Interpretation Normal Spirometry Obstructive pattern Restrictive pattern Mixed pattern Small airway obstruction Non-specific ventilatory pattern Probably normal pattern Upper airway obstruction pattern Neuromuscular diseases

Normal Spirogram All parameters are normal Normal shape in VT and FV loop

A. Normal: both the FVC and the FEV 1 /VC ratio are normal. “Knee ”

Obstructive pattern

The severity of the abnormality is graded: - % Pred FEV 1 > 100 = May be a physiological variant - % Pred FEV 1 70 Mild - % Pred FEV 1 60 Moderate severe -% Pred FEV 1 50 Moderately - % Pred FEV 1 35 Severe - % Pred FEV 1 < 35 Very severe

Severe obstructive pattern

Restrictive pattern

The severity of the abnormality might be graded as follows: - % Pred FVC 70 mild - % Pred FVC 60 Moderate -% Pred FVC 50 Moderately severe -% Pred FVC 34 Severe - % Pred FVC < 34 Very severe

Mixed pattern

Small airway obstruction

Early small airway obx FV curve :upward concavity FV curve :upward concavity FVC, FEV1, FEV1/FVC :NL FVC, FEV1, FEV1/FVC :NL  FEF ???  FEF ??? ATS states that FEF25-75% should not be used to diagnose small airway disease or to assess respiratory impairment

Probably normal

Isolated decrease in FEF25-75 Isolated decrease in FEV1/FVC

Probably normal spirogram Only  FEF Only  FEF  No small airway disease (ATS) Only  FEV1/FVC Only  FEV1/FVC FEV1> 100% Probably Normal FEV1> 100% Probably Normal FVC>100% FVC>100%

Nonspecific ventilatory pattern Similar to restrictive pattern Normal TLC, RV & DLco Obesity Asthma COPD Normal variant

Upper airway obx

Upper airway obstruction pattern

Indications for referral FEV1/FVC less than %75 and FEV1 less than %80 FEV1/FVC more than %75 and FVC less than %80 Significant reduction across time Pulmonary symptoms or signs even with normal spirogram

Screening Spirometry General health Occupational health screening

Screening Spirometry in General Healthy Population Baseline spirogram in all at Periodic spirogram depends on risk factors such as smoking each 1-5 yrs.

Occupational screening spirogram In certain occupational exposures Asbestos, silica, cadmium, cotton, coal, beryllium, wood dust,…. Usually each 1-2 yrs

Comparison of periodic spirogram Significant change in FEV1 or FVC  Cross-shift  Week-to-week  Year-to-year Definition

Considerations in periodic spirogram Using:  Similar reference values  Similar patient position  Similar time  Standard spirometer  Standard technique

Change in spirometric indices over time malefemalemalefemale 30 ml/yr 30 ml/yr 25 ml/yr FEV1 FEV1 FVC FVC NIOSH : (0.85.initial FEV1 or FVC) – (number of yr ) (value on time 1 – value on time 2 / value on time 1) × 100

In an ongoing annual surveillance of asbestos workers, a 24 year old woman is found to have an FVC of 3.59 liters. Her previous FVC was 4.17 liters. What is your interpretation ? Absolute change: =.58 liters She showed a loss of.58 liters. Percent change: (( )/4.17) x 100 = 13.9% She showed a loss of 13.9% in her FVC.

