UNIVERSITY OF AZUAY

FACULTY OF SCIENCE AND TECHNOLOGY

School of Electronic Engineering

Spirometry as a diagnostic test

Graduation work prior to obtaining the title of Electronic Engineer

Author:

Darío Javier Aguirre Orellana

Director:

Germán Alfonso Cabrera Zúñiga.

Ecuador basin

2013
 Orellana Aguirre ii

DEDICATION

Before anyone I want to thank God and devote the fulfillment of this goal

because without whom none of this would have been possible, my Holy San Judas Tadeo since

he has been my partner in this whole student life watching and caring for me.

Secondly I want to dedicate my parents Rubén Aguirre Márquez, Rosario

Vazquez Orellana, my brother and best friend since Israel Aguirre Orellana

Thanks to full support from the moment the course and during my student life,

by their love and understanding they made this all possible.

 Aguirre iii Orellana

INDEX OF CONTENTS

Dedication................................................. .................................................. ........................... ii

Index of contents ............................................... .................................................. iii ............

Figures Index ............................................... .................................................. ................... v

Summary ................................................. .................................................. ........................... viii

Abstract ................................................. .................................................. ix ...............................

INTRODUCTION ................................................. .................................................. ............. one

CHAPTER I: SPIROMETRY

1.1 Introduction to Respiratory System ............................................. .............................. 3

1.2 spirometry. .................................................. .................................................. ........... 10

1.2.1 History of spirometry. .................................................. ................................ 10

1.2.2 Introduction to Spirometry. .................................................. ......................... 14

1.3 As spirometric test is performed. .................................................. ................. 24

CHAPTER II: TYPES OF spirometers

.............................................. 2.1 volume spirometers ............................................ 37

Spirometer 2.2 Flow (pneumotachographs) ........................................... ....................... 37

2.1.1. Bell spirometers ............................................... .................................... 38

2.1.2 Piston spirometers. .................................................. ...................................... 40

2.1.3. Bellow spirometers. .................................................. ..................................... 42

2.2.1 Differential type Fleisch spirometer. .................................................. ................ 44

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2.2.2 Differential Lilly type spirometer. .................................................. .................... Four. Five

2.3. Spirometer Turbine. .................................................. .......................................... 47

2.4 Hot Wire spirometer. .................................................. ................................. fifty

Ultrasound Spirometer 2.5 .............................................. .......................................... 51

CHAPTER III: MAINTENANCE AND SELECTION spirometers

3.1 Calibration Maintenance and spirometers. .................................................. ....... 54

3.2 Cleaning spirometer .............................................. ............................................ 56

3.3 Indications and Contraindications .............................................. ............................... 59

3.3.1 Indications .............................................. .................................................. .......... 59

3.3.2 Contraindications .............................................. ................................................ 60

3.4 Requirements for choosing a spirometer. .................................................. ............ 60

3.4 Election of spirometer .............................................. .............................................. 63

CONCLUSIONS AND RECOMMENDATIONS ............................................... ................ 65

BIBLIOGRAPHY ................................................. .................................................. ............. 67

 Orellana Aguirre v

LIST OF FIGURES

Figure-1.1.1 -Parties Respiratory System. .................................................. ..................... 3

Figure-1.1.2- phases of respiration. .................................................. ................................. 5

Figure-1.1.3- Parts Airway ....................................... ................................. 6

Figure-1.1.4- Respiratory Unit. .................................................. ....................................... 7

Figure-1.1.5 - Alveolo ........................................... .................................................. ............. 8

Figure-1.1.6- Stages breathing. .................................................. ................................ 9

Figure-1.2.1- Pulmómetro Kentish E. ....................................... ....................................... eleven

Figure-1.2.2- Hutchinson spirometer. .................................................. ......................... 12

Figure-1.2.3-Wintrich spirometer. .................................................. .............................. 13

Figure-1.2.4 spirometry. .................................................. .................................... 16

Figure-1.2.5- First Spirometer. .................................................. ................................ 17

