• Adequate height, as measured with a stadiometer,
is crucial to ensure utilization of appropriate predicted values.
• A positive response to bronchodilator testing is defined as a
12% increase in the forced expiratory volume in 1 second
• Explain the procedure in a developmentally appropriate manner
before and during procedure.
• Coach the patient for optimal effort to ensure acceptable results.
• In older patients, it is ideal to recommend no smoking for 24
hours prior to testing.
• If assessing response to a bronchodilator, any bronchodilator
medications should not be used for at least 8 hours before testing.
• Place nose clips on patient.
• Patient makes a seal with lips around mouthpiece.
• Ensure tongue does not block opening.
• Have the patient breathe comfortably for 3 breaths (tidal breathing).
• At end exhalation, have patient take fast breath in to fill lungs
completely (to total lung capacity).
• At top of inspiration, have patient exhale fast and hard and
keep exhaling for 6 seconds or until flow plateaus.
• At end of exhalation, inhale to fill lungs completely (total lung
• Maneuver should be repeated to obtain 3 tests that are acceptable
• A test must first be considered acceptable and
• A test is acceptable if it fulfills the following criteria:
• No cough or glottic closure in first second of exhalation.
• No leaks or obstruction of mouthpiece.
• Adequate start of test without hesitation.
• Full exhalation of 6 seconds or until plateau of volume.
• No early termination of test.
• Reproducibility in children can be defined as the values of the
forced vital capacity (FVC) and FEV1 being within 5% on
3 acceptable maneuvers.
• Obstructive lung disease is determined by a combination of the
• Decreased flows (FEV1, FVC, mid-range flows).
• Scooped appearance to the flow volume curve (Figure
• Restrictive lung disease is suggested by a decreased FEV1 and
FVC and a normal or decreased FEV1/FVC ratio (see Figure 19–1).
• In order to adequately determine restrictive lung disease, full
pulmonary function tests should be obtained to include lung volumes.
Flow-volume loops showing normal pulmonary function as
well as obstructive and restrictive lung disease.
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