SPIROMETRY PROTOCOL AND SOFTWARE TRAINING HANDOUT
Spirometry Protocol
Key Points in Performing Spirometry ▪ Always demonstrate the maneuver ▪ Prompt the participant to BLAST out the air ▪ Continue by having the participant PUSH out the air ▪ Continue until the balloon bursts or at least six seconds
Getting ready to do Spirometry Subjects will be instructed to not use any bronchodilator medicines for at least 4 hours prior to the appointment (in the case of salmeterol [Serevent] or Fomoterol (foradil)or Tritoprium (Spiriva) avoid for 12 hours prior to the test). Bronchodilator medicines include:
Short acting bronchodilators
Albuterol (ventolin, proventil, airet, volmax tablet)
Levalbuterol (xopenex)
Metaproterenol (alupent)
Pirbuterol (maxair)
Terbutaline (brethaire, brethine, bricanyl)
Isoetharine (bronkosol)
Ipratropium (atrovent)
Ipratropium and albuterol combination (Combivent)
Isoproteranol (isuprel)
Primatine
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Bitolterol (tornalate)
Long acting bronchodilator
Salmeterol (serevent)
Fomoterol (foradil)
Tritoprium (Spiriva)
Bronchodilators should be avoided because they can affect the spirometry results. If the patient is having symptoms from asthma and needs to use the medicine, ask that the medicine be used 4 hours before the visit, so that the next dose is due during the visit. Patients can then do the spirometry and then the patient can take the medicine after the test is completed.
When scheduling the follow-up spirometry visit, if at all possible, try to make the visit at the same time as the initial baseline visit.
1. Preparing the Computer 1. Check to see if the time and date on the lower right hand corner is current. If the date and time is NOT, the spirometer will NOT sync with the computer or the Easy One software. a. If the date and time is not current, shut down the computer. Start up the computer again and as soon as the DELL screen comes on, press key F2. b. In the upper left hand corner is the Time: And Date: change both of those boxes to the current date and time. Note that the time is in military time. 2. Put the USB end of the spirometer cable into the back of the computer. You will hear a ding. 3. Put the large end of the cable into the bottom of the hand held spirometer. The curved edge of the large cord end with the prongs facing forward; is inserted into the bottom of the spirometer unit. 4. Go to the computer and double click on the EasyWare Icon. 5. Turn the Spirometer on. 6. The EasyWare screen with participant a list of participant tests will appear.
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If everything is connected correctly, the EasyOne page will show in the lower right hand corner, “Device Connected”.
2. Preparing the Spirometer and Computer
1. Put a Spirette into the hand held spirometer. The arrows will line up between the spirometer and the Spirette.
2. Return to the computer, Go to the EDIT menu and select New Patient.
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3. Enter the participant data from the participant file. The ID number is the number that is assigned to the participant and is located on the tab of the file. The number is written on the tab of the file folder. You will need to enter the DOB, your initials, height and weight, gender, asthma diagnosis, ethnicity and if they are a smoker. All of this information is available in the participant file.
4. Click on OK.
5. You will see the participant record on the top line of the table. Highlight the row with the participant data.
6. Go to the “On-line” icon. This is the first icon on the second tool bar and is located beneath the File menu. This is what connects the computer to the spirometer.
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7. The test page will show. It will be blank.
8. Go to the “Incentives for FVC” drop down menu. This is on the right hand side of the form, just above the “On-Line Mode” box.
9. Select “Children Balloon. swf” from the drop down list. The child with the balloon will appear on the right hand side of the screen.
10. The program is now ready with the animated incentive showing
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11. Go to the hand held spirometer. The screen will say Perform Test.
12. Press “Enter.”
13. The next screen on the spirometer will say “Select Test”. Use the right arrow to move the black highlight to “RECALL.”
14. Press “Enter.”
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15. The next screen will say “Search Test.”
16. Make sure “Last Test” is highlighted.
17. Press “Enter”
18. The screen will have the current participant’s information that you entered into the computer.
19. Press “Enter.”
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20. This screen with have “test” written down the side of the screen and the top of the screen will say “FVC Expiration.”