Figure-1.2.6-Spirometers Modern .......................................... ......................................... 18

Figure-1.2.7- volumes Spirometry. .................................................. ........................ 18

Figure-1.2.8- diagram Fletcher and Peto ....................................... ................................... 22

Figure 1.3.1 Space-enabled practice of spirometry. ...................................... 25

Figure-1.3.2.1 Nozzles and disposable filter. .................................................. .................... 26

Figure-1.3.2.2 Calibration Syringe .......................................... ........................................ 26

Figure-1.3.3-Postures Patient ......................................... .............................................. 30

Figure-1.3.4 Nasal Colocacion Gripper .......................................... ......................................... 30

Figure-1.3.5-Colocacion nozzle .......................................... .............................................. 31

Figure-1.3.6- volume / time curve with a suitable duration (more than 6 seconds) .... 33

Figure-1.3.7- curve volume / time with an incorrect duration (less than 6 seconds)

........................................................ . .................................................................................... . 3. 4
 Orellana Aguirre vi

Figure-1.3.8-coughing spells the volume / time curve during the first 34 seconds ......

Figure-1.3.9- coughing spells in the flow / volume curve in the test termination 35 ..

flow / volume curve Figure-1.3.10-effortlessly ..................................... ................ 36

Figure-1.3.11- volume / time curve effortless but similar to the normal curve ............ 36

Figure-2.1- Classification Spirometer (REF 2.1) ....................................... ................... 38

Figure-2.1.1-spirometer Water ......................................... .............................................. 39

Figure-2.1.2- Scheme spirometer Water ....................................... .......................... 39

Figure-2.2.1- spirometer Piston ......................................... ........................................... 41

Figure-2.2.2- Scheme spirometer Piston ........................................ ............................. 41

Figure-2.3.1- spirometer gusset Vitalografh ........................................ ......................... 43

Figure-2.3.2- Scheme spirometer gusset ....................................... ......................... 43

Figure-2.4.1- Fleisch type Vitalograph spirometer. .................................................. ........ 44

Figure-2.4.2- spirometer Fleisch type head. .................................................. ................ Four. Five

Figure-2.4.3- Operating Principle Fleisch type spirometer. ................................. Four. Five

Figure-2.5.1- spirometer type Lilly ......................................... ........................................... 46

Figure-2.5.2 spirometer head Lilly and Pitot ....................................... ........................... 46

Figure-2.5.3- Operating Principle spirometer Lilly and Pitot type. ........................ 46

Figure-2.6.1- Operating Principle turbine spirometer .................................. 49

Figure-2.6.2- spirometer head turbine ........................................ ............................ 49

Figure-2.6.3- spirometer Turbine Cosmed Pony Graphics ...................................... ..... 49

Figure-2.7.1- diagram of a spirometer Hot Wire ..................................... ........... 51

Figure-2.7.2- spirometer Hot Wire CMS ....................................... ......................... 51

Figure-2.8.1- Operating Principle Ultrasound ............................ spirometer 52

Figure-2.8.2- spirometer Ultrasound EASYONE ........................................ ................ 53

Figure-3.1.1- connection Calibration ......................................... .................................... 55

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Figure-3.1.2- Calibration syringe 3 liters ...................................... 56 ..............................

Figure-3.1.3- Calibration syringe 1 liter ...................................... ................................ 56

 Orellana Aguirre 1

Darío Javier Aguirre Orellana

Degree work

Ing. Germán Zúñiga.

March 2013

Spirometry as a diagnostic test

INTRODUCTION

Spirometry is a functional test of breathing is today

winning a lot of space in everyday life as it is essential to control

our respiratory function as well in some companies where

They produce toxic gases that can harm human health and mines, require

this test is made to the employee to verify that none exist

disease or if there is a case that this does not escalate.

The realization of this issue is that, as recently is dabbling in

the world most people do not know what the topic is and

how they should be tested, as well as people who should be

trained to perform the same. As for the apparatus spirometry

it is unknown how is the working principle and the parties have

for the acquisition of results.