Further investigation recommended for follow-up results if : 1. Decline in FEV1 or FVC > 15% in longitudinal screening. If the period is > 5 years, adjust for the decline due to aging (25 ml/year) 2. FEV1, FVC or FEV1/FVC < LLN at any time 3. >10% decline between pre and post shift screening

Case 1 A 71 yrs male Height :175,weight :88 Height :175,weight :88 FVC:45% FVC:45% FEV1: 31% FEV1: 31% FEV1/ FVC :53% FEV1/ FVC :53% FEF25-75 :15% FEF25-75 :15% TLC :142% TLC :142% very severe obx very severe obx

Case 2 A 36 yrs female Height :162,weight :83 Height :162,weight :83 FVC:89% FVC:89% FEV1: 94% FEV1: 94% FEV1/ FVC :89% FEV1/ FVC :89% FEF25-75 :131% FEF25-75 :131% TLC :92% TLC :92% normal normal

Case 3 A 29 yrs female Height :165,weight :129 Height :165,weight :129 FVC:78% FVC:78% FEV1: 79% FEV1: 79% FEV1/ FVC :86% FEV1/ FVC :86% FEF25-75 :85% FEF25-75 :85% TLC :82% TLC :82% non specific ventilatory non specific ventilatory

Case 4 A 43 yrs female Height :61,weight :167 Height :61,weight :167 FVC:33% FVC:33% FEV1: 17% FEV1: 17% FEV1/ FVC :42% FEV1/ FVC :42% TLC :114% TLC :114% variable inthratoracic variable inthratoracic obx obx

Case 5 A 30 yrs male Height :186,weight :68 Height :186,weight :68 FVC:19% FVC:19% FEV1: 21% FEV1: 21% FEV1/ FVC :93% FEV1/ FVC :93% FEF25-75% :48% FEF25-75% :48% TLC :28% TLC :28% very severe restriction very severe restriction

Case 6 A 30 yrs male Height :175,weight :70 Height :175,weight :70 FVC: 88% FVC: 88% FEV1: 69% FEV1: 69% FEV1/ FVC :66% FEV1/ FVC :66% FEF25-75 :38% FEF25-75 :38% VEXT : 90 VEXT : 90 moderate obx moderate obx

Case 7 A 29 yrs male Height :179,weight :83 Height :179,weight :83 FVC: 95% FVC: 95% FEV1: 84% FEV1: 84% FEV1/ FVC :67% FEV1/ FVC :67% FEF25-75 :51% FEF25-75 :51% VEXT : 120 VEXT : 120 Mild obx

Case 8 A 26 yrs male Height :177,weight :67 Height :177,weight :67 FVC: 97% FVC: 97% FEV1: 77% FEV1: 77% FEV1/ FVC :66% FEV1/ FVC :66% FEF25-75 :48% FEF25-75 :48% VEXT : 60 VEXT : 60 mild obx mild obx

Post bronchodilator spirometry (reversibility testing) Short-acting inhaled drugs should not be used within 4h of testing Short-acting inhaled drugs should not be used within 4h of testing Long-acting should be stopped for 12h prior test Long-acting should be stopped for 12h prior test Smoking should be avoided for ≥ 1h Smoking should be avoided for ≥ 1h Salbutamol 400 µg (4 puffs) at 30 s intervals → ≥ 10 min and up to 15 min Salbutamol 400 µg (4 puffs) at 30 s intervals → ≥ 10 min and up to 15 min Ipratropium bromide 160 µg (4 puffs)→30 min Ipratropium bromide 160 µg (4 puffs)→30 min later

Positive reversibility testing Percent change from baseline & absolute change in FEV1 and/or FVC : >12% AND 200 CC Other criteria include: At least 20% increase in FEF25-75%

A 24 yrs male Height :170,weight :82 Height :170,weight :82 FVC:80% FVC:80% FEV1: 70% FEV1: 70% FEV1/ FVC :69% FEV1/ FVC :69% FEF25-75 :50% FEF25-75 :50%

pre post %change pre post %change FVC FVC FEV FEV FEV1/ FVC FEV1/ FVC FEF FEF

Case A 70 yrs male, Height :172,weight :65 pre %pred post %chg pre %pred post %chg FVC FVC FEV FEV FEV1/ FVC 64.5 FEV1/ FVC 64.5

Case A 28 yrs male, Height :192,weight :92 pre %pred post %chg pre %pred post %chg FVC FEV FEV1/ FVC 68.2

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