Office Spirometers Research Articles

The impact of body position on vital capacity among pregnant women in the second trimester.

Pregnancy introduces significant physiological changes, notably impacting respiratory dynamics, especially during the second trimester. Data remain inconclusive about how body posture might influence lung function in pregnant women. We aimed to examine the impact of body position on slow vital capacity in pregnant women during their second trimester. This observational study was carried out at King Khalid Hospital in Saudi Arabia, involving pregnant women in their second trimester, from 14 to 26 weeks of gestation. We utilized the KoKo® Legend Portable Office Spirometer to measure slow vital capacity (SVC) in both sitting and standing positions. Participants' demographic details were recorded, ensuring a comprehensive analysis that accounted for age, BMI, and gestational age. 136 pregnant women participated in this study, a paired-sample t-test revealed no statistically significant difference between sitting (M = 2.31, SD = 0.49) and standing (M = 2.33, SD = 0.5) positions, p = 0.24, However; the mean value of SVC in sitting position was significantly different between 4th month of pregnancy (M = 2.17, SD = 0.44) and 6th month of pregnancy (M = 2.45, SD = 0.48), p = 0.016. The performance of the SVC in both positions was not significantly affected. However, an increase in gestational age had a notable impact on SVC performance, particularly during sitting positions, due to the changes in respiratory physiology during pregnancy.

The effect of diuretics on spirometric parameters in patients with ischemic heart failure

Heart failure is the failure of the cardiac pump under physiological loading conditions to impart sufficient hydraulic energy output in order to maintain a physiological circulation. A cohort study extended over a period of 14 months from the first of august 2010 to the first of November 2011. The patient was diagnosed as having heart failure according to the recommendation of the European Society of Cardiology, depending on the result of history, examination and echocardiographic conformation. Spirometric data were collected in accordance with American Thoracic Society standards. All the patients had a restrictive spirometric defect before treatment with diuretics, but after treatment all show normal spirometric pattern. The present study recommend the followings: - The use of a cheap office spirometer in rural area by general practitioner (GP) doctors and nursing staff could be useful for follow up patients with ischemic heart failure to detect early deterioration by objective mean to refer the patient for specialized care. Also, the office spirometer needs no special skills and the nursing staff can master the procedure with a 2 weeks training course.

Effects of maxillomandibular fixation and rigid internal fixation on pulmonary function in patients with mandibular fractures

Closed reduction and maxillomandibular fixation (MMF) is associated with airway obstruction. The ventilatory effect of open reduction and rigid internal fixation (ORIF) as an alternative treatment has not been determined. The aim of this study was to compare the effects of MMF and ORIF on pulmonary function (PF) in patients with mandibular fractures. Using a computer-generated simple randomization protocol, 40 eligible participants were allocated to MMF and ORIF treatment groups. PF tests were done preoperatively and at 24hours, 1, 6, and 7 weeks postoperative in all participants in both groups, using a portable office spirometer (Spirobank G). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, and peak expiratory flow rate (PEFR) were determined. At 6 weeks postoperative, PF tests were performed after the release of MMF. PF tests in the MMF and ORIF groups were similar preoperatively. At 24hours postoperative, FEV1/FVC was significantly lower in the MMF group than in the ORIF group (p<0.001). Values of FEV1 (p=0.022), FEV1/FVC (p=0.001) and PEFR (p<0.001) were significantly lower in the MMF group than in the ORIF group at 1 week postoperative. While MMF negatively impacted on PF, ORIF had no adverse effect on PF.

Use of office spirometers in Flemish general practice: results of a telephone survey

While office spirometry is seen as potentially useful and feasible in general practice, little is known about its use in Flemish general practice. Our aim was to describe the use of spirometers by Flemish GPs, characteristics of their spirometry practice, training needs and preferences, and attitudes towards office spirometry. A telephone survey was set up in a random sample of Flemish GPs. Interviews were carried out by a GP researcher using a structured piloted questionnaire. 197 out of 243 eligible GPs (81%) were interviewed. Most GPs (66%) had never used an office spirometer, 17.3% were using one and 16.7% stopped using one. Time constraints (54%) and insufficient knowledge and skills (27%) were the main reasons for not using an office spirometer (any longer). GPs particularly used their spirometer to diagnose COPD and asthma, and less frequently in follow-up. GPs (67.9%), especially current users (91.2%), considered spirometry as a GP task. Spirometry training should be provided (86%) and spirometry by GPs should be reimbursed (79.5%). More information on spirometry would be very useful (62.3%), with a marked preference for training in small groups (86.8%). Although office spirometry is not widespread in Flemish general practice, GPs show an undoubted interest in it. They need educational and financial support to overcome prevailing barriers in establishing office spirometry on a routine basis.

