Learning Curves Spirometry Video: 7: Reporting Spirometry Test Results

This video section reviews test reports in detail. Two different reports should be available when reporting spirometry test results. First is the calibration check report. Second is the spirometry test results. These must include a summary of the test procedure in addition to the parameters that were measured. Technician assessment of the testing session should include any information that may be important for test interpretation. Your clinic should have written protocols for how long medical records are stored and a process to retrieve both the calibration reports and the spirometry test reports. The calibration report should include the clinic's name, address, telephone number, and email. The calibration report should also include the date and time that the calibration checks were performed, a name or code number identifying the technician who performed the calibration checks, the syringe volume used for calibration, ambient testing conditions including barometric pressure, temperature, and relative humidity, and the spirometer model and serial number. Each occupational health clinic should establish protocols and procedures for reporting that are consistent with the health and respiratory surveillance program. The following information should be included in the spirometry results report. Clinic information such as clinic name, facility ID number, city, state, zip code, county, phone number, and email. Information about the spirometer should be included in the test report. The worker's name and or identification number, date of birth, height, sex, and race or ethnicity should be recorded. It must be stressed that subject data be entered correctly. Let's watch as our instructor shows what can happen if a technician enters incorrect subject information. Notice that this test had predicted values over here in the values box. 158 percent predicted. So I looked up here and I saw it was a 68 year old female but her height was 53 inches. So we actually called this person and found out that it was actually incorrect. So now it's 102 percent, 104 percent. She's actually 5'2", 62 inches. We fixed the height and made that test valid. Report the responses to pre-test questions either on the report or a separate sheet to be retained in the worker's health record. The worker's testing position standing or sitting should be documented. The technician administering the spirometry test must be identified. The reference value set used for predicted values such as NHANES 3 and lower limits of normal values or LLN must be recorded. Ambient testing conditions including room temperature, barometric pressure if required, and relative humidity must be reported. This information will be used to determine the appropriate BTPS conversion factor. Remember, do not use spirometry factory default settings for ambient conditions. There are a number of volumes, flow rates, and ratios that must be reported. At a minimum, the spirometry report should include the following test parameters, the FVC, the FEV1, the FEV1 to FVC ratio, and the peak expiratory flow rate from all maneuvers. The best FVC should be reported. The highest values for FVC and FEV1 should be reported, even if they are from different maneuvers. The ratio of the largest FEV1 to the largest FVC indicates the fraction of the total volume that was exhaled in the first second. This ratio is required for the interpretation of an individual's lung function. The FEV6 is the amount of air forcefully exhaled within the first six seconds. The largest FEV6 from three acceptable curves should be included on the test report. Some clinicians use this parameter to follow patients with chronic obstructive pulmonary disease. It is not frequently used for spirometric interpretation in occupational health. The PEF, or peak expiratory flow rate, expressed in liters per second, is the highest point on the flow volume curve. A sharp peak shows that a strong, forceful blast is completed at the beginning of exhalation. The FEF2575% represents the mean forced expiratory flow during the middle half of the expiratory maneuver. The FEF2575% and its normal values are variable. Since 1991, the American Thoracic Society, also called the ATS, has recommended not using this measurement. Extrapolated volume may be referred to as VEXT, BEV, or EV on the report. It is a helpful assessment that ensures that the start of test is satisfactory. This measurement will indicate if there is hesitation or a slow start. If back extrapolated volume is too large, spirometers should alert the technician. These maneuvers must be rejected. Forced expiratory time, expressed as FET, is a measure that guides the technician to assess complete emptying of the lungs. Test repeatability for FVC and FEV1 is helpful to the interpreter. Repeatability criteria are met when the differences between the highest and second highest values for both FVC and FEV1 are less than or equal to 0.15 liters or 150 milliliters. Predicted values represent the average value expected for non-smoking healthy persons who share the subject's age, height, race, and sex. Predicted values, percent predicted values, and LLNs need to be included in the spirometric report for each of the parameters except the extrapolated volume and forced expiratory time. The NHANES-3 spirometry values are recommended for general use in the United States. The worker's highest measured value is used for comparison to their NHANES-3 expected value and must come from an acceptable maneuver. Because the range of normal is wide, we use the lower limit of normal as a threshold below which the spirometry result is considered abnormal. This cutoff level is usually set at a point where 95 percent of the normal population will have values above the LLN and 5 percent of the normal population will fall below the LLN. The ATS recommends using the LLN to define abnormal spirometric measurement. The flow volume and the volume time curves must be included in the spirometry test report. A minimum of three acceptable maneuvers must be included. Preferably, all maneuvers should be shown. Technician comments provide valuable information to the interpreter. Any unusual circumstances that can affect test results should be included in the comments. A change to different testing position should be noted, for example, when a worker develops lightheadedness and changes from a standing to a seated position. Any symptoms that develop during testing, such as lightheadedness, shortness of breath, or coughing, are important to note. Provide an assessment of the worker's effort during the test. This concludes the spirometry training video. We hope you will apply this knowledge as you practice your skills to become an expert spirometry technician.