Chapter 19

• • Assessment of pulmonary function in patients with respiratory complaints.

### Absolute

• • Pneumothorax.

• Hemoptysis.

### Relative

• • Age; patients can usually perform maneuver starting between ages 4 and 5 years.

• • Spirometer.

• Individual mouthpieces.

• Nose clips.

• • Pneumothorax (rare).

• • 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 (FEV1).

• • 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.

• • Patient should be sitting upright or standing tall.

• • 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 capacity).

• Maneuver should be repeated to obtain 3 tests that are acceptable and reproducible.

• • A test must first be considered acceptable and reproducible.

• 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 following:

• • Decreased flows (FEV1, FVC, mid-range flows).

• Scooped appearance to the flow volume curve (Figure 19–1).

• • Decreased FEV1/FVC ratio.

• 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.

###### Figure 19–1.

Flow-volume loops showing normal pulmonary function as well as obstructive and restrictive lung disease.

• • Spirometry alone may not give a complete assessment of ...

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