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Diagnostic performance of lung volumes in assessment of reversibility in chronic obstructive pulmonary disease. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Reversibility measured by spirometry in chronic obstructive pulmonary disease (COPD) is defined as an increase in forced expiratory volume in first second (FEV1) that is both more than 12% and 200 mL above the pre-bronchodilator value in response to inhaled bronchodilators. FEV1 only may not fully reverberate the changes caused by reduction in air trapping or hyperinflation. To date, the studies that examined the effect of inhaled bronchodilators (BD) on residual volume (RV) and total lung capacity (TLC) are limited. This study was carried out to assess the differences between flow and volume responses after bronchodilator reversibility testing in patients with different COPD GOLD stages (GOLD stage I to stage IV). Spirometry and whole body plethysmography were done before and 15 min after inhalation of 400 μg salbutamol.
Results
Majority (53.3%) of cases were volume responders, 18.7% were flow responders, 20% were flow and volume responders, and 8% were non responders. Significant increase in Δ FEV1% was found in 15% of cases while 55% showed a significant increase in Δ FVC (P= < 0.001). Mean difference of Δ FVC (L) post BD was significantly increased with advancing GOLD stage (P= 0.03). A cutoff point > 20% for Δ RV% had 70% sensitivity and 60% specificity and > 12% for Δ TLC% showed 90% sensitivity and 45% specificity for prediction of clinically significant response to BD based on FEV1. A cutoff point > 18% for Δ RV% had 78% sensitivity and 29% specificity and > 14% for Δ TLC% had 50% sensitivity and 70% specificity for prediction of clinically significant response to BD based on FVC.
Conclusion
ΔFEV1 underestimates the true effect of bronchodilators with advancing GOLD stage. Measurement of lung volumes in addition to the standard spirometric indices is recommended when determining bronchodilator response in COPD patients.
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Ranzieri S, Corradi M. Conducting spirometry in occupational health at COVID-19 times: international standards. LA MEDICINA DEL LAVORO 2021; 112:95-106. [PMID: 33881003 PMCID: PMC8095332 DOI: 10.23749/mdl.v112i2.11420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
Spirometry is a commonly performed assessment of lung function for diagnostic purposes as well as for monitoring of chronic lung diseases. The last international standardization of this technique was published in 2005. After 14 years, a group of experts from two leading scientific societies, American Thoracic Society (ATS) and European Respiratory Society (ERS), published a joint position that updated the standardization of spirometry, with an extensive criteria re-organization, including key updates such as: relative contraindications, instrumentation requirement to meet the International Organization for Standardization (ISO) standards, quality assurance, operator training, pre-test requirements, acceptability and usability criteria. New standards underline three key elements to obtain high quality pulmonary function data: an accurate and precise instrumentation, a patient/subject capable of performing acceptable and repeatable measurements, and a motivated technologist to elicit maximum performance from the patient. Never- theless, although COVID-19 pandemic has enormously impacted and limited a widespread application of spirometry, it has prompted much attention on hygienic procedures and on further research on noncontact spirometers.
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Affiliation(s)
- Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, Italy.
| | - Massimo Corradi
- Department of Medicine and Surgery, University of Parma, Italy.
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Schneider I, Rodwell L, Baum S, Borg BM, Del Colle EA, Ingram ER, Swanney M, Taylor D. Assessing spirometry competence through certification in community-based healthcare settings in Australia and New Zealand: A position paper of the Australian and New Zealand Society of Respiratory Science. Respirology 2020; 26:147-152. [PMID: 33319478 PMCID: PMC7898916 DOI: 10.1111/resp.13987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/02/2020] [Accepted: 11/23/2020] [Indexed: 12/03/2022]
Abstract
Spirometry has been established as an essential test for diagnosing and monitoring respiratory disease, particularly asthma and COPD, as well as in occupational health surveillance. In Australia and New Zealand, there is currently no pathway for spirometry operators in community‐based healthcare settings to demonstrate spirometry competence. The Australia and New Zealand Society of Respiratory Science (ANZSRS) has identified a need for developing a pathway for operators working in community‐based practices in Australia and New Zealand to demonstrate spirometry competence and certification. Spirometry certification provides evidence to patients, clients, employers and organizations that an individual has participated in an assessment process that qualifies them to perform spirometry to current international spirometry standards set out by the American Thoracic Society and the European Respiratory Society (ATS/ERS). This document describes a competence assessment pathway that incorporates a portfolio and practical assessment. The completion of this pathway and the award of certification confer an individual is competent to perform spirometry for 3 years, after which re‐certification is required. The adoption of this competency assessment and certification process by specialist organizations, and the commitment of operators performing spirometry to undergo this process, will enhance spirometry quality and practice in community‐based healthcare settings.
