Spirometry and peak flow metry in bronchial asthma
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Transcript of Spirometry and peak flow metry in bronchial asthma
WORLD ASTHMA DAY 2012
YOU CAN CONTROL YOUR ASTHMA
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
SPIROMETRY AND PEAK FLOMETRY IN BRONCHIAL ASTHMA
Presented by Dr. PANKAJ [email protected]
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
SPIROMETRY IS A PULMONARY FUNCTION TEST THAT MEASURES THE VOLUME OF AIR AN INDIVIDUAL INHALES OR EXHALES AS A FUNCTION OF TIME.
SPIROMETRY MEASURES HOW MUCH AND HOW QUICKLY AIR CAN BE EXPELLED FOLLOWING A DEEP BREATH.
FLOW , OR THE RATE AT WHICH VOLUME IS CHANGING AS A FUNCTION OF TIME, CAN ALSO BE MEASURED WITH SPIROMETRY. world asthma week 2012
Department of paediatrics FEHRC
WHAT IS SPIROMETRY ?
EARLIEST SPIROMETRIC MEASUREMENT OF LUNG VOLUMES AND ITS EXPIRABLE COMPONENTS WAS DONE BY HUTCHINSON IN 1846
EQUIPMENT FOR TESTING CHILDREN SHOULD BE CAPABLE OF MEASURING SMALL VOLUMES AND LOW FLOWS
CAN BE PERFORMED BY THE AGE OF 3 YEARS
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
Method – how to perform
1. 4 normal breaths2. Inhale as deeply as
possible3. Exhale to normal depth4. 3 normal breaths5. Exhale as much as
possible6. 3 normal breaths7. Inhale as much as
possible8. Exhale as fast and
completely as possible9. 4 normal breaths
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
VOLUME OF GAS EXPIRED AND RATE AT WHICH THEY ARE EXPIRED ARE MEASURED
PERMITS ASSESSMENT OF THOSE VOLUMES WHICH CAN BE VOLUNTARILY EXCHANGED
ALL THE COMPONENTS OF TOTAL LUNG CAPACITY EXCEPT RV, FRC, AND TLC CAN BE MEASURED
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
INTERPRETATION DEPENDS ON SOME FACTORS
Normal values vary and depend on:
Height
Age
Gender
Ethnicity
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
REFERENCE STANDARDS
PULMONARY FUNCTION MEASUREMENTS ON CHILDREN WITHOUT RESPIRATORY DISEASE FOR COMPARISION
TELL HOW LUNG FUNCTION SHOULD CHANGE OVER TIME WITH NORMAL GROWTH
GROWTH RELATED CHANGES IN PFT CORELATE BEST WITH HEIGHT
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
SPECIAL CONSIDERATION IN PAEDIATRIC PATIENT
ABILITY TO PERFORM SPIROMETRY DEPENDS ON DEVELOPMENTAL AGE OF CHILD , PERSONALITY, AND INTEREST OF THE CHILD.
PATIENT NEED A CALM , RELAXED ENVIRONMENT AND GOOD COACHING, PATIENCE IS THE KEY.
EVEN WITH BEST ENVIRONMENT AND COACHING, A CHILD MAY NOT BE ABLE TO PERFORM SPIROMETRY.
