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PubMed2001

Future of spirometry.

This paper discusses some major findings published over the last decade in the field of lung mechanics and respiratory physiology that could potentially be included in the next guidelines for spirometry. Special comment is made on vital capacity, bronchomotor effect of full lung inflation, bronchodilator tests, expiratory airflow reserve and limitation, and use of the flow-volume loops during exercise tests. New and unconventional interpretative strategies presented in the paper may be of assistance in respiratory diagnosis and choice of therapeutic interventions.

Female↗
PubMed1993

Spirometry, blood gas analysis and ultrasonography of the diaphragm after Winnie's interscalene brachial plexus block.

Ten patients with healthy lungs were subjected to radiology, sonography, spirometry and blood gas analysis before and after an interscalene brachial plexus block prior to shoulder surgery. Winnie's interscalene block induced ipsilateral hemidiaphragmatic paresis that was confirmed by radiology and sonography. Changes in forced expiratory vital capacity (FVC), forced expiratory volume (FEV1) and peak expiratory flow rate (PEFR) were significant and PaO2 declined by an average of 1.3 kPa. These changes should not cause further clinical symptoms in sitting patients with unaffected lungs. In patients with pulmonary disease, this method of nerve block should be limited to cases for which there is a clear indication.

Adult↗
PubMed2001

Assessing the reproducibility of nasal spirometry parameters in the measurement of nasal patency.

The reproducibility of nasal spirometry was assessed in ten subjects at two visits. Topical nasal decongestion was applied to minimise mucosal variation. Eleven parameters of flow volume were measured. Data analysis using Spearman's rank correlation coefficients revealed peak inspiratory flow rate (PIFR) followed by forced expiratory volume in first one second (FEV1) to be the most reproducible measures, yielding significance values of < 0.05. For all other spirometric parameters significance was not reached. Analysis revealed that using a naso-pulmonary index (a ratio of nasal to pulmonary flow) was detrimental to reproducibility. We conclude that future nasal spirometric studies should use PIFR and FEV1 as their derived variables of flow-volume loops in the assessment of nasal patency, and the naso-pulmonary index is of no value.

Forced Expiratory Volume↗
PubMed2002

[Spirometry evaluation of montelukast treatment in children with bronchial asthma].

Difficulties associated with the management of asthma were the cause of using the leukotriene antagonists. There was performed a randomised group of 31 children aged 6-18 y (mean 12 yrs., 10 girls and 21 boys) with persistent asthma and poor asthma control. Montelukast was administered once daily, 5-10 mg depended of the age of the patients. This treatment was conducted for three months. Montelukast significantly improved pulmonary lung function (as measured by spirometry). Another effect of montelukast treatment was possibility the reduction beta 2-agonist use and the required dose of inhaled corticosteroids.

Acetates↗
PubMed2002

[Spirometry, pulse oximetry, brochospasmolytic test. The pillars of COPD diagnosis].

In addition to case history and clinical examination, the basic diagnostic work-up of chronic obstructive pulmonary disease comprises in particular lung function testing by means of spirometry. In the event of an uncertain diagnosis, or in a search for underlying causes, an additional EKG, chest X-ray and bronchospasmolytic testing to determine the reversibility of the airways obstruction are employed. In COPD patients younger than 50, as well as in those with pulmonary edema largely confined to the basal fields, determination of the alpha-1-antitrypsin should be carried out. In the case of an exacerbation of the clinical presentation, the sputum should be cultured to determine the possible presence of pathogenic bacteria. Recurrent exacerbations or a rapid worsening of dyspnea necessitate hospitalization.

Adrenergic beta-Agonists↗
PubMed1975

[Pediatric spirometry as a prognostic test of adult obstructive bronchopneumopathy].

Authors study the spirometry of 40 asthmatic children between 6 and 12 years in age. Spirometric determination was performed immediately after the asthmatic attack and also at least 15 days after the last attack. The cases have been subdivided into four groups for what concerns Tiffeneau's index and Mottly's index. The group of subjects with abnormal Tiffeneau's and Mottly's indices is of particular interest. There exists probably in such subjects a beginning emphysema that might lead up, at the adult age, to a picture of obstructive bronchopneumopathy.

Asthma↗
PubMedDate not supplied

Procedure for the assessment of lung function with spirometry.

Spirometry records breath movements, inhalation and exhalation, and is integral to the management of lung disease, alongside good history taking and careful documentation. Tests can indicate a patient's optimal response to treatment or triggers, and the rate of decline in lung function. It is useful to detect the presence of lung disease, those susceptible to developing lung disease and to classify patients into severity classifications to optimise management.