Testing spirometers: are the standard curves of the american thoracic society sufficient?

The performance of spirometers is often measured only under ideal conditions, with a mechanical simulator reproducing the expiratory standard American Thoracic Society (ATS) curves generated by a computer. Studies have questioned the value of these results in real-life conditions. The aim of this study was to evaluate the accuracy and precision of 5 office spirometers with a flow-volume simulator using the ATS curves and using flow-volume curves obtained from patients. We measured the FVC, peak expiratory flow, and FEV1 by simulating different dynamic waveforms applied by a computer-driven syringe, the Hans Rudolph flow-volume simulator. In addition to testing standard curves recommended by the ATS, we also tested curves obtained with subjects. The precision of the office spirometers was good and comparable using the standard ATS curves. One device presented the best performances in terms of accuracy and precision according to the ATS recommendations, but we observed significant biases in all devices with Bland-Altman analysis, particularly with the curves obtained from subjects with severe COPD. The global quality of most spirometers makes them acceptable for the detection of pulmonary diseases. However, we demonstrated accuracy issues not shown by the standard testing procedure. We propose to improve the testing of spirometers by implementing more realistic flow-volume curves and to refine the analysis of the results.

Technical Assessment of Spirometers Connected in Series

Office spirometers are now widely used to detect obstructive lung diseases. To test the technical characteristics of these devices, simulation of different forced expiratory maneuvers is performed, using computer generated waveforms. However, the tests with human subjects are also useful to detect technical flaws. The procedure used by some authors to test the accuracy of office spirometers is to compare measurements made by 2 spirometers connected in series. The aim of this study was to evaluate the accuracy of this latter procedure. Two sets of 2 spirometers connected in series were used: the PocketSpiro with the MicroLoop, and the PocketSpiro with the SpiroScout. Different standard American Thoracic Society curves were selected for both ambient temperature and pressure (ATP) and body temperature and pressure saturated (BTPS) conditions and generated with a waveform simulator. We compared lung function indices (FVC, peak expiratory flow, and FEV(1)) recorded by the PocketSpiro when it was placed respectively upstream or downstream in the assembly. In ATP conditions, lung function indices were generally higher when the spirometer was placed downstream rather than upstream. The observed deviations reached up to 10%. In BTPS conditions, lung function indices were underestimated when the spirometer was placed downstream, as compared to the ATP procedure. The modification of the flow characteristics and the temperature drop are the 2 mechanisms that could explain our results. Connecting the spirometers in series gives variable results, depending on the position of the spirometer in the assembly. Individual tests are therefore essential, as results are not interchangeable.

Achieving quality spirometry in the office

Summary Ever since pioneering technology brought objective lung function measurement out of the laboratory with the introduction of “office spirometers” nearly 50 yrs ago, there has been a debate on whether nonspecialist practitioners can reliably achieve accurate lung function measurements. This debate continues today, because although it is certain that some users can achieve excellent-quality lung function measurements in general practice, occupational medicine and other nonspecialist practices, it is equally certain that some very poor-quality spirometry measurements are being performed. Examples of these poor quality measurements are presented as evidence that respiratory measurements should only be performed in controlled conditions by expert operators. Whether this is true can only be speculated upon, unless it is possible for an expert to review every spirometry measurement. You may think that this would be impossibly time consuming and expensive, but the internet, expert software and other technological advances have made this achievable and inexpensive; much cheaper than inaccurate lung function measurements.