The objectives of this project is to know all about

spirometry, as to the performance of the test, the measured variables,

staff and places where should be performed; and calibration, cleaning and

maintenance of spirometric devices, which must be made

instructions carefully and manufacturers that most people

unknown.
 Orellana Aguirre 2

As there are several types of spirometers in the market with different prices

and features, it is not known what is the ideal for use in a hospital, in

emergency in an ambulance, or the control can be performed in

home, then by this project may be recommended

by the needs of these three cases, which is ideal for spirometer

each one of them. For all the above is performed the

investigation of each of the above topics will be released

continuation.
 Orellana Aguirre 3

CHAPTER 1

SPIROMETRY

1.1 INTRODUCTION TO BREATHING APPARATUS

Breathing is an involuntary and automatic process that the body

which we absorb oxygen and expel air with CO2. At the time of

respiratory action, " We inhale air through the nose, where it is heated and

wets. Then all that hot and damp air passes through the pharynx, continues

the larynx and trachea enters at chest level, then we have the

trachea divides into two bronchi thereof which divide again and again

time in secondary, tertiary bronchus and finally some 250,000

bronchioles about " one as it indicated in Figura.1.1.1.

Figure- -Parties Respiratory System 1.1.1. (Source: Mazzei, Nazario, Monge, apparatus

Respiratory-7-. Retrieved January 10, 2013-)

one - ( Mazzei, Nazario, Monge, Respiratory. 4) -having been consulted on January 10, 2013-
 Orellana Aguirre 4

" At the end of the bronchioles in the lungs are grouped in clusters of alveoli, the

which are small bags where gas exchange is performed with the

blood. In humans the lungs contain approximately 300

million alveoli, which deployed occupy an area of ​70 meters

squares " two.

During respiration we highlight two phases that are performed

continually, these are controlled by the respiratory center bulb

raquídeo that make muscle action into the diaphragm and muscles

intercostal, these phases are: the inhalation and exhalation as indicated in

Figure-. 1.1.2.

When inspiration happens, we can see that the diaphragm contracts and

intercostal muscles rise and ribs at the same time, because

This wins the ribcage air volume to fill the empty space. In the

another phase when it happens exhalation, we have the opposite of the previous phase, here

the diaphragm relaxes and ribs descend and move inwards,

because of this the rib cage decreases its volume and lungs stop

air escape.

two Mazzei, Nazario, Monge, Respiratory. 8) -having been consulted on January 10, 2013-
 Orellana Aguirre 5

Figure 1.1.2- phases of respiration. (Source: Mazzei, Nazario, Monge, Appliance Respiratory.

11- Accessed January 10, 2013-)

The respiratory system provides necessary oxygen that the body needs and

eliminates waste gases as carbon dioxide produced in all

body cells.

We define two main parts of the respiratory tract:

• Respiratory tract

• lungs

Respiratory tract

The airways are formed through the mouth, nostrils, the

pharynx, larynx, trachea, bronchi and bronchioles.

The larynx is an organ in which the voice is produced, this consists of the

vowels and a plug called epiglottis ropes which helps us to make

food or drinks do not pass through the airways. Then the

we trachea is a tube formed by about twenty cartilaginous rings

 Orellana Aguirre 6

which remain always open the trachea this is divided into two branches: the

bronchi and bronchioles.

The bronchi and bronchioles branches are found in the

inside of our lungs, they end up in sacks called alveoli

lung them which in turn have smaller bags or vesicles

lung which are surrounded by a multitude of capillaries in which it passes

oxygen to blood and removing CO2 exchange is performed, as

shown in Figure-1.1.3.

lungs

The lungs are spongy mass of reddish found in the

thorax on both sides of the heart, right lung is the largest is

composed of three parts or lobes and the left has two parts or lobes,

They have a membrane double wall that surrounds called pleura.