Documentation↗
PubMedDate not supplied

Normal range for nasal partitioning of airflow determined by nasal spirometry in 100 healthy subjects.

BACKGROUND: Nasal spirometry has been used previously to monitor the nasal cycle. Asymmetry of nasal airflow is expressed as a nasal partitioning ratio (NPR) that ranges from -1 (left nasal cavity obstruction) to + (right nasal cavity obstruction) with 0 indicating symmetry of airflow. This study investigated the normal range of NPR in the decongested nose as a means of assessing the degree of nasal septal deviation. METHODS: NPR was measured in 100 healthy volunteers using a portable spirometer. RESULTS: Mean NPR before decongestion was -0.1 +/- 0.32 SD (range, -0.84-0.75), and after decongestion mean NPR was -0.02 +/- 0.16 SD (range, -0.46-0.51). Male NPR ranged from -0.46 to 0.51 (mean, -0.1 +/- 0.22) whereas female NPR was from -0.21 to 0.37 (mean, -0.03 +/- 0.1; p < 0.001). There was a significant correlation between the clinicians assessment of the degree of septal deviation and NPR, r(s) = 0.69 (p < 0.01). The 95% reference range for NPR in this normal population was found to be between +0.30 and -0.34. CONCLUSION: A normal range of NPR may prove useful in assessing patients complaining of nasal obstruction. A case may be made that patients on the waiting list that fall within the normal range of NPR are unlikely to benefit from septal surgery because their nasal passages are not greatly asymmetrical.

Adolescent↗
PubMed1992

[Spirometry in the physician's office].

Spirometry is a valuable tool for the estimation of lung function in the daily practice. Some basic criteria for its use, its interpretation, as well as for the selection of a good spirometer are shortly discussed.

Family Practice↗
PubMed2004

Improving early detection of COPD: the role of spirometry screening assessment.

Chronic obstructive pulmonary disease is on the increase, yet public awareness of the condition remains low. Early diagnosis and smoking cessation can arrest the decline in lung status. A primary care-based spirometry screening assessment initiative has improved diagnosis, resulting in early intervention for patients with COPD.

Early Diagnosis↗
PubMed2005

Positive expiratory pressure device acceptance by hospitalized children with sickle cell disease is comparable to incentive spirometry.

BACKGROUND: The pulmonary complication in sickle cell disease known as acute chest syndrome (ACS) has potential for high morbidity and mortality. A randomized trial demonstrated that incentive spirometry (IS) reduces the rate of ACS, leading to a role for respiratory therapy in hospital management of sickle cell pain. However, use of IS can be limited by chest wall pain, or by difficulty with the coordinated inspiration in a young child. Intermittent positive expiratory pressure (PEP) therapy may be easier for a child's coordination and more comfortable than IS for a child with chest wall pain. PURPOSE: To compare PEP therapy with conventional IS for children hospitalized for sickle cell pain with respect to patient satisfaction, length of hospital stay, and progression to ACS. METHODS: This pilot study enrolled 20 children upon hospitalization for sickle cell pain in the thorax, randomly assigning them to either PEP (n = 11) or IS (n = 9) therapy, administered by a therapist hourly while awake. RESULTS: The randomization assigned an older distribution to PEP than IS (12.3 vs 8.8 y). Patient satisfaction was high for both respiratory care devices, and there was no difference between the PEP and IS groups (4.5 vs 4.4, p = 0.81). Length of hospital stay was similar (5 vs 4.3 d, p = 0.56). No children in either group progressed to ACS. CONCLUSION: These preliminary results show no difference in the primary outcomes in the 2 groups. Intermittent PEP therapy warrants further study as an alternative to IS for sickle cell patients at high risk for ACS, as effective preventive respiratory therapy.

Anemia, Sickle Cell↗
PubMed2004

Use of submaximal inhalation and spirometry to assess the effects of ozone exposure.

Spirometric measures of airway obstruction are strongly influenced by the neurally mediated reduction in total lung capacity that accompanies ozone exposure. This study was conducted to evaluate a method for quantifying the effects of performing spirometry from a reduced inspiratory position on measures of airway obstruction, and to apply the method to published ozone-response data. Nineteen healthy, nonsmoking adults, 18-30 yr of age, each performed 17 forced expiratory maneuvers from inspiratory volumes that ranged from functional residual capacity to total lung capacity. In general, measures of airway obstruction were related strongly to total expired volume, and approximately 80% of the ozone-induced decrease in forced expiratory volume in 1 s (FEV1.0) resulted from the reduction in forced vital capacity. Results indicated that, for young, healthy, nonsmoking adults, spirometric values from maneuvers conducted from reduced inspiratory positions can be predicted accurately and precisely in the unexposed state, allowing interpretation of measures of ozone-induced airway obstruction.

