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PubMed1990

[Studies of normal values and prediction equations for pulmonary function--spirometry and flow-volume measurements in healthy Japanese children 6 to 14 years of age].

We analyzed spirometric data (spirograms and flow-volume curves) on 1,357 healthy Japanese children (6-14 yr, 709 males and 648 females) in Higashimatsuyama, Saitama. The area was selected as the representative of the less polluted area in Japan, as we intended to exclude possible effects of air-pollution on spirometric values. Hot-wire anaemometers (AS 3500, AS 4500, MINATO) were used in the spirometry and the test procedures were done following the American Thoracic Society recommendations. By multiple regression analysis prediction equations were obtained for VC, FVC, FEV1, FEV1/FVC (%), MMFR, PEFR (Peak Expiratory Flow Rate), V75, V50, and V25. The selected variables were height and weight for VC, FVC and FEV1 but only height for MMFR, PEFR, V75, V50 and V25. Since there was no significant correlations between FEV1/FVC (%) and these variables, we defined normal ranges for FEV1/FVC (%). The predicted values derived from our equations were larger than those obtained from the other studies published in Japan. The difference is probably due to the improvement in the body size of Japanese children and the equipments used.

Adolescent↗
PubMed1989

Spirometry and flow-volume curves.

Spirometry is the best and most widely used pulmonary function test. Equipment recommendations are made and performance information about different types of spirometers is given. Methods for obtaining clinically applicable spirometric results for use in making diagnostic and treatment decisions are presented. Selection and use of reference or "normal" values and interpretive strategies are discussed.

Forced Expiratory Flow Rates↗
PubMedDate not supplied

Rating of breathlessness at rest during acute asthma: correlation with spirometry and usefulness of breath-holding time.

We studied 13 patients with acute attacks of asthma to test the hypothesis that magnitude of dyspnea at rest correlates well with spirometry and with breath-holding time. Dyspnea ("falta de aire" in Spanish) was quantitated with a linear numerical scale from 0 to 10. We measured breath-holding time, breathing frequency (f), and FEV1 and FVC both expressed as percent of normal. Measurements were done on the patient's arrival and were repeated 3 to 6 times until dyspnea at rest disappeared or was minimal. Dyspnea magnitude, f, and breath-holding time correlated well with FEV1% and FVC% (r between 0.65 and 0.78), and better with changes in FEV1% and FVC% with respect to initial values (delta FEV1 y delta FVC; r between 0.80 and 0.89). Breath-holding time and f changed in proportion to magnitude of dyspnea (r = -0.85 and 0.87 respectively). Regression equations were: dyspnea = 6.34 -0.16 (delta FEV1) r = 0.80, and dyspnea = 7.82-0.105 (FEV1%) r = 0.62. Using multiple regression we improved prediction of FEV1% with easily obtained variables (R = 0.76). These results suggest that: 1) magnitude of dysnea, f, and breath-holding time correlate with severity of airflow obstruction in acute asthma attacks associated with dyspnea at rest; and 2) breath-holding time varies inversely with dyspnea magnitude when it is present at rest.

Acute Disease↗
PubMed1988

Nocturnal asthma: effects of slow-release terbutaline on spirometry and arterial blood-gases.

The effect of terbutaline, in a slow-release preparation, on spirometry and arterial blood-gases, was studied in fourteen patients with nocturnal asthma. The patients were treated with either 15 mg of slow-release terbutaline or placebo given as a single dose at 10 pm for eight days in a double-blind crossover trial. The patients were studied in the hospital for one night at the end of each treatment period. During active treatment the patients had a significantly higher FEV1 and PaO2 compared with placebo. Tolerance to the high single dose was good and none of the patients discontinued treatment because of side-effects. In patients with nocturnal asthma treatment with a high dose of slow-release terbutaline given as a single dose in the evening appears to be effective.

Asthma↗
PubMedDate not supplied

Standardizing spirometry: problems and prospects.

