ms priya pattni - gp cme north/sat_sports_1100... · by priya l pattni clinical physiologist crfs....
TRANSCRIPT
Ms Priya PattniClinical Physiologist
WDHB
Hamilton
11:00 - 11:30 How to Improve Lung Function Testing
How To Improve Lung function Testing
By Priya L Pattni
Clinical Physiologist CRFS
Key Points
• Spirometry testing
• Indication and contra-indication in brief
• Requirements for the test
• Understand what it measures
• Acceptability and repeatability in detail
• Some common dialogues to improve coaching spirometry
Spirometers
• Portable with minimum moving parts
• Turbine spirometers
• Directly measure flow
• Directly measure volume
Indications
• Screening• Chest pain with no cardiac explanation
• Shortness of breath (COPD early pathology is inflammation and is asymptomatic until FEV1< 50% predicted)
• Cough (chronic or acute) (productive or not)
• Hyperinflation• Respiratory wheeze, stridor or chest tightness
• Scoliosis
• Reduced breath sounds
• Cyanosis• Monitoring
Contra-indications
• Hemoptysis
• Pneumothorax
• Unstable cardiovascular state (recent MI or pulmonary embolism).
• Aneurysm - abdominal, thoracic or cerebral.
• Recent eye surgery
• Uncontrolled hypertension
• Incontinence
• Dementia
• Acute process e.g. nausea & vomiting• Patient not willing
Complications?
• Increased intra-cranial pressure
• Dizziness
• Chest pain only minor stitch pain due to exertion, unless any unstable cardiac condition present
• Paroxysmal coughing
• Hypoxemia
• Bronchospasm
Patient Preparation
∙ No xanthine or caffeine ( tea, coffee, coke)∙ Resting for 15 minutes∙ Make note of all medications patient is taking∙ Note of patient’s smoking history ∙ Ask about any recent illness or medical procedures done∙ Ensure that patient’s clothes are loose
∙ Take standing height and weight without shoes
please note: tests may also be done on inhalers, depending on the clinical question asked
Airway network
Lung volumes
Volume-Time Graph
Components of FV-Loop
• FV-Loop labelled with components
Components of FV-Loop
• FEV1: Forced expiratory volume in first second, is the volume of air exhaled forcefully in first second after maximal inhalation
• FVC: Forced Vital capacity, is the total volume of air exhaled forcefully until no more air can be expired
• FEV1/FVC%: AKA (FER) that is forced expiratory ratio. The FEV1 is presented as a percentage of FVC
• MMEF or FEF25-75%- Maximum Mid Expiratory Flow, decreased in obstructive lung disorders with a concaving pattern of the loop
Spirometry Testing
• Simple brief instructions, followed by prompts during testing in a timely manner.
• Deep breath in and blast out with no pause or hesitation, hard and fast
• Continuous encouragement to keep exhaling is very important
• Then take hard fast deep breath in before coming off the mouthpiece
Phases of Spirometry
Spirometry Testing
• Take a deep breath in..
• Without any pause blast out…
• And keep breathing out….
• Keep going until six seconds reached or patient unable to breath out any further.
• Encourage patient right through the trial…then take a deep breath in and catch your breath.
Acceptability 1
Slow start?
Acceptability 2
Acceptability 3
Acceptability 4
• Short blow with normal ratio and restrictive indication
Acceptability 5
Acceptability 6
• Same patient with much long breath out
Acceptability 7
Acceptability 8
Acceptability 9
Acceptability 10
Acceptability
• No Coughing
• No Hesitation
• No obstruction of mouthpiece
• Full inspiration prior to forced expiratory maneuver
• Maximum efforts required
• No Glottic closure
• No Closing teeth or loose dentures
• Good seal with lips around the mouthpeice
Acceptability
• A full big breath in..
• Good start that is no hesitation
• No cough in 1st second
• Exhalation for 6 - 15 seconds or 3 seconds for children
• No leakage or obstruction
Repeatable
“3 REPEATABLE trials”
• 2 Largest FVC within 0.15 l of one another
• 2 Largest FEV1within 0.15 l of one another or within 0.10 l if FVC ≤ 1.00 l.
(not necessarily from the same attempt)OR
• 8 trials (exhausted!) - use the best 3
Repeatable 1
Repeatable 2
Repeatability
Acceptable and Repeatable?
Acceptable?
Repeatable?
Acceptable?
Acceptable?
Acceptable?
Repeatable?
Acceptable?
Repeatable?
Not getting consistent trials
• Review the trials
• Let patient know where the mistakes are, cough, hesitation, slow start or not blast hard enough etc
• Give time in between trials
• If you don’t want to perform test it will reflect on results
• Encourage patient and be enthusiastic
Try different dialogues
• Describe what is expected
• If possible demonstrate
• Explain nod emphasize the fact that this is not a relaxed test
• Exertion maximally is main part and holding the forceful breath out also as important
Timing
• Timing is everything,
• Pause in your instruction will reflect with either hesitation or pause on the test results
• Review the flow volume loop as the test is being done
• Keep encouraging right through the procedure
Spirometry
• Simply
• Describe
• Demonstrate and get patient to
• Do the test
• ☺