Spirometry and peak flow metry in bronchial asthma

SPIROMETRY AND PEAK FLOMETRY� in � BRONCHIAL ASTHMA
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.

1. WORLD ASTHMA DAY 2012 YOU CAN CONTROL YOUR ASTHMA world asthma week 2012 [email protected] Department of paediatrics FEHRC

2. SPIROMETRY AND PEAK FLOMETRY in BRONCHIAL ASTHMA Presented by Dr. PANKAJ YADAV [email protected] world asthma week 2012 [email protected] Department of paediatrics FEHRC

3. 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 [email protected] Department of paediatrics FEHRC WHAT IS SPIROMETRY ?

4. 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

5. SPIROMETER world asthma week 2012 [email protected] Department of paediatrics FEHRC

6. Method – how to perform 4 normal breaths Inhale as deeply as possible Exhale to normal depth 3 normal breaths Exhale as much as possible 3 normal breaths Inhale as much as possible Exhale as fast and completely as possible 4 normal breaths world asthma week 2012 [email protected] Department of paediatrics FEHRC

7. 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

8. 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

9. 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

10. 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

11. 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 world asthma week 2012 [email protected] Department of paediatrics FEHRC

12. 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 REDUCED world asthma week 2012 [email protected] Department of paediatrics FEHRC

13. 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

14. 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 shape world asthma week 2012 [email protected] Department of paediatrics FEHRC

15. Normal Obstruction world asthma week 2012 [email protected] Department of paediatrics FEHRC

16. 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 [email protected] Department of paediatrics FEHRC

17. 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

18. 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

19. 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

20. 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

21. 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 DISEASE world asthma week 2012 [email protected] Department of paediatrics FEHRC

22. 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

23. 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 [email protected] Department of paediatrics FEHRC

24. 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

25. THANK YOU world asthma week 2012 [email protected] Department of paediatrics FEHRC