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Affiliation(s)
- Irene Schneider
- Respiratory Investigation Unit, The Prince Charles Hospital, Brisbane, QLD, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Leanne Rodwell
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Sarah Baum
- Spirometry Training Company (Aust), Sessional Academic, Charles Sturt University, Sydney, NSW, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eleonora A Del Colle
- Respiratory Laboratory Services, Department of Respiratory Medicine, Box Hill Hospital, Melbourne, VIC, Australia.,Pulmetrics Pty Ltd, Melbourne, VIC, Australia
| | - Emily R Ingram
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Maureen Swanney
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Deborah Taylor
- Respiratory Laboratory, Hawke's Bay District Health Board, New Zealand, Hawke's Bay, New Zealand.,Spiro Me Training, Hawke's Bay, New Zealand
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Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, Hallstrand TS, Kaminsky DA, McCarthy K, McCormack MC, Oropez CE, Rosenfeld M, Stanojevic S, Swanney MP, Thompson BR. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2020; 200:e70-e88. [PMID: 31613151 PMCID: PMC6794117 DOI: 10.1164/rccm.201908-1590st] [Citation(s) in RCA: 1645] [Impact Index Per Article: 411.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities.Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients' experiences.Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices.Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.
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Lopez Lopez L, Granados Santiago M, Donaire Galindo M, Torres Sanchez I, Ortiz Rubio A, Valenza MC. Efficacy of combined electrostimulation in patients with acute exacerbation of COPD: randomised clinical trial. Med Clin (Barc) 2018; 151:323-328. [PMID: 29705158 DOI: 10.1016/j.medcli.2018.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVE Muscle dysfunction is very common in patients with chronic obstructive pulmonary disease (COPD). Muscular strength depletion is a result of numerous hospitalisations and this causes an increase in the symptomatology. Numerous interventions have been used in these patients, but there is no consensus on the best. The main objective of this study is to compare the effectiveness of two physiotherapy interventions during hospitalisation in COPD patients. PATIENTS AND METHODS In this clinical trial, we included 39 patients who were randomised into three groups. A control group received standard medical treatment (oxygen therapy and pharmacotherapy), and two groups received, in addition to standard medical treatment, a physiotherapy intervention, one with functional electrostimulation and one with calisthenic exercises. The main variables were the ability to exercise using the Five-time sit-to-stand test as well as the functionality associated with symptomatology, as measured by the London Chest Activity of Daily Living Scale. RESULTS After comparing the results, there was a significant improvement in dyspnea on discharge versus admission in all three groups. In addition, we found significant differences in functionality, exercise capacity, and fatigue in both intervention groups, being better in the electrostimulation with calisthenic exercises group than in the functional group. CONCLUSION An electrostimulation treatment improves the exercise capacity, functionality and fatigue in hospitalised AECOPD patients.
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Affiliation(s)
- Laura Lopez Lopez
- Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Universidad de Granada, Granada, España
| | - Maria Granados Santiago
- Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Universidad de Granada, Granada, España
| | - Maria Donaire Galindo
- Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Universidad de Granada, Granada, España
| | - Irene Torres Sanchez
- Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Universidad de Granada, Granada, España
| | - Araceli Ortiz Rubio
- Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Universidad de Granada, Granada, España
| | - Marie Carmen Valenza
- Facultad de Ciencias de la Salud, Departamento de Fisioterapia, Universidad de Granada, Granada, España.
