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Protocol - Spirometry - Adult

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Description:

A spirometric test requires that the subject take a full, deep breath and then exhale as forcefully as possible into a handheld portable spirometer. The subject’s effort is called the forced expiratory maneuver and most commonly measures the amount and speed of air that is exhaled. The total amount (volume) of air exhaled is called the forced vital capacity (FVC). The amount of air exhaled in 1 second is called the forced expiratory volume in 1 second (FEV1). Although handheld spirometers are commonly used in clinical research studies, the same results can be obtained from more-sophisticated floor-mounted devices, which are typically available in a respiratory function testing laboratory.

Protocol:

The following description summarizes some of the key points. For the full protocol, see Miller et al., 2005.

Equipment

Spirometers usually come with computer software. The spirometer must be connected to a computer during the spirometry tests. Provide subjects with a mouthpiece and a noseclip. Use of a noseclip is highly recommended but not mandatory. Allow subjects to put the mouthpiece in their mouth and blow with the noseclip attached to their nose. Record whether the noseclip was used.

Quality control

To calibrate the spirometer, attach the device to a 3 liter syringe. Attach the spirometer to a computer and open the spirometry software to calibrate the spirometer. This calibration will measure the flow rate of the spirometer. Conduct three tests with the syringe and ensure that each result is ± 3% of the other tests. This is called a calibration check. Similarly, the syringe must also be calibrated; generally, the syringe flow rate results should be ± 0.5% of the other tests. Perform quality control tests on a weekly basis (see the manufacturer recommendations) and record the results in a log.

Demonstration

Provide a brief explanation of the spirometry test. Do multiple demonstrations of the spirometry test for each subject. Allow subjects to do practice attempts by putting their mouths on the spirometer, inhaling fully, and exhaling as forcefully as possible until no more air can be expelled. It may be useful to refer to the exhalation as a “blast” to ensure subjects exhale as forcefully as possible.

Setting

The subject should be sitting in a chair. Record the position (sitting or standing).

Successful maneuvers

After the subject blows into the spirometer, the technician determines whether the attempt was a successful “maneuver.” An adequate spirometry test requires a minimum of three acceptable maneuvers (see the full protocol for more details about successful maneuvers).

Recorded results

Record the following results.

  • Forced Vital Capacity (FVC)
  • Forced Expiratory Volume in 0.5 seconds (FEV.5)
  • Forced Expiratory Volume in 0.75 seconds (FEV.75)
  • Forced Expiratory Volume in 1 second (FEV1)
  • Repeatability of parameters above (see repeatability maneuver criteria in full protocol)
  • Number of satisfactory attempts (maneuvers)
  • Posture (sitting/standing)

Nose clips (yes/no)

Protocol Name from Source:

Spirometry

Availability:

Publicly available

Personnel and Training Required

Technician trained in conducting Pulmonary Function Tests (PFTs) with a spirometer

Equipment Needs

The primary instrument used in pulmonary function testing is the spirometer.

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Physical Examination

Life Stage:

Adolescent, Adult

Participants:

Adults

Specific Instructions:

Numerous instructions are embedded in the protocol and in Table 1 of the protocol. This protocol is mainly for adults. The Spirometry - Preschool and Child protocol uses animated computer software and visual cues, which are necessary for young children.

Selection Rationale

Spirometry is invaluable as a screening test of general respiratory health. This protocol is the international standard supported by both the American Thoracic Society and the European Respiratory Society. The selected protocol is well-established over many years and serves as the unambiguous standard for lung function assessment in clinical research studies.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Pulmonary Function Test Measurement Text 2970229 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Resp spirometry proto 62639-0 LOINC
Process and Review

Expert Review Panel #6 (ERP 6) reviewed the measures in the Respiratory domain.

Guidance from the ERP 6 includes the following:

• No significant changes to measure

Back-compatible: no changes to the Data Dictionary

Previous version in Toolkit archive (link)

Source

Miller, M. R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., . . . Wanger, J. (2005). Standardisation of spirometry. Series “ATS/ERS task force: Standardisation of lung function testing.” European Respiratory Journal, 26(2), 330-331.