Figure 1.1.3- parts of the airways. (Source: Mazzei, Nazario, Monge, apparatus

Respiratory. -20- Retrieved January 12, 2013-)

 Orellana Aguirre 7

In the lungs there is a very important part which is responsible for

our breathing process " alveolo-capillary unit is the place where

performs gas exchange, the respiratory membrane " 3. Indicated in the

Figure-1.1.4

Figure 1.1.4- respiratory drive. (Source: Mazzei, Nazario, Monge, Respiratory 22-.

Retrieved January 12, 2013-)

The three most important functions performed in breathing are:

• Exchange in the lungs

Gas exchange that takes place in the lungs, is that you take

oxygen from the outside air, and when expiratory CO2 is discarded.

• Transport gas

When the air reaches the alveoli at the time of inspiration, part of

It is carrying oxygen through the extremely thin walls and passes the red blood cells

where blood is brought into the heart, where it is distributed by the arteries

all body cells. Carbon dioxide collected is transported

3 Mazzei, Nazario, Monge, Respiratory. Asked 22- 12, January-2013

 Orellana Aguirre 8

by the vena cava to the heart where it is carried to the lungs to

throw outside.

alveoli indicated in Figure-1.1.5, They are the most delicate part of the

lungs because when there is a disorder that destroys, decrease

designated area to exchange gases, which can cause various diseases

causing serious consequences.

Figure-1.1.5 - Alveolo (Source:. Mazzei, Nazario, Monge, Respiratory 30- consulted

January 12, 2013-)

• Respiration in cells and tissues

In this process oxygen carrying red blood cells is taken and

They are used to burn food absorbed by the body, through this

process we acquire the energy that the body needs and heat that keeps the

human body temperature about 37 degrees, as shown in (Figure-

1.1.6.)
 Orellana Aguirre 9

Figure- 1.1.6- Stages of breath. (Source: Mazzei, Nazario, Monge, Respiratory.

Accessed January 15-33--2013)

Finally something you need to know about breathing is mechanical

ventilatory which tells us that:

• Pulmonary ventilation is air movement that move the lungs

• Pulmonary ventilation depends on:

one. Volume of air entering each breath.

two. Breathing frequency.

 Orellana Aguirre 10

1.2 Spirometry.

1.2.1 HISTORY spirometry.

When this diagnostic test called spirometry was discovered nobody knows

because I adopted this name, which was based on the variables average, so

we have to " Spirometry measurement etymologically means breath or

the breathing " Four.

• 129-200 AD

The first finding was when "Galen conducted an experiment with

Human ventilation in a child breathing in a bladder of an animal. I observe

the volume of gas entering and leaving stabilized but not measured

absolute volume " 5. thus performing the first measurement

breathing.

• 1681

" Borelli attempted to measure the volume of air inspired by a single breath,

sucking air made of a container with liquid then held his nose. But

due to the required negative pressure, measurements were very low

(<230ml). 6 "

• 1718

This year " Jurin breathed air in a bladder volume measured according to the principle

Archimedes. It measured one Vt (total volume) of 650 ml and a maximum expiratory

3610 ml " 7 measuring the first variable volume in a person.

4 DE VITO, labneumo@lanari.fmed.uba.ar 2- Accessed January 15, 2013-

5 DE VITO, labneumo@lanari.fmed.uba.ar , 3- Accessed January 15, 2013-.

6 DE VITO, labneumo@lanari.fmed.uba.ar , 4- Accessed January 16, 2013-
7 DE VITO, labneumo@lanari.fmed.uba.ar 5-Accessed January 16, 2013-
 Orellana Aguirre 11

• 1813

" E. kentish used to study the pulmómetro ventilatory volumes

diseases, has a sealed inverted bell with water, air inlet

higher rankings. " 8 It was a breakthrough for what later would become the

First spirometer. It can be illustrated in Figure-1.2.1.

