
16
van Schalkwyk EM, Schultz C, Joubert JR, White
NW South African Thoracic Society Standards of
Spirometry Committee. Guideline for office
spirometry in adults, 2004. S Afr Med J. 2004
Jul94(7 Pt 2)576-87. Ferguson GT, Enright PL,
Buist AS, Higgins MW. Office spirometry for lung
health assessment in adults A consensus
statement from the National Lung Health
Education Program. Chest. 2000
Apr117(4)1146-61.
17
The necessity for each new office spirometry
system to have a "real-world" validation study
before it is marketed.
Ferguson GT et al Chest. 20001171146-1161
Each new office spirometry system must pass
a real world validation study, ensuring that
both the false positive and false-negative rates
are less than 5 . No spirometry system has
completed such a validation study,
however, and their real world accuracy is
unknown
Enright PL Ferguson GT et al Clin Chest Med
21645-6522000.
18
Gold Standard
19
Precision or Reproducibility
  • Is reliability
  • Indicates the ability of an instrument to yield
    the same measurement for a variable when the
    variable is measured repeatedly
  • Precision does not infer accuracy

20
Accuracy or Validity
  • The ability of an instrument to measure its true
    value.
  • If accurate it is also valid and reliable (or
    precise)
  • Can be accurate at one level (magnitude) of
    measurement but inaccurate at others
  • Instruments should reflect acceptable accuracy
    over range of values you measure

21
Ten patients were asked to perform the same
maneuvers. They represented various degrees of
severity of COPD
G Liistro et al. ERS 2004
22
Coefficient of variability measured in the highly
trained subjects
G Liistro et al. ERS 2004
23
Bland Altman
Proportional error
1,2
1
0,8
0,6
Difference (reference-test)
0,4
0,2
0
1
2
3
4
5
6
-0,2
-0,4
Mean
G Liistro et al. ERS 2004
24
G Liistro et al. ERS 2004
25
UNDERESTIMATION
G Liistro et al. ERS 2004
26
Some devices presented a proportional error for
some parameters
27
Office-based spirometer value minus portable
spirometer value vs mean of two values
YES
NO
Mortimer, K. M. et al. Chest 20031231899-1907
28
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29
Effect of errors on respiratory screening and
surveillance programs
Townsend, M. C. et al. Chest 20041251902-1909
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