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Marina N, López de Santa María E, Gáldiz JB. Telemedicina, una oportunidad para la espirometría. Arch Bronconeumol 2018; 54:306-307. [DOI: 10.1016/j.arbres.2017.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
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Migliori GB, Bel E, Joos G, Elliott M, Rohde G, Holgate ST, Gratziou C, Smyth D, Gaga M, Cordeiro CR, Burghuber OC, Brusselle G, Martin-Burrieza F, Bill W, Sax B, Vestbo J. The European Respiratory Society evaluates its 2013–2018 strategic plan implementation. Eur Respir J 2016; 47:693-8. [DOI: 10.1183/13993003.02110-2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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8
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López-Campos JL, Tan W, Soriano JB. Global burden of COPD. Respirology 2015; 21:14-23. [DOI: 10.1111/resp.12660] [Citation(s) in RCA: 480] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/12/2015] [Accepted: 07/23/2015] [Indexed: 12/23/2022]
Affiliation(s)
- José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS); Hospital Universitario Virgen del Rocío/Universidad de Sevilla; Sevilla Spain
- CIBER de Enfermedades Respiratorias (CIBERES); Instituto de Salud Carlos III; Madrid Spain
| | - Wan Tan
- James Hogg Research Laboratories; St Paul's Hospital, University of British Columbia Providence Heart and Lung Institute; Vancouver Canada
| | - Joan B. Soriano
- Cátedra UAM-Linde; Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid; Madrid Spain
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Márquez-Martín E, Soriano JB, Rubio MC, Lopez-Campos JL. Differences in the use of spirometry between rural and urban primary care centers in Spain. Int J Chron Obstruct Pulmon Dis 2015; 10:1633-9. [PMID: 26316737 PMCID: PMC4544627 DOI: 10.2147/copd.s86074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate the ability and practice of spirometry, training of technicians, and spirometry features in primary care centers in Spain, evaluating those located in a rural environment against those in urban areas. METHODS An observational cross-sectional study was conducted in 2012 by a telephone survey in 970 primary health care centers in Spain. The centers were divided into rural or urban depending on the catchment population. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test that included the following topics: center resources, training doctors and technicians, using the spirometer, bronchodilator test, and the availability of spirometry and maintenance. RESULTS Although the sample size was achieved in both settings, rural centers (RCs) gave a lower response rate than urban centers (UCs). The number of centers without spirometry in rural areas doubled those in the urban areas. Most centers had between one and two spirometers. However, the number of spirometry tests per week was significantly lower in RCs than in UCs (4 [4.1%] vs 6.9 [5.7%], P<0.01). The availability of a specific schedule for conducting spirometries was higher in RCs than in UCs (209 [73.0%] vs 207 [64.2%], P=0.003). RCs were more satisfied with the spirometries (7.8 vs 7.6, P=0.019) and received more training course for interpreting spirometry (41.0% vs 33.2%, P=0.004). The performance of the bronchodilator test showed a homogeneous measure in different ways. The spirometer type and the reference values were unknown to the majority of respondents. CONCLUSION This study shows the differences between primary care RCs and UCs in Spain in terms of performing spirometry. The findings in the present study can be used to improve the performance of spirometry in these areas.
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Affiliation(s)
- Eduardo Márquez-Martín
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid, Spain
| | - Myriam Calle Rubio
- Servicio de Neumología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Marina N, Bayón JC, López de Santa María E, Gutiérrez A, Inchausti M, Bustamante V, Gáldiz JB. Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting. Arch Bronconeumol 2015; 52:24-8. [PMID: 25912937 DOI: 10.1016/j.arbres.2015.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method. MATERIALS AND METHODS The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied. RESULTS TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013). CONCLUSION The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method.