Figure 1.2.1- Pulmómetro Kentish E. (Source: historia_espirometria_dic_2000.ppt, 13) -

Accessed January 16, 2013-)

• 1844

" John Hutchinson started first using the spirometer, creating

1852 his first spirometer shown in Fig-1.2.2., other input

importantly, it gave the concept and name the same vital capacity

I showed a linear relationship with the height of patients and not the weight, had

a great impact on the disease. " 9

8: VITO, historia_espirometria_dic_2000.ppt, 13) - Accessed January 16, 2013-

9 DE VITO, labneumo@lanari.fmed.uba.ar , -7) - Accessed January 16, 2013-
 Orellana Aguirre 12

Figure-1.2.2- Hutchinson spirometer. (Source: (De Vito, labneumo@lanari.fmed.uba.ar , -7) -

Accessed January 16, 2013-)

In 1852 he published his article about his water spirometer which is still

with few modifications being used today.

• 1854

" Wintrich developed a simpler model study in which over 4000

patients and concluded that the three parameters that determine the CV (capacity

vital) are height, weight and age. " 10 Indicated in Figure 1.1.6-as was the

Old spirometer.

10 DE VITO, labneumo@lanari.fmed.uba.ar 11) - Accessed January 17, 2013-

 Orellana Aguirre 13

Figure-1.2.3-Wintrich spirometer. (Source: De Vito, labneumo@lanari.fmed.uba.ar , eleven)-

Retrieved January 17, 2013-)

• 1910-1961

" Robert Tiffeneau a pharmacologist who study discovered broncho-motor skills

FEV (CPUE) which is the catch per unit of effort and relate to the

CV% in bronchitis, emphysema, asthma, etc. The relationship of age of patients

with the spirometric test. Severity of ventilatory disorders according

CPUE. He introduced the concept of time in the CV. " eleven

eleven DE VITO, historia_espirometria_dic_2000.ppt, 15.18) - Accessed January 18, 2013-

 Orellana Aguirre 14

1.2.2 INTRODUCTION TO SPIROMETRY

Spirometry is a functional test of the lungs and apparatus

respiratory, performed by a device called spirometer which

records the amount and frequency of the inhaled and exhaled air for a period

of time. Unlike other respiratory function tests, use

It transcends the field of pulmonologists and in recent years is

gradually incorporating primary care.

The spirometry various scientific societies have made known to us

recommendations and regulations intended to ensure standards of

good quality. Despite all efforts and regulations societies

They have given us, spirometry still considered as a process

in theory it seems easy to do, but in practice it is difficult to perform

correctly; only if strictly they fulfill certain requirements

quality technicians, we could say that there is a valid spirometry for

medical practice.

Spirometry is the science that measures the magnitude of lung volumes

and how quickly they can be mobilized, in a nutshell would

Speaking of airflow. Graphical representations to make

This examination can make the following groups of variables, a curve

Volume / Time (V / T) or the flow curve / volume (F / V). This is a test

easy to perform but it requires great cooperation from the patient and

the person performing the test that we will see later.

Respiratory diseases are one of the most important causes of

morbidity and mortality in developed countries. But spirometry is a

basis for the diagnosis of many patients who is suspected

respiratory disease.
 Orellana Aguirre 15

Spirometry are instructed doctors if the lungs are

working properly or have any problems, plus it serves to

help diagnose and monitor diseases that affect the lungs

obstructs breathing, such as asthma and cystic fibrosis among other

diseases. And finally it can be used to determine the cause of the

shortness of breath in a person coughing or wheezing and monitor treatment

respiratory problems to assess the functioning of the lungs before

a surgery.

There are two types of spirometry: simple and forced.

Simple spirometry measures the static lung volumes, except

residual volume (RV) and those derivatives in calculating it as are

functional residual capacity (FRC) and total lung capacity (TLC). In

This test asks the patient to perform a maximum inhalation but

relaxed and perform equally exhalation time it

necessary.

Spirometry and lung volumes measured dynamic provides

most clinically relevant information. The performance of this test is

similar to the above in which the patient makes a maximal inhalation but

relaxed all the air you can collect, but at the time of the

exhalation has to abruptly and in the shortest time it

possible. In this paper we will refer exclusively to spirometry

forced.