General References

Andreeva, E., Pokhaznikova, M., Lebedev, A., Moiseeva, I., Kozlov, A., Kuznetsova, O., & Degryse, J. (2015). The RESPECT study: RESearch on the PrEvalence and the diagnosis of COPD and its Tobacco-related etiology: a study protocol. BMC Public Health, 15(1), 831.

Berntsen, S., Stølevik, S. B., Mowinckel, P., Nystad, W., & Stensrud, T. (2016). Lung function monitoring; A randomized agreement study. Open Respiratory Medicine Journal, 10, 51-57.

Centers for Disease Control and Prevention (CDC). National Health and Nutrition Examination Survey (NHANES) 2007-2008. Respiratory Health Spirometry Procedures Manual.

Protocol ID:

91601

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX091601_Acceptable_Maneuver PX091601120000 Acceptable manoeuvre 4 Variable Mapping
PX091601_Age PX091601360000 Age 4 Variable Mapping
PX091601_Barometric_Pressure PX091601040000 Barometric pressure 4 Variable Mapping
PX091601_Blank10 PX091601730000 Blank 10 4 N/A
PX091601_Blank1_Or_FEF25 PX091601640000 Blank 1 or FEF25% 4 Variable Mapping
PX091601_Blank2_Or_FEF50 PX091601650000 Blank 2 or FEF50% 4 Variable Mapping
PX091601_Blank3_Or_FEF75 PX091601660000 Blank 3 or FEF75% 4 Variable Mapping
PX091601_Blank4_Or_FEF90 PX091601670000 Blank 4 or FEF90% 4 N/A
PX091601_Blank5 PX091601680000 Blank 5 4 N/A
PX091601_Blank6 PX091601690000 Blank 6 4 N/A
PX091601_Blank7 PX091601700000 Blank 7 4 N/A
PX091601_Blank8 PX091601710000 Blank 8 4 N/A
PX091601_Blank9 PX091601720000 Blank 9 4 N/A
PX091601_BTPS_Calculation_Temperature PX091601050000 Temperature (ºC) used in BTPS calculation 4 N/A
PX091601_BTPS_Factor PX091601190000 BTPS factor 4 Variable Mapping
PX091601_Calibration_Date PX091601290000 Calibration date 4 N/A
PX091601_Calibration_Result PX091601310000 Calibration result 4 Variable Mapping
PX091601_Calibration_Time PX091601300000 Calibration time 4 Variable Mapping
PX091601_City PX091601230000 City 4 N/A
PX091601_Comments_Text PX091601620000 Comments text 4 Variable Mapping
PX091601_Computer_Quality PX091601140000 Computer quality code 4 Variable Mapping
PX091601_Country PX091601260000 Country 4 N/A
PX091601_Data_Type PX091601030000 Data type 4 N/A
PX091601_Date PX091601320000 Date 4 N/A
PX091601_Date_Of_Birth PX091601410000 Date of birth 4 Variable Mapping
PX091601_Date_Of_Review PX091601170000 Date of review 4 N/A
PX091601_Deleted_Maneuver PX091601110000 Deleted manoeuvre 4 Variable Mapping
PX091601_Effort_Attribute PX091601090000 Effort attribute 4 N/A
PX091601_Email PX091601270000 E-mail 4 N/A
PX091601_Extrapolated_Volume PX091601490000 Extrapolated volume 4 Variable Mapping
PX091601_FES_25_75 PX091601530000 FEF25-75% 4 Variable Mapping
PX091601_FEV1 PX091601500000 FEV1 4 Variable Mapping
PX091601_FEV1_Quality PX091601080000 FEV1 quality attribute 4 Variable Mapping
PX091601_FEV6 PX091601510000 FEV6 4 Variable Mapping
PX091601_Flow_Data_Points PX091601750000 Flow data points (mL/s; variable number contained in number of data points) 4 N/A
PX091601_Forced_Expiratory_Time PX091601550000 Forced expiratory time 4 Variable Mapping
PX091601_FVC PX091601480000 FVC 4 Variable Mapping
