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How to Get Quality Spirometry (and NOT report junk!)

How to Get Quality Spirometry (and NOT report junk!)

Rule of 3 for Spirometry

Spirometry may be one of the most boring (and grossly overlooked) procedures in the diagnostic process at the primary care level. When reading scientific studies and best practices, many clinicians eyes glaze over and it is easy to assume the paralysis by analysis response. My sole purpose in writing is to take the messiness out of this necessary procedure and make data gathering simple. Here’s my primary tip;if you can remember the number 3, you can remember the instructions and fundamentals performing quality spirometry!

First, Instructions! It is ALWAYS best to spend more time on instruction to verify the patient can do the maneuver correctly rather than just receiving an accepting nod and realizing after their first attempt that they didn’t understand what you were asking them to do. SO, let’s break it down into 3 steps;

  1. Deep breath in (from your toes please!)
  2. Blast it out (I refer to this as “the spit fast blast” and give the patient a mental image spitballs flying)
  3. Blow for a long time (often you must demonstrate what this looks like otherwise your patient will feel “empty” shortly after they’ve achieved FEV1 and give up short) 

After you have got the maneuver down pat, you must obtain 3 technically acceptable efforts. To make sure that collected efforts are acceptable per the ATS guidelines, look for the following:

  1. Did the effort start without hesitation (it’s best to make sure that the volume-time graph is initiated at zero flow)
  2. Is there artifact (ie does it have lots of squiggles?, if artifact is unavoidable, make sure they do not fall within FEV1- I’ll show some pics in a later post)
  3. Does it meet MINIMAL end of test requirements? (3 secs for kids under 8yr, 6 secs for anyone older) AND flow plateau? THIS is key to having a good test, many clinicians performing spirometry don’t realize that the average adult will not plateau flow until close to 8 seconds PLUS the more obstructed the airway, the longer it takes to reach end of test. ALWAYS, ALWAYS refer back to the FET (forced expiratory time) metric, which should be on the test report, and then verify from the Volume-time curve to minimal exhalation and flow plateau (when it gets flat) has been achieved.

After you have an acceptable test, it’s time to make notes. Any notes recorded on the exam give the interpreting provider an indication of the quality of the exam and can allow them to read between the lines to make the most appropriate diagnosis.

Quick Recap on The Rule of 3 for Spirometry:

      1. Give 3 Patient Instructions 
2. Verify 3 Quality Metrics
       3. Obtain 3 Acceptable Efforts 

I hope you find this useful! Click here to download the ATS SpirometryStandardization . Don’t forget to download the NIOSH poster to use as quick reference guide while performing spirometry. Happy Testing!