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
world asthma week 2012 [email protected] Department of paediatrics FEHRC
SPIROMETRY IN ASTHMA
ASPECTS OF LUNG FUNCTION MEASURED BY SPIROMETRY IN DETERMINING SEVERITY AND CONTROL OF ASTHMA :-
FORCED VITAL CAPACITY – TOTAL AMOUNT OF AIR FORCEFULLY EXHALED AFTER MAXIMAL INSPIRATION
FORCED EXPIRATORY VOLUME AT ONE SECOND- AMOUNT OF AIR FORCEFULLY EXHALED AT ONE SECOND
world asthma week 2012
Department of paediatrics FEHRC
FEV1 / FVC RATIO
FEV1 / FVC IN NORMAL INDIVIDUALS – APPROX 85%
RESTRICTIVE LUNG DISEASE – AIRFLOW IS REDUCED IN PROPORTION TO REDUCTION IN LUNG VOLUME - FEV1 / FVC > 80%
OBSTRUCTIVE LUNG DISEASE – AIRFLOW IS REDUCED MORE THAN LUNG VOLUME - FEV1 / FVC IS REDUCEDworld asthma week 2012
[email protected] Department of paediatrics FEHRC
NORMAL FLOW VOLUME LOOP
A NORMAL FLOW VOLUME LOOP HAS A RAPID PEAK EXPIRATORY FLOW RATE WITH A GRADUAL DECLINE IN FLOW BACK TO ZERO.
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
OBSTRUCTIVE LUNG DISEASE
Obstructive lung disease changes the appearance of the flow volume curve
As with a normal curve, there is a rapid peak expiratory flow, but the curve descends more quickly than normal and takes on a concave shapeworld asthma week 2012
Department of paediatrics FEHRC
RESTRICTIVE FLOW VOLUME LOOP
The shape of the flow volume loop is relatively unaffected in restrictive disease, but the overall size of the curve will appear smaller when compared to normals on the same scale.world asthma week 2012
Department of paediatrics FEHRC
INTERPRETATION OF THE VALUES
FVC Interpretation of %
predicted: 80-120% Normal
70-79% Mild
50%-69% Moderate
<49% Severe world asthma week 2012 [email protected]
Department of paediatrics FEHRC
INTERPRETATION
FEV1 > 80%
FEV1 60 – 79%
FEV1 40 – 59%
FEV1 <40%
NORMAL
MILD
MODERATE
SEVERE
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
INTERPRETATION OF VALUES
FEF 25-75% Interpretation of %
predicted: >79% Normal 60-79% Mild
obstruction 40-59%
Moderate obstruction
<40% Severe obstruction
FEV1/FVC Interpretation of
absolute value: 80 or higher
Normal
79 or lower Abnormal
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
IF STILL IN DOUBT OF PATIENT HAVING ASTHMA, REPEAT THE TEST AFTER SHORT ACTING BRONCHODILATOR LIKE SALBUTAMOL
IMPROVEMENT IN FEV1 OF 12% OR MORE CONFIRMS DIAGNOSIS
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
ROLE OF SPIROMETRY IN ASTHMA HELPS TO MAKE DIAGNOSIS
ASSESS DEGREE OF AIRFLOW OBSTRUCTION
TO PREDICT WHETHER OBSTRUCTION IS REVERSIBLE
AIDS IN MANAGEMENT OF ASTHMA
TO MONITOR PROGRESSION OF DISEASEworld asthma week 2012 [email protected]
Department of paediatrics FEHRC
PEAK FLOW METRY
MEASURES PEAK EXPIRATORY FLOW RATE (PEFR)
DETECTS OBSTRUCTION IN LARGE CENTRAL AIRWAYS ONLY
NOT RECOMMENDED FOR ALL PATIENTS, USED ONLY IN THOSE WITH MODERATE TO SEVERE ASTHMA
world asthma week 2012 [email protected]
Department of paediatrics FEHRC
INTERPRETATION
PEF COMPARED TO PATIENT’S OWN PREVIOUS BEST MEASUREMENTS USING HIS OWN PEAK FLOW METER
IMPROVEMENT OF 60L/MIN OR >20% OF PRE BRONCHODILATOR PEF
OR DIURNAL VARIATION OF >20%world asthma week 2012
Department of paediatrics FEHRC
SUMMARY
Spirometry is a reproducible and inexpensive tool in the management of asthma
Spirometry is useful in the diagnosis of asthma (demonstrations of reversibility)
Spirometry measures both large and small airways function and can be used to monitor patients
world asthma week 2012 [email protected]
Department of paediatrics FEHRC