1. Interpretation Normal Spirometry Obstructive pattern
Restrictive pattern
Mixed pattern
Small airway obstruction
Non-specific ventilatory pattern
Probably normal pattern
Upper airway obstruction pattern
Neuromuscular diseases

5. Normal Spirogram All parameters are normal
Normal shape in VT and FV loop

6. A. Normal: both the FVC and the FEV1/VC ratio are normal.
“Knee”

7. Obstructive pattern

8. Obstructive pattern

9. The severity of the abnormality is graded:
- % Pred FEV1 > 100 = May be a physiological variant
- % Pred FEV1 < 80 and > Mild
- % Pred FEV1 < 70 and > 60 Moderate severe
-% Pred FEV1 < 60 and > Moderately
- % Pred FEV1 < 50 and > Severe
- % Pred FEV1 < Very severe

10. Severe obstructive pattern

14. Restrictive pattern

15. Restrictive pattern

17. The severity of the abnormality might be graded as follows:
- % Pred FVC < LLN and > 70 mild
- % Pred FVC < 70 and > 60 Moderate
-% Pred FVC < 60 and > 50 Moderately severe
-% Pred FVC < 50 and > Severe
- % Pred FVC < Very severe

18. Mixed pattern

19. Small airway obstruction

21. Early small airway obx FV curve :upward concavity
FVC, FEV1, FEV1/FVC :NL
 FEF ???
ATS states that FEF25-75% should not be used to diagnose small airway disease or to assess respiratory impairment

22. Probably normal

23. Isolated decrease in FEF25-75 Isolated decrease in FEV1/FVC

24. Probably normal spirogram
Only  FEF 25-75
No small airway disease (ATS)
Only  FEV1/FVC
FEV1> 100% Probably Normal
FVC>100%

25. Nonspecific ventilatory pattern
Similar to restrictive pattern
Normal TLC, RV & DLco
Obesity
Asthma
COPD
Normal variant

29. Upper airway obx

30. Upper airway obstruction pattern

34. Indications for referral
FEV1/FVC less than %75 and FEV1 less than %80
FEV1/FVC more than %75 and FVC less than %80
Significant reduction across time
Pulmonary symptoms or signs even with normal spirogram

35. Screening Spirometry
General health
Occupational health screening

36. Screening Spirometry in General Healthy Population
Baseline spirogram in all at 20-25
Periodic spirogram depends on risk factors such as smoking each 1-5 yrs.

37. Occupational screening spirogram
In certain occupational exposures
Asbestos, silica, cadmium, cotton, coal, beryllium, wood dust,….
Usually each 1-2 yrs

38. Comparison of periodic spirogram
Significant change in FEV1 or FVC
Cross-shift
Week-to-week
Year-to-year
Definition

39. Considerations in periodic spirogram
Using:
Similar reference values
Similar patient position
Similar time
Standard spirometer
Standard technique

40. Change in spirometric indices over time
NIOSH :
(0.85 .initial FEV1 or FVC) – (number of yr )
FVC
FEV1
male
female
30 ml/yr
25 ml/yr
(value on time 1 – value on time 2 / value on time 1) × 100

41. In an ongoing annual surveillance of asbestos workers, a 24 year old woman is found to have an FVC of 3.59 liters. Her previous FVC was 4.17 liters. What is your interpretation?
Absolute change: = .58 liters
She showed a loss of .58 liters.
Percent change: (( )/4.17) x 100 = 13.9%
She showed a loss of 13.9% in her FVC.

42. Further investigation recommended for follow-up results if:
Decline in FEV1 or FVC > 15% in longitudinal screening. If the period is > 5 years, adjust for the decline due to aging (25 ml/year)
FEV1, FVC or FEV1/FVC < LLN at any time
>10% decline between pre and post shift screening

43. Case 1 A 71 yrs male Height :175 ,weight :88 FVC:45% FEV1: 31%
FEV1/ FVC :53%
FEF25-75 :15%
TLC :142%
very severe obx

44. Case 2 A 36 yrs female Height :162 ,weight :83 FVC:89% FEV1: 94%
FEV1/ FVC :89%
FEF25-75 :131%
TLC :92%
normal

45. Case 3 A 29 yrs female Height :165 ,weight :129 FVC:78% FEV1: 79%
FEV1/ FVC :86%
FEF25-75 :85%
TLC :82%
non specific ventilatory

46. Case 4 A 43 yrs female Height :61,weight :167 FVC:33% FEV1: 17%
FEV1/ FVC :42%
TLC :114%
variable inthratoracic
obx

47. Case 5 A 30 yrs male Height :186,weight :68 FVC:19% FEV1: 21%
FEV1/ FVC :93%
FEF25-75% :48%
TLC :28%
very severe restriction

48. Case 6 A 30 yrs male Height :175 ,weight :70 FVC: 88% FEV1: 69%
FEV1/ FVC :66%
FEF25-75 :38%
VEXT : 90
moderate obx

49. Case 7 A 29 yrs male Height :179 ,weight :83 FVC: 95% FEV1: 84%
FEV1/ FVC :67%
FEF25-75 :51%
VEXT : 120
Mild obx

50. Case 8 A 26 yrs male Height :177 ,weight :67 FVC: 97% FEV1: 77%
FEV1/ FVC :66%
FEF25-75 :48%
VEXT : 60
mild obx

51. Post bronchodilator spirometry (reversibility testing)
Short-acting inhaled drugs should not be used within 4h of testing
Long-acting should be stopped for 12h prior test
Smoking should be avoided for ≥ 1h
Salbutamol 400 µg (4 puffs) at 30s intervals → ≥ 10 min and up to 15 min
Ipratropium bromide 160 µg (4 puffs)→30 min later

52. Positive reversibility testing
Percent change from baseline & absolute change in FEV1 and/or FVC :
>12% AND 200 CC
Other criteria include:
At least 20% increase in FEF25-75%

53. A 24 yrs male
Height :170 ,weight :82
FVC:80%
FEV1: 70%
FEV1/ FVC :69%
FEF25-75 :50%

54. pre post %change
FVC
FEV
FEV1/ FVC
FEF

55. Case A 70 yrs male, Height :172 ,weight :65 pre %pred post %chg
FVC
FEV
FEV1/ FVC

56. Case A 28 yrs male , Height :192 ,weight :92 pre %pred post %chg
FVC
FEV
FEV1/ FVC

57. Thank you