1. Lynn Orford Community Respiratory Team and HOSAR Lead
GP Practice Update
Lynn Orford
Community Respiratory Team and HOSAR Lead

2. Spirometry Guidelines published by the PCC in 2013
National recommendation for Diagnostic Spirometry to be quality assured come into effect 2020

3. Equipment A spirometer that meets the correct industry standard
One way mouthpieces and nose clips
Bacterial / viral filters
Height measure and weighing scales
For reversibility testing
Nebuliser or single patient use volumatics
Short acting broncholdilator

4. Calibration Need a 3 litre syringe
This needs to be checked annually to ensure accuracy to within 15 ml
Calibrate before every session ( or 10 patients)
Document calibration/ verification

5. Cleaning Regular cleaning schedule Document schedule
Need appropriate cleaning solution to the machine.

6. Reasons for spirometry
Detect the presence of lung disease
Assist in diagnosis
Classify severity
Monitor deterioration of disease
To help guide optimal medication management

7. Contra- indications to Spirometry
Active infection ( ideally to be 6 weeks post )
Recent MI ( 6 weeks)
Aneurysm
Pneumothorax
Recent surgery ( 6 weeks)
Ophthalmic surgery
Communication/ability to follow instructions

8. Infection control Follow general infection control
Immune compromised patients ideally at beginning of session
Known infective patients should be at the end of the session and with a filter ( if not used routinely)

9. The test Is it acceptable ? Is it repeatable ?
At least 3 forced manoeuvres – FEV1 & FVC
Graph should be smooth and free from irregularities
Exhalation – at least 6 seconds
VC, FVC– use the best one to calculate ratio
2 best tests within 5% or 100 mL of each other

10. Results
Numbers
Flow volume curve / loop
Volume/time curve

11. Classifying Abnormal Function
Obstruction
Apparent restriction
Mixed
FEV1
Normal or
FVC
FEV1/FVC

12. Problems as seen on volume / time curve

13. Problems as seen on flow volume curve

14. Normal

15. Obstructive pattern FEV1/FVC ratio less that 70%
Should also be below the lower limit of normal to help prevent false positive in the elderly and false negative in the younger age groups
FEV1 is used to measure the severity of obstruction

16. Obstruction

17. Restrictive Pattern Normal or increased FEV1/FVC ratio Low FVC
Need full lung function to determine cause
Easy to get false positive due to lack of patient cooperation or early termination leading to a falsely low FVC

18. Restriction

19. Different curves

20. Mixed pattern Restrictive and obstructive patterns occur together
FVC and FEV1/FVC ratio below the lower limit of normal
Need full lung function e.g. Total lung capacity and gas transfer

21. Mixed Pattern

22. South East London Guideline

23. Relievers- short acting
First line
Examples are
Ventolin, Salbutamol,
Bricanyl, Terbutaline
Atrovent, Ipratropium bromide
Typically previously mostly came in MDI format now available in dry powder

24. MDI

25. MDI and Spacer

26. Easi-breathe

27. Easyhaler

28. Relievers – long acting
Examples are:
LABA
LAMA
Serevent
Seebri
Oxis
Eklira
Onbrez
Incruse
Striverdi
Spiriva ( generic- Braltus)

29. Serevent Accuhaler (LABA)

30. Oxis Turbohaler (LABA)

31. Striverdi Respimat (LABA)

32. Onbrez Breezhaler(LABA)

33. Spiriva Handihaler (LAMA)

34. Spiriva Respimat (LAMA)

35. Seebri Breezhaler ( LAMA)

36. Eklira Genuair ( LAMA)

37. Incruse Ellipta ( LAMA)

38. LABA /LAMA Combinations
Long acting
Once or twice a day
Maximal Bronchodilatation

39. Anoro

40. Ultibro

41. Duaklir

42. Spiolto

43. LABA/ICS Combination Inhalers
Only 4 Licensed products used locally
Combine a long acting bronchodilator and an inhaled steroid
Seretide 500 Accuhaler – generic- Aerivio Spiromax/ Airflusal Forspiro/ Fusacomb Easyhaler
Symbicort 400/12 and 200/6 Turbohaler - generic is Duoresp Spiromax
Fostair 100/6 MDI and Nexthaler
Relvar Ellipta 92/22
NB Sirdupla / Sereflo /Airflusal / Aloflute- generic versions of Seretide 250 MDI- do not have COPD Licence

44. Seretide 500

45. Symbicort

46. Fostair

47. Relvar

48. Triple Therapy Combination of inhaled corticosteroid/ LABA/LAMA
Should only be started after seeking advice from or referring to respiratory specialist

49. Trimbow
Two puffs twice a day- used with a spacer

50. Trelegy
Once a day

51. MDI
Slow and steady

52. DPI
Fast and deep

53. PRESCRIBE ALL THERAPIES BY BRAND
BRAND PRESCRIBING
PRESCRIBE ALL THERAPIES BY BRAND

54. RightBreathe
Or As an APP for patients as well as HCP’s Available as Android or Apple