21. Press “Enter.”
22. The next screen is the “Baseline Setting.” The screen will ask to block the Spirette until prompted to blast out.
23. Have the participant place his/her hand over the end of the Spirette and blow gently.
24. Press “Enter”.
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25. The test screen will appear.
26. While the patient is performing the test, the 27. Here is the first completed test displayed. The balloon animation will inflate as a visual program will order the tests according to best reference of the patient’s progress. results. After three successful tests are completed, click the square box at the bottom of the screen to save the results and return to the main screen.
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28. The patient record has now changed to a data file that can be accessed to view test results.
29. In order to review the patient’s results, double click on the patient record and the test results screen will appear.
4. Preparing the Participant
The subjects should be seated during spirometry testing. The mouthpiece of the spirometer should comfortably fit in the mouth of the test subject without undue effort. Tight fitting belts or garments should be loosened, and loose fitting dentures, oral appliances, chewing gum, candy and other foreign bodies should be removed from the test subject’s mouth.
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5. Explain and Demonstrate the Maneuver
The maneuver should be briefly explained to the participant in words that he/she will understand: “I want you to take as deep a breath as you can and blast it out as fast and as hard as possible until no more air comes out. It is like trying to blow out all of your birthday candles.”
Effort and time can be saved by giving a demonstration of the maneuver by pretending you use the spirometer. This should be done in all cases. Take a deep breath with participant’s mouth wide open, elevate participant’s shoulders, stick out participant’s tongue, lay the mouthpiece on it, close participant’s mouth around the mouthpiece, and forcefully blast out through the mouthpiece, continuing to blow for at least 6 seconds. Use enough body language to demonstrate that it must be a forceful and prolonged effort.
6. Perform the Test
The subject should now perform the test. The words used to coach the subject should be expressive. Before the forced expiration, coach the subject to take as big a breath as possible—“FILL it up. . . More, More, More.” Have them inset the mouthpiece in their mouth and tell them to BLAST out all of your air!!!” Continue to coach the effort for a minimum of six seconds or until the flow falls to zero. During exhalation, use phrases like “Push, push, push. . .” or “Squeeze” to motivate the subject.
1. The computer screen will show the child blow up the balloon and record the results. 2. You will see the results on the spirometer. 3. Select “Enter”. 4. Testing screen will show. NEXT will be highlighted in black. 5. Select “Enter” for next test. 6. Repeat blowing three times. 7. After the 3rd time, use the arrow to move over to the quit. 8. Select “Quit” 9. You will be at the “testing” screen. 10. Go to the computer screen and click on the square button. This will synchronize the spirometer results with the computer.
7. When is a Testing Session Done?
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The goal of the testing session is to obtain three good quality or “good effort” maneuvers this will be a “C” or better. Acceptable maneuvers are those that have a rapid onset of maximum flow, that are smooth, without hesitation or coughing, and that continue until the flow rate is zero and have a minimum expiratory time of 6 seconds. If all of these criteria are met, the display will say, ‘good effort, do next effort’.
No more than eight maneuvers are allowed in a single session. Experience has shown that the likelihood of improving the quality of the session is slight and the likelihood of fatiguing and frustrating the test subject (and the technician!) increases with more than eight maneuvers. If this happens, document on the participant allergy form that you were unable to do this test and identify the reason.
8. If Participant Make a Mistake
Spirometry sessions will not always be perfect,. If there is a problem with a session, the most important thing is to recognize what the problem is, and to take actions to prevent its recurrence. It is much better to be aware of an error than to ignore it, or even worse, try to cover it up. Below is a list of the most common errors observed in performing spirometry.
Participant breaths in while performing
Doesn’t take a deep enough breath
Too many attempts
Coughing.
Key Points in Performing Spirometry
▪ Always demonstrate the maneuver ▪ Prompt the participant to BLAST out the air ▪ Continue by having the participant PUSH out the air ▪ Continue until flow falls to zero or at least six seconds
Goals of Spirometry Test Session
▪ At least three acceptable maneuvers of a “C” or better. ▪ At least three “good effort” maneuvers, terminating in, “Good Session, meets ATS”
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▪ All FEV and FVC measures at to be within 5% of best effort ▪ Rapid onset of expiration ▪ High initial peak flow ▪ No hesitation or coughing ▪ At least six seconds effort ▪ Terminal flows of zero
**No more than eight attempts
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