Primary care spirometry*

Primary care spirometry is a uniquely valuable tool in the evaluation of patients with respiratory symptoms, allowing the general practitioner to diagnose or exclude chronic obstructive pulmonary disease (COPD), sometimes to confirm asthma, to determine the efficacy of asthma treatment and to correctly stage patients with COPD. The use of spirometry for case finding in asymptomatic COPD patients might become an option, once early intervention studies have shown it to be beneficial in these patients. The diagnosis of airway obstruction requires accurate and reproducible spirometric measurements, which should comply with the American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines. Low acceptability of spirometric manoeuvres has been reported in primary care practices. This may hamper the validity of the results and affect clinical decision making. Training and refresher courses may produce and maintain good-quality testing, promote the use of spirometric results in clinical practice and enhance the quality of interpretation. Softening the stringent ATS/ERS criteria could enhance the acceptability rates of spirometry when used in a general practice. However, the implications of potential simplifications on the quality of the data and clinical decision making remain to be investigated. Hand-held office spirometers have been developed in recent years, with a global quality and user-friendliness that makes them acceptable for use in general practices. The precision of the forced vital capacity measurements could be improved in some of the available models.

Value of recommended spirometer accuracy checks on office spirometers in primary care unknown

Value of recommended spirometer accuracy checks on office spirometers in primary care unknown

Response to the letter: Value of recommended spirometer accuracy checks on office spirometers in primary care unknown

Response to the letter: Value of recommended spirometer accuracy checks on office spirometers in primary care unknown

Technical and Functional Assessment of 10 Office Spirometers

To investigate the technical properties and user friendliness of 10 office spirometers devoted for use in general practice, and to compare the results with standard diagnostic spirometers.Multicenter study.Ten spirometer models were tested independently in three pulmonary function laboratories and by three general practitioners (GPs).The laboratories studied the technical quality of the office spirometers in terms of precision and agreement with standard spirometers, whereas the three GPs assessed their user friendliness. The spirometers tested were as follows: Spirobank (Medical International Research; Rome, Italy); Simplicity (Puritan Bennett; Pleasanton, CA); OneFlow (Clement Clarke International; Harlow, Essex, UK); Datospir 70 (Sibelmed; Barcelona, Spain); Datospir 120 (Sibelmed); SpiroPro (SensorMedics; Yorba Linda, CA); EasyOne (NDD; Zurich, Switzerland); MicroLoop (Micro Medical; Chatham, Kent, UK); SpiroStar (Medikro; Kuopio, Finland); and Pneumotrac (Vitalograph; Maids Moreton, Buckingham, UK). FVC and FEV1 were measured in 399 subjects. User friendliness was assessed by the three GPs using a questionnaire.The precision of FEV1 of the office and standard spirometers was comparable, but three office spirometers had > 200 mL limits of precision for FVC. Some devices presented a proportional difference on the FEV1 with standard spirometers, underestimating the small values. The limits of agreements between standard and some office spirometers for FEV1/FVC ratio was > 10%. The overall user friendliness was estimated as good.The global quality and user friendliness of several office spirometers make them acceptable for the detection of COPD, although differences between the laboratory and some of the office spirometers values suggest that the misclassification rates may be increased when using some models of office spirometers.

Attitudes of physicians toward objective measures of airway function in asthma

Background The National Asthma Education and Prevention Program (NAEPP) recommends pulmonary function testing as part of asthma evaluation. The objectives of this study were to determine the use of spirometry in patients with asthma by primary care physicians and asthma specialists, and to identify barriers to use of spirometry. Methods We developed, validated, and administered a mailed survey to primary care physicians and asthma specialists in the general community. We asked about the use of spirometry, access to spirometry, and barriers to spirometry use. Results Of 975 eligible subjects, 672 (69%) completed the survey. Asthma specialists were more likely to have an office spirometer (78% [216/277] vs. 43% [169/395], P <0.001) than were primary care physicians, and more likely to report measuring pulmonary function in at least 75% of their patients with asthma (83% [223/270] vs. 34% [131/388], P <0.001). In logistic regression analysis, factors most strongly associated with reported spirometry use (in at least 75% of patients) among asthma specialists were owning a spirometer, disagreeing with the statement that the test requires excessive use of office resources, and agreeing that spirometry is a necessary part of the asthma evaluation. Among primary care physicians, owning a spirometer, agreeing that the data are necessary for accurate diagnosis, and believing that they were trained to perform and interpret the test were most strongly associated with reported spirometry use. Conclusion Pulmonary function testing is underutilized by physicians, with rates of utilization lowest among primary care physicians. Providing primary care physicians with better access to spirometry, through provision of a machine and appropriate training in its use and interpretation, may improve compliance with the NAEPP recommendations.