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Affiliation(s)
- Nuria Marina
- Departamento de Neumología, Hospital Universitario Cruces, Barakaldo, España.
| | - Juan Carlos Bayón
- Servicio de Evaluación de Tecnologías Sanitarias (OSTEBA), Departamento de Salud del Gobierno Vasco, Vitoria-Gasteiz, España
| | | | - Asunción Gutiérrez
- Servicio de Evaluación de Tecnologías Sanitarias (OSTEBA), Departamento de Salud del Gobierno Vasco, Vitoria-Gasteiz, España
| | - Marta Inchausti
- Departamento de Neumología, Hospital Universitario Cruces, Barakaldo, España
| | - Victor Bustamante
- Departamento de Neumología, Hospital Universitario Basurto, Bilbao, España; Universidad del País Vasco (UPV-EHU) Biocruces, Hospital Universitario Cruces, Barakaldo, España
| | - Juan B Gáldiz
- Departamento de Neumología, Hospital Universitario Cruces, Barakaldo, España; Departamento de Neumología, Hospital Universitario Basurto, Bilbao, España; Universidad del País Vasco (UPV-EHU) Biocruces, Hospital Universitario Cruces, Barakaldo, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), España
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Burgos F, Melia U, Vallverdú M, Velickovski F, Lluch-Ariet M, Caminal P, Roca J. Clinical decision support system to enhance quality control of spirometry using information and communication technologies. JMIR Med Inform 2014; 2:e29. [PMID: 25600957 PMCID: PMC4288080 DOI: 10.2196/medinform.3179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/27/2014] [Accepted: 08/21/2014] [Indexed: 02/05/2023] Open
Abstract
Background We recently demonstrated that quality of spirometry in primary care could markedly improve with remote offline support from specialized professionals. It is hypothesized that implementation of automatic online assessment of quality of spirometry using information and communication technologies may significantly enhance the potential for extensive deployment of a high quality spirometry program in integrated care settings. Objective The objective of the study was to elaborate and validate a Clinical Decision Support System (CDSS) for automatic online quality assessment of spirometry. Methods The CDSS was done through a three step process including: (1) identification of optimal sampling frequency; (2) iterations to build-up an initial version using the 24 standard spirometry curves recommended by the American Thoracic Society; and (3) iterations to refine the CDSS using 270 curves from 90 patients. In each of these steps the results were checked against one expert. Finally, 778 spirometry curves from 291 patients were analyzed for validation purposes. Results The CDSS generated appropriate online classification and certification in 685/778 (88.1%) of spirometry testing, with 96% sensitivity and 95% specificity. Conclusions Consequently, only 93/778 (11.9%) of spirometry testing required offline remote classification by an expert, indicating a potential positive role of the CDSS in the deployment of a high quality spirometry program in an integrated care setting.
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Affiliation(s)
- Felip Burgos
- Hospital Clinic - IDIBAPS - Ciberes, Respiratory Diagnostic Center, University of Barcelona, Barcelona, Spain.
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Redlich CA, Tarlo SM, Hankinson JL, Townsend MC, Eschenbacher WL, Von Essen SG, Sigsgaard T, Weissman DN. Official American Thoracic Society technical standards: spirometry in the occupational setting. Am J Respir Crit Care Med 2014; 189:983-93. [PMID: 24735032 DOI: 10.1164/rccm.201402-0337st] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This document addresses aspects of the performance and interpretation of spirometry that are particularly important in the workplace, where inhalation exposures can affect lung function and cause or exacerbate lung diseases, such as asthma, chronic obstructive pulmonary disease, or fibrosis. METHODS Issues that previous American Thoracic Society spirometry statements did not adequately address with respect to the workplace were identified for systematic review. Medline 1950-2012 and Embase 1980-2012 were searched for evidence related to the following: training for spirometry technicians; testing posture; appropriate reference values to use for Asians in North America; and interpretative strategies for analyzing longitudinal change in lung function. The evidence was reviewed and technical recommendations were developed. RESULTS Spirometry performed in the work setting should be part of a comprehensive workplace respiratory health program. Effective technician training and feedback can improve the quality of spirometry testing. Posture-related changes in FEV1 and FVC, although small, may impact interpretation, so testing posture should be kept consistent and documented on repeat testing. Until North American Asian-specific equations are developed, applying a correction factor of 0.88 to white reference values is considered reasonable when testing Asian American individuals in North America. Current spirometry should be compared with previous tests. Excessive loss in FEV1 over time should be evaluated using either a percentage decline (15% plus loss expected due to aging) or one of the other approaches discussed, taking into consideration testing variability, worker exposures, symptoms, and other clinical information. CONCLUSIONS Important aspects of workplace spirometry are discussed and recommendations are provided for the performance and interpretation of workplace spirometry.
