Fitting
Quality Spirometry into a Standard Consultation
The following sequence is commonly employed:
- Measure the patient’s standing height.
- Perform pre-bronchodilator spirometry as soon as you
have determined that your patient requires the test.
- Administer a bronchodilator and then complete the
rest of the consultation.
- By the time you have done this, sufficient time will
have passed for the post-bronchodilator spirometry to be done (e.g. 10
minutes).
- With the results of spirometry now available you will
be better equipped to discuss the diagnosis, outlook and agree on a
management plan with your patient.
Selecting the Most Appropriate Reference Values
Spirometric indices such as FEV1 and FVC vary with
age, height, gender and ethnic origin. It is important to note that if the
patient’s height, age or gender is entered incorrectly inaccurate reference
values will result and the subsequent interpretation of the lung function test
results will be affected.
The choice of predicted reference values against which the
results are compared is important. The reference values chosen should closely
match the subjects you are testing. More information on reference value
selection is provided in Section 2. In general, Caucasian predicted values for
FEV1 and FVC are usually reduced by 12-15% when testing people of other ethnic
backgrounds
Spirometry Training
Inadequate operator training will result in poor quality
spirometry. To obtain clinically useful results the operator must comprehend the
basic principals of quality spirometry.
Anybody performing spirometry on patients must be:
- Adequately trained in the performance of the correct
breathing manoeuvre.
- Trained to identify and overcome poor technique.
- Trained to use, maintain and validate the spirometer
correctly.
- Trained to identify whether the tests have been done
properly and are consistent with previous results.
It is strongly recommended that staff performing
spirometry attend a comprehensive spirometry training course. Some of these
training courses are modular and allow flexibility in time and content to suit
the range of different settings in which spirometry is measured. It is possible
for the practice nurse to attend training on spirometry test performance while
the doctor attends training on spirometry test interpretation. A list of
certified spirometry training courses is available from the Australian and New
Zealand Society of Respiratory Science (www.anzsrs.org.au)
and Thoracic Society of Australia and New Zealand (www.thoracic.org.au).