PX091601_FVC_Quality PX091601070000 FVC quality attribute 4 Variable Mapping
PX091601_Height PX091601370000 Height 4 Variable Mapping
PX091601_Maneuver_Number PX091601350000 Manoeuvre number 4 N/A
PX091601_Methacholine_Concentration PX091601460000 Methacholine Concentration 4 N/A
PX091601_Methacholine_Dose PX091601470000 Methacholine dose 4 N/A
PX091601_Number_Of_Data_Points PX091601740000 Number of data points 4 N/A
PX091601_Original_Sampling_Interval PX091601630000 Original sampling interval 4 N/A
PX091601_PEF PX091601520000 PEF 4 Variable Mapping
PX091601_Phone_Number PX091601280000 Phone number 4 N/A
PX091601_Plateau PX091601150000 Plateau achieved 4 Variable Mapping
PX091601_Predicted_FEV1 PX091601580000 Predicted FEV1 4 Variable Mapping
PX091601_Predicted_FEV1/FEV6 PX091601610000 Predicted FEV1/FEV6% 4 Variable Mapping
PX091601_Predicted_FEV1/FVC PX091601600000 Predicted FEV1/FVC% 4 Variable Mapping
PX091601_Predicted_FEV6 PX091601590000 Predicted FEV6 4 N/A
PX091601_Predicted_FVC PX091601570000 Predicted FVC 4 Variable Mapping
PX091601_Race PX091601400000 Race (2-character race code) 4 Variable Mapping
PX091601_Reference_Value_Correction PX091601430000 Reference values correction factor 4 N/A
PX091601_Reference_Value_Source PX091601420000 Reference values source (first author surname and date of publication, e.g.''Knudson 1983'') 4 N/A
PX091601_Relative_Humidity PX091601060000 Relative humidity (%) 4 N/A
PX091601_Review PX091601160000 Review 4 N/A
PX091601_Reviewer_Initials PX091601180000 Reviewer initials 4 N/A
PX091601_Sex PX091601390000 Sex 4 Variable Mapping
PX091601_Spirometer_Manufacturer PX091601200100 Spirometer manufacturer 4 N/A
PX091601_Spirometer_Model PX091601200200 Spirometer model 4 N/A
PX091601_Spirometer_Serial_Number PX091601200300 Spirometer serial number 4 N/A
PX091601_Spirometer_Type PX091601210000 Spirometer type 4 N/A
PX091601_State_Region PX091601240000 State/region 4 N/A
PX091601_Technician_ID PX091601340000 Technician ID 4 Variable Mapping
PX091601_Technician_Quality PX091601130000 Technician quality control code 4 Variable Mapping
PX091601_Testing_Facility PX091601220000 Testing facility name 4 N/A
PX091601_Testing_Position PX091601440000 Testing position 4 Variable Mapping
PX091601_Test_Type PX091601450000 Test type 4 N/A
PX091601_Time PX091601330000 Time 4 N/A
PX091601_Time_To_PEF PX091601560000 Time to PEF 4 Variable Mapping
PX091601_VC PX091601540000 VC 4 Variable Mapping
PX091601_Weight PX091601380000 Weight 4 Variable Mapping
PX091601_Zip_Code PX091601250000 Zip/post code 4 N/A
Research Domain Information
Measure Name:

Spirometry

Release Date:

November 28, 2017

Definition

Spirometry is a common pulmonary function test (PFT) measuring the amount (volume) and/or speed (flow) of air being inhaled and exhaled.

Purpose

Spirometry is a tool used to screen for the presence of obstructive and restrictive lung diseases.

Keywords

Respiratory, pulmonary function test, PFT, American Thoracic Society, ATS, European Respiratory Society, ERS, forced vital capacity, FVC, forced expiratory volume, FEV