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Inter-regional changes in the performance and interpretation of spirometry in Spain: 3E study. Arch Bronconeumol 2014; 50:475-83. [PMID: 24816035 DOI: 10.1016/j.arbres.2014.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 03/16/2014] [Accepted: 03/28/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This report shows the results of a nation-wide survey on spirometry to assess regional differences. METHODS Observational cross-sectional study conducted by means of a telephone survey in 805 primary care (PC) and specialized centers (SC) in all regions. The survey contacted technicians in charge of spirometry and consisted of 36 questions related to the test. RESULTS The results showed major differences between regions. Most centers had 1-2 spirometers. The number of spirometry tests per week ranged from 2 to 8.9 in PC and between 34.3 and 98.3 in SC. Some training had been given in most centers (63.6-100% in PC and 60.0-100% in SC) but not on a regular basis. Most centers used several short-acting bronchodilators for the bronchodilation test, but with insufficient inhalations (2.0-3.8 in PC and 2.0-3.3 in SC) and frequently incorrect waiting time (29.4-83.3% PC and 33.3-87.5% in SC). Daily calibration was not performed in all centers (0-100% in PC and 66.7-100% in SC). Significant inter-regional differences in spirometry quality criteria were observed, with 6 or more criteria met in 9.1-84.6% of PC centers and 37.5-100% in SC. CONCLUSIONS Our results show the current situation of spirometry in primary and specialized care in Spain, highlighting considerable variability and areas for improvement. This information should be considered by health officials to improve the quality and accessibility of such tests.
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García-Río F, Calle M, Burgos F, Casan P, del Campo F, Galdiz JB, Giner J, González-Mangado N, Ortega F, Puente Maestu L. Spirometry. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Represas-Represas C, Botana-Rial M, Leiro-Fernández V, González-Silva AI, García-Martínez A, Fernández-Villar A. Short- and Long-Term Effectiveness of a Supervised Training Program in Spirometry Use for Primary Care Professionals. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2013.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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López-Campos JL, Calle M, Soriano JB. Continuing education in spirometry: a light along the way. Arch Bronconeumol 2013; 49:369-70. [PMID: 23845760 DOI: 10.1016/j.arbres.2013.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/27/2013] [Accepted: 04/30/2013] [Indexed: 11/29/2022]
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García-Río F, Calle M, Burgos F, Casan P, Del Campo F, Galdiz JB, Giner J, González-Mangado N, Ortega F, Puente Maestu L. Spirometry. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR). Arch Bronconeumol 2013; 49:388-401. [PMID: 23726118 DOI: 10.1016/j.arbres.2013.04.001] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/23/2013] [Accepted: 04/01/2013] [Indexed: 11/19/2022]
Abstract
Spirometry is the main pulmonary function test and is essential for the evaluation and monitoring of respiratory diseases. Its utility transcends the field of Respiratory Medicine, is becoming increasingly important in primary care and applications have even been described outside the field of respiratory diseases. This document is therefore intended to serve as support for all health professionals who use spirometry, providing recommendations based on the best scientific evidence available. An update of the indications and contraindications of the test is proposed. The document sets out recommendations on the requirements necessary for conventional spirometers and portable office equipment, as well as on spirometer hygiene and quality control measures. Spirometric parameters that must be considered, performance of manoeuvres, criteria for acceptability and repeatability of measurements and their quality control are defined. A proposal is also established for presentation of the results and an evaluation and interpretation is proposed according to information generated in recent years. Finally, lines of adaptation and integration of spirometry in the field of new technologies are considered.