Adolescent↗
PubMedDate not supplied

Lung functions with spirometry: an Indian perspective--II: on the vital capacity of Indians.

Spirometry has been used in India since 1929 to evaluate vital capacity. The mean value for this parameter has changed slightly for the better over about eight decades. It is currently recorded at about 21.8 ml/cm height for males and about 18 ml/cm height for females, the difference between the two sexes being statistically significant throughout the period studied. The vital capacity reaches its peak at about 30 years of age in both Indian men and women and declines there after. There is no significant statistical difference in the vital capacities of subjects from different regions of India. Composite regressions have been generated for use as reference equations for estimating. Vital capacity of Indians is lower than that of Caucasians, but the age related decline is much greater for Caucasians.

Age Factors↗
PubMed1991

A new device of incentive spirometry.

Incentive spirometry is a feedback system to encourage patients to take a deep breath and produce a sustained maximal inspiration (SMI) for the primary purpose of opening and stabilizing atelectatic areas of the lung. However, currently available incentive devices are not reusable, expensive, and emphasize inspiratory effort only. We have designed a new device of incentive spirometer based on pursed-lip breathing technique. The device consists of a piece of paper hanging on a frame. The patient is instructed to take a deep and slow inspiration followed by holding the breath for 5 seconds. Then, using pursed-lip technique, the patient generates a flow to keep the paper attached to a bar as long as possible. The duration of paper blowing is recorded and is compared with vital capacity. In the present study 96 cases were recorded. Vital capacity was correlated well with paper blowing time (multiple regression test r = 0.87, p less than 0.0001). The advantages of our device include (1) reusibility and less cost, (2) equal emphasis of both inspiration and expiration, and (3) being especially helpful for patients with chronic obstructive lung disease (COPD). This is a preliminary result and further clinical study is needed.

Breathing Exercises↗
PubMed1991

[Use of spirometry and bicycle ergometry in the assessment of the stability of mitral valve bioprosthesis].

Muscular and cardiac performance was assessed a spirometry and bicycle ergometry in two groups of patients aged 25-55 with mitral xenobioprostheses functioning normally. 36 patients were examined 1-3 years following surgery (group I), 23 patients in 3.5-8 years. Functional results were found not inferior in group II. Stable parameters were more characteristic for patients having preoperative functional classes I-III.

Adult↗
PubMedDate not supplied

[Ineffectiveness of incentive spirometry as coadjuvant of conventional physiotherapy for the prevention of postoperative respiratory complications after thoracic and esophageal surgery].

We have studied the efficacy of routine use of incentive spirometry (IS) in two groups of patients: group 1 (n = 18) with IS, and group 2 (n = 19), no IS. All patients suffered from lung or esophagus neoplasm and received respiratory physiotherapy before and after the operation. They underwent high chest and abdomen surgery. The incidence of alterations of pulmonary auscultation, roentgenologic abnormalities and alterations of the alveolar-arterial difference of oxygen (D[A-a]O2) as well as postoperative complications were similar in both groups. Patients undergoing digestive surgery presented a higher frequency of pleural effusion (p less than 0.05) and of them, the subgroup with IS stayed at the hospital for a longer time (47.2 +/- 32 days) than the subgroup undergoing digestive surgery not submitted to IS (p less than 0.01) probably because of the higher incidence of neoplasms of the mean third of the esophagus in such group. In our study and in the context of the type of surgery studied, the routine use of IS does not decrease the frequency of clinical and roentgenologic alterations neither improves the efficacy of postoperative gas interchange.

Adult↗
PubMed1990

[The bronchospasmolytic test with anticholinergic drugs and sympathomimetics: differences between body plethysmography and spirometry measuring procedures].

The different bronchodilator effects after inhalation of anticholinergic and beta-adrenergic drugs due to the different methods of measurement (i.a. body plethysmography vs. spirometry) were studied in 43 patients with COLD and in 20 healthy subjects. The greatest changes occur when the body plethysmographic value Rt was chosen. The spirometric values FEV1 and PEF show the greatest bronchodilator effect. The patients with COLD have the best bronchodilation after inhalation of the beta-adrenergic drug, whereas the healthy subjects show the greatest effect after anticholinergic drugs.

Airway Resistance↗