Pulmonary function tests, as well as clinical tests of other physiologic functions, have been adopted from the clinical setting for use in epidemiologic studies. Because these tests require an individual's maximal effort, they present a challenge to conventional standards of measurement validity. The author demonstrates that attempts to standardize spirometry in current epidemiologic studies reveal a bias that causes underestimation of adverse pulmonary effects of occupational hazards.

Forced Expiratory Volume↗
PubMed1987

Influence of spirometry and chest roentgenography on the management of pulmonary outpatients.

Spirometry and chest roentgenography are frequently employed to evaluate patients with respiratory problems. To determine their impact on the management of outpatients with lung disease, both tests were performed on 100 consecutive patients (40 men and 60 women; mean age, 52 +/- 15 years) who returned for reevaluation 16 +/- 9 weeks after their previous clinic visit. Patients with obstructive (n = 45), restrictive (n = 35), and mixed (n = 20) lung diseases were initially assessed by history and physical examination and classified clinically as improved, stable, or worse. A clinical management plan (CMP) was formulated based on this initial evaluation. Changes in the proposed CMP due to spirographic or roentgenographic results were then noted. None of the 19 patients who were clinically improved and only two (3%) of the 64 clinically stable patients had a change in CMP. In contrast, five (29%) of the 17 patients whose conditions deteriorated clinically had their proposed CMP modified after review of the spirograms and roentgenograms. Therapy was intensified in three of the seven patients whose CMPs were modified, while in the other four, treatment was withheld because results of both tests were unchanged. These results indicate that routine spirograms and chest films have little influence on the CMP of clinically stable patients. However, unexpected roentgenographic and spirometric findings frequently alter the management of the individual whose condition has clinically deteriorated.

Adult↗
PubMed1985

Spirometry reference values for nonexposed blue-collar workers.

Epidemiologic research into occupationally related lung disease often requires the comparison of a study population with an external reference group. To establish such a reference group, carefully selected blue-collar workers who had no obvious adverse occupational pulmonary exposure performed simple spirometry, were administered a standard questionnaire, and had standard chest roentgenograms taken. Prediction equations were established for six pulmonary function indices, and a method is given for using these equations to compare a study group with this external nonexposed group. Asymptomatic nonsmokers with negative roentgenograms were extracted from the overall group, and comparison with published data for other such normal groups indicated that the present group is similar to most of them, indicating that there are no serious biases in the present group.

Adult↗
PubMedDate not supplied

[Atmospheric pollution and spirometry in healthy children of the Distrito Federal].

Investigation of the vital capacity, maximum expiratory flow and maximum mean expiratory flow was carried out in children living in two areas of Mexico City, one of them with a high degree (azcapotzalco) and the other one with low degree (Tizapán) of air pollution. Timed spirometry was carried out on children attending 4th, 5th and 6th grades in two official grammar schools so both groups were as uniform as possible in their social-economical level and nutritional and health conditions. This goal was attained quite satisfactorily and groups turned similar, after comparing results and analysing statistically somatometric data, together with scholarship of the parents, economical income, history of respiratory diseases and physical examination. However, quite a significant statistical difference (p less than 0.001) was found between the parameters involving measurements of ventilation in favor of Tizapán children. The difference between Azcapotzalco and Tizapán children in terms of the three ventilatory parameters analyzed was possibly due to the fact the former lived in a greater polluted area.

Air Pollution↗
PubMed1984

[Experiences with oscilloresistometry in addition to spirometry in preoperative function diagnosis in the elderly].

A sample of 57 geriatric surgical patients were investigated with the aim of establishing which additional information the forced oscillation method yields for the assessment of an increased operation risk as compared with spirometry. In addition to the proved diagnosis of a restrictive ventilatory disturbance as causing a limitation of the maximum available respiratory volume, the measuring of the oscillatory resistance makes it possible in particular to prove and quantify the obstruction. Over and above this, the measuring of resistance fluctuation while breathing at rest makes it possible to differentiate a geronto-typical exobronchial component of the obstruction. Conclusions are drawn for the improved care of geriatric surgical patients.

