Respiratory Health Spirometry Procedures Manual January 2008 TABLE OF CONTENTS Chapter Page 1 SPIROMETRY OVERVIEW.......................................................................... 1-1 1.1 Overview of the Spirometry Exam Component.................................. 1-1 1.2 The Bronchodilator Subcomponent .................................................... 1-2 1.3 Chronic Obstructive Pulmonary Disease............................................ 1-3 1.4 Asthma................................................................................................ 1-4 1.5 Basics of Respiration .......................................................................... 1-5 1.6 Spirometric Measurements ................................................................. 1-6 ACKNOWLEDGMENTS AND REFERENCES............................................ 1-13 2 EQUIPMENT AND SUPPLIES...................................................................... 2-1 2.1 List of Equipment and Supplies.......................................................... 2-1 2.2 Description of Equipment and Supplies ............................................. 2-2 2.2.1 Equipment ........................................................................... 2-2 2.2.2 Supplies............................................................................... 2-3 2.3 Equipment Setup Procedures .............................................................. 2-4 2.3.1 Equipment ........................................................................... 2-4 2.3.2 Supplies............................................................................... 2-6 2.4 Equipment Care and Maintenance...................................................... 2-6 2.4.1 Spirometer........................................................................... 2-6 2.4.2 Hoses................................................................................... 2-7 2.5 Equipment Packup Procedures ........................................................... 2-7 2.5.1 Equipment ........................................................................... 2-8 2.5.2 Supplies............................................................................... 2-8 3 EXAMINATION PROTOCOL....................................................................... 3-1 3.1 Eligibility Criteria for Spirometry and Bronchodilator Components ........................................................................................ 3-1 3.2 Spirometry Safety Exclusion Questions ............................................. 3-1 3.3 Spirometry Examination Procedures .................................................. 3-6 3.3.1 Spirometry Testing Procedures ........................................... 3-7 iii TABLE OF CONTENTS (continued) Chapter Page 3.3.2 Instruction and Preparation ................................................. 3-8 3.3.3 Initiate Test......................................................................... 3-10 3.3.4 End of Test .......................................................................... 3-16 3.3.5 Procedures for Repeat Spirometry Testing ......................... 3-18 3.4 Troubleshooting Spirometry Examinations ........................................ 3-20 3.5 Report of Findings .............................................................................. 3-22 4 QUALITY CONTROL.................................................................................... 4-1 4.1 Equipment Cleaning and Calibration.................................................. 4-1 4.1.1 Quality Control Checks Screens ......................................... 4-1 4.1.2 Equipment Cleaning............................................................ 4-5 4.1.3 Equipment Calibration........................................................ 4-5 4.2 Equipment Maintenance..................................................................... 4-8 4.3 Review of Results During the Exam................................................... 4-8 4.4 Observation......................................................................................... 4-9 4.5 Review of Exam Status....................................................................... 4-9 4.6 Review of Results During Analysis.................................................... 4-9 4.7 NIOSH Quality Control Reports......................................................... 4-10 4.7.1 Operator Reports ................................................................. 4-10 4.7.2 Statistics .............................................................................. 4-11 4.7.3 Grades ................................................................................. 4-11 4.7.4 Summary and Trend Analysis Reports................................ 4-11 5 SAFETY PROCEDURES............................................................................... 5-1 5.1 Spirometry Safety Precautions............................................................ 5-1 5.1.1 Safety Exclusion Screening................................................. 5-1 5.1.2 Infection Control Measures................................................. 5-1 5.1.3 Prevention of Electric Shock............................................... 5-2 5.2 Standing vs. Sitting During Spirometric Testing................................ 5-2 5.3 Comprehension or Language Difficulties........................................... 5-3 5.4 Emergency Procedures....................................................................... 5-3 iv TABLE OF CONTENTS (continued) List of Appendixes Appendix Page A NIOSH Spirometry System Design Criteria .................................................... A-1 B Screenshots for Spirometry Safety Exclusion Questions................................. B-1 List of Tables Table 1-1 Lung diseases and spirometry results .............................................................. 1-12 3-1 Spirometry safety exclusion items by age ....................................................... 3-2 List of Figures Figure 1-1 The respiratory tract......................................................................................... 1-5 1-2 Normal volume-time curve.............................................................................. 1-8 1-3 Normal flow-volume curve.............................................................................. 1-8 1-4 FVC and FEV1 on a normal volume-time curve ............................................. 1-9 1-5 FVC on normal flow-volume curve................................................................. 1-9 1-6 Normal and restrictive patterns volume-time curves ....................................... 1-10 1-7 Flow-volume curves........................................................................................ 1-10 1-8 Obstructive pattern shown on a volume-time curve ........................................ 1-11 1-9 Obstructive pattern shown on a flow-volume curve ........................................ 1-11 v TABLE OF CONTENTS (continued) List of Exhibits (continued) Exhibit Page 3-1 Aneurysm help screen...................................................................................... 3-3 3-2 Spirometry exclusion....................................................................................... 3-4 3-3 End of subsection screen.................................................................................. 3-4 3-4 End of exam screen.......................................................................................... 3-5 3-5 Begin spirometry test screen............................................................................ 3-6 3-6 OMI/NIOSH main program screen.................................................................. 3-7 3-7 Proceed with testing screen.............................................................................. 3-8 3-8 Curve display screen – pre-test........................................................................ 3-10 3-9 Curve display screen........................................................................................ 3-11 3-10 Test results screen............................................................................................ 3-12 3-11 Results and quality code box ........................................................................... 3-13 3-12 Override acceptability code screen .................................................................. 3-15 3-13 Post-Test data screen ....................................................................................... 3-16 3-14 End of subsection – complete screen ............................................................... 3-17 3-15 End of exam screen.......................................................................................... 3-18 3-16 Technologist bronchodilator referral script screen .......................................... 3-19 3-17 End of exam – SP to bronchodilator screen..................................................... 3-19 4-1 Quality Control Checks – Start of Stand QC ................................................... 4-2 4-2 Quality Control Checks – Daily QC ................................................................ 4-2 4-3 Quality Control Checks – Start of Session QC................................................ 4-3 4-4 Quality Control Checks – Weekly QC............................................................. 4-3 vi TABLE OF CONTENTS (continued) List of Exhibits (continued) Exhibit Page 4-5 Quality Control Checks – End of Stand QC .................................................... 4-4 4-6 Quality Control Checks