Spirometry

Overview:

Spirometry helps to know the lung function based on the amount of air that goes in and outside the lungs while breathing. It determines the amount of air in the lungs and the strength of the lungs. It is represented in the form of graphs based on the capacity of the lungs. It is a useful diagnostic tool for individuals with lung disorders. 

Lung function: 

Lungs help in breathing by taking in air. The air travels from the nose through the windpipe. The windpipe divides to form two tubes called bronchi. They further divide into bronchioles that end in right and left lungs. Oxygen from the air is taken by blood vessels and carbon dioxide is released out of the lungs. In lung diseases, the ability of the lungs to inhale and exhale decreases which is measured by a spirometer. 

Indications:

The spirometry test is used as a diagnostic tool for lung functions and to monitor the disease. It is used for various lung diseases like:

• Asthma
• Chronic obstructive lung disease 
• Chronic bronchitis
• Lung and cystic fibrosis
• Other diseases of the lung

For diagnostic purposes, it is used for 

• Evaluate the effect of a certain disease on the patient 
• Screening individuals who are at risk of lung diseases 
• Assessing the course, severity, and prognosis of a lung disease 

For monitoring purposes, it is used for 

• Assessing the efficacy of a treatment 
• Monitor lung function in individuals with high-risk occupational exposure to lung diseases 

Clinical symptoms that necessitate spirometry test are:

• Chest pain or tightness 
• Mucous in cough 
• Difficulty in deep breathing 
• Shortness of breath 
• A sound called wheezing while breathing 

Contraindications:

Spirometry is not indicated in individuals who are not stable and with life-threatening conditions. It is also not suitable for individuals with

• recent heart failure, 
• recent infections to the lung, 
• unstable blood flow, 
• clots in the lungs
• Aneurysm in the chest or abdomen 
• Unstable and high blood pressure 
• The detached retina of the eye 
• It is also not indicated in individuals who cannot perform the test like children and psychological disorders. 
• Recent surgeries 
• Facial paralysis that causes difficulty in doing the test 

Advantages: 

The spirometry test has the following advantages. They are: 

• It helps to distinguish between asthma and other medical conditions. 
• It can distinguish between blockage and narrowing of airways. 
• It can assess the disease severity, if the disease is stable or worsening.

Before the procedure:

Before undergoing a spirometer test, an individual should refrain from smoking and alcohol. One should also not eat heavily as it may make forced expiration difficult. One has to inform the healthcare professional of the medications that are being taken. An individual has to stop using bronchodilators if they are using it. One should not strain their body or do heavy exercise before the test. 

Spirometry procedure:

While doing a spirometry test one has to know the instructions on how to perform the test. The height and weight of an individual will be recorded and in case of deformities like scoliosis, the span will be measured. 

An individual is made to sit comfortably on a chair. A nose clip is placed to close the nostrils to prevent leakage of the air from the nostrils. They have to with their back supported and not lean forward. Having dentures in the mouth will interfere with the procedure and hence they have to be removed before the procedure. 

An individual has to breathe into a tube that is attached to a machine. This machine is called a spirometer. This machine in turn connected to a computer to display the airflow measurements. Spirometers are of two types. They are Closed-circuit and open-circuit spirometers. Closed-circuit spirometers are classified as wet and dry spirometers. Closed-circuit spirometers have a piston that acts as an air-collecting system. Open-circuit spirometers are commonly used spirometers that do not have an air-collecting system. They are again of different types like:

• Turbine flow meters measure airflow and lung capacity with the help of turbine rotations. 
• Pnuemotachographs use resistance to measure the pressure differences as air passes through them. 
• Hotwire spirometers use heated wires. They measure airflow capacity by the cooling effect of exhaled air on the heated wire. 
• Ultrasound spirometers function on any of the above methods. 

The mouthpiece of the spirometer is placed in the mouth between the teeth after a deep inhalation. One has to inhale and exhale deeply many times into the tube. Tightly seal the lips around the mouthpiece. Breathing out of air should last at least 6 seconds. 

One has to do the test at least three times to avoid any errors. The highest value among the three is taken as the result. The entire test lasts about 15-30 minutes. 

Interpretation:

Spirometry test results vary depending on age, sex, and body mass index of individuals. The spirometry results are interpreted as:

• Forced vital capacity (FVC): It indicates the amount of air that is expelled forcefully by an individual after a deep breath. Any value less than normal, indicates breathing problems. 
• Forced expiratory volume (FEV): It indicates the amount of air that is expelled forcefully by an individual in one second. Any value less than normal, indicates blockages of the bronchial tubes. 

Spirometry test results help to distinguish between obstructive and restrictive lung diseases. 

Risks and complications: 

There are no risks or complications associated with the procedure. Dizziness, lightheadedness, and continuous cough are some of the side effects of the procedure. Sometimes inaccurate readings can be obtained when one cannot exhale correctly or use medication before undergoing the test. 

Conclusion: 

A spirometry test is a common lung function test. It is a simple test where one has to exhale air into a tube of a spirometer machine. It helps to diagnose, monitor, and assess the prognosis of a lung disease. 

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