Adenoma↗
PubMed1978

Spirometry in convalescent hemiplegic patients.

The forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) were determined in 20 patients with convalescent hemiplegia. The FVC and FEV1 were reduced and the PEFR was within normal range. These results indicate a restrictive ventilatory defect with an FEV% that approached the vital capacity. The physical ability of each patient was assessed on the basis of the time it took to walk a distance of 18.5 meters as quickly as possible. Although it appears from the results that physical ability did not bear any relationship to the degree of restrictive ventilatory defect, other parameters of spirometry may be needed to confirm this. The results suggest that the restrictive ventilatory defect will be of more clinical importance in exercise tolerance for strenuous exercise than in ordinary daily activities.

Adult↗
PubMed1980

The response of asthmatic patients and normal subjects to maximum respiratory manoeuvres. Spirometry--induced bronchoconstriction.

Fourteen atopic asthmatics, 12 non-atopic asthmatics, and 14 normal subjects performed a series of pairs of FEV1.0 measurements, with the first and second measurements separated by initially 10 seconds, then 30 seconds and finally 60 seconds. Two further pairs of FEV1.0 measurements were made at the interval that had produced the greatest fall in FEV1.0 to examine the consistency of this response. A correlation with bronchial lability on exercise testing was sought in 16 patients. In the asthmatics a further pair of FEV1.0 measurements was performed after bronchodilatation with 200 mcg salbutamol. Both atopic and non-atopic asthmatics showed a slight fall in FEV1.0 in successive measurements which was not seen in normal subjects. The small size of the fall is unlikely to interfere with spirometry results in clinical testing. Some subjects show a larger response and should be excluded from trials of drugs. Salbutamol diminished or abolished the response. The fall in FEV1.0 did not correlate with the results of exercise testing.

Adult↗
PubMed1981

Evaluation of the Cavitron Spirometric Computer for accuracy in clinical screening spirometry.

Ten healthy male cardiopulmonary technicians, 10 aircrew members, and 10 patients performed a series of pulmonary function studies to compare the Cavitron Spirometric Computer to the conventional water-sealed Collins 13.5-/spirometer. A total of 50 studies were performed on the spirometers individually and then with the spirometers linked in-line. The Cavitron FVC averaged 6% less, the FEV1--7% less, and the FEF 25-75%--11.6% less than comparable measurements from the Collins spirometer. Since these difference are within the suggested guidelines for screening studies, the Cavitron Spirometric Computer is acceptable for use in clinical screening spirometry.

Adult↗
PubMed1981

Spirometry and other pulmonary function tests.

Pulmonary function tests provide important clinical information in patients with pulmonary disease. Spirometry gives accurate, rapid information regarding the presence or absence of obstructive or restrictive lung disease and the response to bronchodilators. Particular attention to technique is necessary for valid results. Further information on pulmonary function is provided by the measurement of static lung volumes by dilution techniques or body plethysmography; in some instances lung compliance measurements are indicated.

Family Practice↗
PubMed1994

Normal variations in spirometry in health following placebo inhalation.

Normal i.e., chance variations in spirometry were evaluated in 80 healthy Indian adults by the measurement of base-line spirometric indices (FVC, FEV1 and FEF25-75%) and the per cent changes following placebo administration of aerosolized saline. There was a mean per cent change of 0.7, 0.4 and 0.3 per cent over the base-line values in FVC, FEV1 and FEF25-75% respectively following placebo inhalation. The cut off responses for 95 per cent confidence limits were 11.2 per cent for FVC and 12.7 per cent for FEV1 following placebo inhalation. Since the test sample represents a healthy Indian population, a per cent change greater than 12.7 per cent in FEV1 is more than that observed in 95 per cent of healthy Indians. It is suggested that for both delta FEV1 per cent and delta FVC per cent, the lower limit should be fixed at more than 15 per cent to define 'abnormality' in clinical practice.

