Standardization of Spirometry 2019 Update (American Thoracic Society and European Respiratory Society) is the source that determines the requirements of any spirometry session. Regardless of the test mode that is being used, spirometry sessions have some things in common.
The most basic fact to keep in mind is that spirometry should be discontinued if the patient experiences pain during any maneuver. Although, this shouldn't be done when the maneuvers are somewhat uncomfortable, as the patient may not have achieved the needed maximal inspiration and expirations for the test if they had not experienced it before.
Performing spirometry can be physically demanding. The forced expiratory movement used increases a lot of the pressure within the body, particularly within the chest wall. Caution must be used for patients with medical conditions that could be adversely affected by these physiological consequences.
Testing environment details
Ambient temperature, barometric pressure and time of day must be recorded. SpiroClinic Pro takes these measurements automatically through its Smart Dock as a part of the process of starting the session, but in some cases with other devices, the operator may need to note them down.
Testing should happen in a quiet and comfortable environment and must be separate from the waiting area or other patients being tested. There should be drinking water and tissues available for the patient.
The patient should be sitting upright with a straight back, shoulders slightly back and chin slightly elevated. The testing chair should have arms that would prevent falling sideways and a height adjustment that would allow the feet to be flat on the floor.
Before starting the session, as a part of hygiene and infection control, the operator must wash their hands or use an approved hand sanitizer. The patient also should be given an approved hand sanitizer. The use of disposable, in-line filters is also vital and all disposable items such as filters, mouthpieces, nose clips, and gloves should be disposed of at the end of each session.
Starting the session
After giving hand sanitizer to the patient, the operator should confirm the patient's identification, age, birth sex, and ethnicity. Then they should measure the patient's weight and height without shoes. The operator also must confirm with the patient about not having any possible contraindications and note down medication use and respiratory symptoms.
Then, the testing can start. The operator must check the positions of the mouthpiece and nose clip, correct the posture of the patient if needed according to the correct pose mentioned above, and then instruct the patient on the maneuvers needed during the test.
One session includes a minimum of three and a maximum of eight trials because after several forced expiratory maneuvers, fatigue can begin to take its toll on patients, and additional maneuvers would be of little added value. Although, there may be some circumstances in which more than eight consecutive FVC maneuvers are needed. For example, when testing children, more than eight attempts may be required because each attempt may not be a full maneuver. Children may benefit from practicing the different phases of the maneuver before attempting a full maneuver.
Session grading does not reflect how good or bad the health of the measured lungs is, it is a reflection on how well the patient performed the test.
Tests graded A, B, or C are usable, tests graded D are considered suspect, tests graded E might be used by only the interpreter in certain cases, U grade means there is no acceptable maneuver but there is at least one usable maneuver and F-grade tests should not be used at all per guidelines.
This grading is calculated as the volume difference between trials. For example, session grading A means that there is a 50 ml or less difference between the trials.
- Standardization of Spirometry 2019 Update". An Official American Thoracic Society and European Respiratory Society Technical Statement, 2019.