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Affiliation(s)
- Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz-IdiPaz, Universidad Autónoma de Madrid, CIBERES, Madrid, España.
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Represas-Represas C, Botana-Rial M, Leiro-Fernández V, González-Silva AI, García-Martínez A, Fernández-Villar A. Short- and long-term effectiveness of a supervised training program in spirometry use for primary care professionals. Arch Bronconeumol 2013; 49:378-82. [PMID: 23481409 DOI: 10.1016/j.arbres.2013.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/19/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Despite the importance of spirometry, its use and quality are limited in the Primary Care setting. There are few accredited training programs that have demonstrated improvement in the quality of spirometric studies. In this paper, we analyze the short- and long-term effectiveness of a supervised training program for performing and interpreting spirometries. METHODOLOGY Ours is an intervention study with before and after measurements. The target population included teams of physicians and nursing staff at 26 health-care centers in the area of Vigo (Galicia, Spain). The structured training program involved 2 theoretical and practical training sessions (that were 2months apart), an intermediate period of 30 supervised spirometries performed in the respective centers and weekly e-mail exercises. Effectiveness was evaluated using exercises at the beginning (test 1) and the end (test 2) of the 1st day, 2nd day (test 3) and one year later (test 4), as well as the analysis of spirometries done in month1, month2 and one year later. Participants also completed a survey about their satisfaction. RESULTS 74 participants initiated the program; 72 completed the program, but only 45 participated in the one-year evaluation. Mean test scores were: 4.1±1.9 on test 1; 7.5±1.6 on test 2; 8.9±1.3 on test 3, and 8.8±1.4 on test 4. During month1, the percentage of correctly done/interpreted tests was 71%, in month two it was 91% and after one year it was 83% (P<.05). CONCLUSIONS A training program based on theoretical and practical workshops and a supervised follow-up of spirometries significantly improved the ability of Primary Care professionals to carry out and interpret spirometric testing, although the quality of the tests diminished over time.
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Stipic I, Polasek O, Vulic M, Punda H, Grandic L, Strinic T. Estrogen replacement therapy improves pulmonary function in postmenopausal women with genital prolapse. Rejuvenation Res 2012; 15:596-600. [PMID: 22950430 DOI: 10.1089/rej.2012.1337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study examined the impact of estrogen replacement therapy with spirometry on pulmonary function in surgically castrated (salpingo-oophorectomy) postmenopausal women with genital prolapse. METHODS The study included 60 postmenopausal women with pelvic organ prolapse. The study received institutional Ethics Committee approval, and all subjects signed an informed consent. Women were randomly divided into two groups of 30 subjects: Group 1 (n=30) was administered estrogen replacement with 1 mg of stradiol hemihydrate (1 mg/day) orally for 6 months, and group 2 (n=30) was not taking estrogen. Both groups were matched by age, height, body mass index, parity, and duration of postmenopause. All subjects were evaluated with spirometry initially and after 6 months. For statistical analysis, descriptive and analytical methods were used, based on data type and distribution. The mean and standard deviations were used as measures of central tendency and variability. Categorical data were expressed as absolute and relative numbers (percentage). The t-test for independent samples (for comparison of groups) and t-test for dependent samples (for comparison of serial measurements in the same patients) were used. The analysis was performed using R software ( www.r-project.org ), with the level of significance set at p<0.05. RESULTS Analysis of spirometry parameters showed statistically significant differences between the estrogen users and the nonusers groups. CONCLUSION The most important study result was the significantly improved lung respiratory function in postmenopausal women with genital prolapse after 6 months of taking estrogen, confirming that hormone replacement therapy should be recommended to postmenopausal women. The findings of our study suggest the need for further research into the effect of estrogen on pulmonary function.
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Affiliation(s)
- Ivica Stipic
- Department of Gynecology and Obstetrics, University Hospital, 21000 Split, Croatia
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Enright P. The new all-age spirometry reference equations are the best available for Caucasians, regardless of where they live. Respirology 2011; 16:871-2. [DOI: 10.1111/j.1440-1843.2011.01980.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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