• 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.
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.