Administration, Inhalation↗
PubMed1994

[Error factors in spirometry].

Spirometry is the more frequently used method to estimate pulmonary function in the clinical laboratory. It is important to comply with technical requisites to approximate the real values sought as well as adequate interpretation of results. Recommendations are made to establish: 1--quality control 2--define abnormality 3--classify the change from normal and its degree 4--define reversibility. In relation to quality control several criteria are pointed out such as end of the test, back-extrapolation and extrapolated volume in order to delineate most common errors. Daily calibration is advised. Inspection of graphical records of the test is mandatory. The limitations to the common use of 80% of predicted values to establish abnormality is stressed. The reasons for employing 95% confidence limits are detailed. It is important to select the reference values equation (in view of the differences in predicted values). It is advisable to validate the selection with local population normal values. In relation to the definition of the defect as restrictive or obstructive, the limitations of vital capacity (VC) to establish restriction, when obstruction is also present, are defined. Also the limitations of maximal mid-expiratory flow 25-75 (FMF 25-75) as an isolated marker of obstruction. Finally the qualities of forced expiratory volume in 1 sec (VEF1) and the difficulties with other indicators (CVF, FMF 25-75, VEF1/CVF) to estimate reversibility after bronchodilators are evaluated. The value of different methods used to define reversibility (% of change in initial value, absolute change or % of predicted), is commented. Clinical spirometric studies in order to be valuable should be performed with the same technical rigour as any other more complex studies.

Adolescent↗
PubMed1993

[A proposal for spirometry standardization in the city of Buenos Aires].

This paper refers to a Multicentric Quality Control Program on spirometry performed in Buenos Aires city. Seventeen spirometers (9 water seal, dry rolling seal or bellows, 5 flow detection type and 3 peak-flow meters) owned by 8 different Hospitals were tested. Reference values were obtained by means of an Explosive Decompression Simulator calibrated against a Stead-Wells bell spirometer, which meets ATS recommendations. Only 42% (6/14) of the tested spirometers agreed with the ATS minimal requirements with regard to FVC and FEV1; volumetric spirometers performed better than flow detectors. The maximal error was 11% when measuring a FVC of 3.41 L. Peak flow showed a very high inter-instrument coefficient of variation. The need of frequent quality control checks is stressed.

Argentina↗
PubMed1993

Daily home spirometry facilitates early detection of rejection in single lung transplant recipients with emphysema.

Eight single lung transplant recipients with emphysema, aged 40-58 yrs, have been followed up for 90 patient months. Starting 2-4 weeks postoperatively, they recorded their forced vital capacity (FVC), and forced expiratory volume in one second (FEV1), at a fixed time every morning using a Micro Spirometer. They were instructed to contact the hospital if the FVC or FEV1 displayed a persistent (two days or more) decrease of 10%, compared with the average values during the last seven days. Transbronchial biopsies (TBB) were performed regularly in the follow-up, and whenever the patients had respiratory symptoms, or the FVC or FEV1 displayed a persistent decline of more than 10%. We performed 59 TBBs, and 23 biopsy specimens showed rejection. The FVC and FEV1 values on the TBB day were compared with the mean values of the 7 previous days. FVC and FEV1, associated with negative TBBs (16 events), showed no significant changes. However, FVC and FEV1 decreased significantly (p < 0.001, paired t-test) during rejections (mean percentage change 14 and 21% respectively, range +8% to -53%). In 16 of the 23 rejections, the FEV1 decreased by > 10%. We recommend the use of daily home spirometry when monitoring single lung recipients with emphysema, and suggest that a persistent 10% decrease in FEV1 or FVC for at least two days is an indication for hospital admission and possible TBB.

Adult↗