Assessing the Financial Viability of Office Spirometr

PURPOSE: Office spirometry is a standard of care for the diagnosis and management of asthma and COPD, for screening of cigarette smokers, and for the evaluation of a variety of symptoms. Limited available data from payors indicates a small penetration of office spirometry in patients seen with respiratory related diagnostic codes. The penetration is much smaller in HMO plans presumably due to financial constraints. The environment of imploding reimbursement and rising costs appears to represent a barrier to the utilization of office spirometry in primary care. We present a practice administration tool that is useful in determining the financial viability of purchasing an office spirometer to perform basic pulmonary function testing.

Office Spirometry for Lung Health Assessment in Adults: A Consensus Statement From the National Lung Health Education Program

COPD is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients >/= 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources. Spirometry also is recommended for patients with respiratory symptoms such as chronic cough, episodic wheezing, and exertional dyspnea in order to detect airways obstruction due to asthma or COPD. Although diagnostic-quality spirometry may be used to detect COPD, we recommend the development, validation, and implementation of a new type of spirometry-office spirometry-for this purpose in the primary-care setting. In order to encourage the widespread use of office spirometers, their specifications differ somewhat from those for diagnostic spirometers, allowing lower instrument cost, smaller size, less effort to perform the test, improved ease of calibration checks, and an improved quality-assurance program.

Office Spirometer Modification

The importance of office spirometry in the evaluation of ventilatory function impairment in offices and clinics has received widespread attention recently. 1 Morris JF Spirometry is the evaluation of pulmonary function. West J Med. 1974; 125: 110-118 Google Scholar , 2 Boysen PB Black AJ Mouldus PV Relationship between preoperative pulmonary function tests and complications after thoracotomy. Surg Gynecol Obstet. 1981; 152: 813-815 PubMed Google Scholar , 3 Petty TL Office spirometry. Semin Respir Dis. 1983; 4: 184-196 Crossref Scopus (1) Google Scholar The American College of Chest Physicians offered a statement on spirometry accuracy and performance of office devices 4 Permutt S Chester EH Anderson WA Cugell DW Petty TL Sharp JT Office spirometry in clinical practice. Chest. 1978; 74: 298 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar that complemented a more detailed statement on spirometer performance standards, following the Snowbird Conference. 5 ATS StatementSnowbird Workshop on Standardization of Spirometry. Am Rev Respir Dis. 1979; 19: 831-838 Google Scholar One popular office spirometer (Breon 2400) met all of the Snowbird standards except for the time base. 6 Gardner RM Harkinson JL West BL Evaluating commercially available spirometers. Am Rev Respir Dis. 1980; 121: 73-82 PubMed Google Scholar We earlier offered data that these time base requirements did not significantly affect accuracy in testing in the clinical setting. 7 Petty TL Spirometric time base considerations. Chest. 1981; 80: 116-117 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Nonetheless, standards have advantages in providing uniform spirometer performance and will assist in allowing for the interchange of data between devices. Accordingly, it became appropriate to modify the device previously reported to meet the time base consideration so that the requirement of the paper speed of at least 2 cm/sec for at least ten seconds could be met. 6 Gardner RM Harkinson JL West BL Evaluating commercially available spirometers. Am Rev Respir Dis. 1980; 121: 73-82 PubMed Google Scholar The time base of the spirometer for a six-second sweep was 1.25 cm/sec.

Clinical evaluation of new office spirometer

Clinical evaluation of new office spirometer

Clinical Evaluation of New Office Spirometer

The accuracy of a simple, pneumatic, direct-recording spirometer suitable for office use was evaluated by comparing spirometry on a water-sealed, 13.5-liter, water-filled spirometer for 120 patients. Good correlation between the two spirometers was seen through a wide range of values for forced vital capacity, forced expiratory volume in one second, and forced expiratory flow during 25% to 75% of forced vital capacity, with coefficients of correlation being .988, .988, and .948, respectively. All correlations were significant. The pneumatic spirometer is accurate, simple to operate, and suitable for spirometry in the office and clinic.