The graph of Figure-1.2.4 indicates as serious breathing curve to

time of spirometry testing.

 Orellana Aguirre 16

Figure-1.2.4 spirometry. (Source: Carruso Mariano, Introduction to Spirometry 4) -

Retrieved January 20, 2013-)

Why is it important to measure lung function?

When performing pulmonary function tests, to assess the degree and type of

dysfunction having the Respiratory. These tests scan function

ventilatory, measure the pulmonary gas exchange, measures the response of

respiratory tract to various stimuli and has scanning techniques

cardiovascular.

Spirometric test besides being important for its functional test as

we have seen, it is now essential to perform for admission to some

Companies working in which people are exposed to gases or some other

situation that may compromise lung function or device

respiratory, so by this test can track

this person to see if there is no problem.

As regards the evolution of spirometry devices, we can

a comparison with the old computers from the spirometer John

Hutchinson which even today is still used albeit with some

but improvements are minimal. The characteristics possessed by these spirometers

is that they are large, so it is difficult to mobilize and cleaning

among others. They do not use any hardware or power connection or

 Orellana Aguirre 17

battery because they have built a paper roll which is writing

depending on the patient's breathing. The three types of first

spirometers are: 1) Water. 2) Bellow 3) piston.

In the graph of Figure 1.2.5-mentioned spirometers are indicated

previously.

Figure-1.2.5- First Spirometer. (Source: Carruso Mariano, Introduction to spirometry,

4) - Accessed January 20, 2013-)

In what concerns the modern spirometers we could mention that it was a

big step in terms of technology and size have now used

hardware and are small in size, which facilitates making mobilization

portable to any place. In addition to these great advances, too

They have USB connection to connect to servers, and others who have bluethood

its own integrated print diagnostic curves printer. Y

one of the best spirometers so to speak has a pulse oximeter

integrated. In Figure-1.2.6 indicate modern spirometers.

 Orellana Aguirre 18

Figure-1.2.6-Spirometers Modern. (Source: Carruso Mariano, Introduction to spirometry,

5) - Accessed January 20, 2013-)

At the time of the spirometric test we can obtain the following

volumes of our lungs, in order to measure lung capacity,

as it indicated in Figure-1.2.7 and then describe mean

each one of them.

Figure-1.2.7- volumes Spirometry. (Source: Carruso Mariano, Introduction to

Spirometry, 2) - Accessed January-20-2013)

 Orellana Aguirre 19

• VC: Normal or current volume, volume is normally in

breathing, this volume is approximately 500cc.

• VRI: Inspired Residual volume is the volume inspired from

tidal volume

• VRE: Residual volume Expired is exhaled volume from the volume

current.

• CV: Vital capacity is the total volume performed by the lungs.

• VR: Residual volume is the volume remaining after exhalation

maximum, this variable can not be measured with the spirometer.

• TLC: Total Lung Capacity is given by the sum of the vital capacity and

residual volume.

• CRF: FRC is given the sum of the volume

residual plus residual volume inspired.

Below we will list the most important variables in testing

spirometric.

Forced vital capacity (FVC)

This variable is the air volume which is recorded when it makes a

complete and in the shortest possible time expiration, starting from a

maximal inspiration. We must not confuse us with the vital capacity (VC) and

this variable can acquire when an expiratory maneuver is performed

slow bone in simple spirometry, in which emphasis is that expiratory

 Orellana Aguirre 20

is complete but not taken into account the time it takes to do it. In

people who are normal, the VC and FVC should be virtually identical.

FVC is a measure of capacity, this variable being an indicator of

lung capacity that people have. The units in which we can

express the value of VCF are in liters or milliliters, plus also

We can be expressed as a percentage of the theoretical reference value. He

considers normal, free person of any disease when this value

It is equal to or greater than 80% of its theoretical value. It is important that the duration of the

forced expiratory maneuver is correct, because if the test does not occupy the

time needed, can make the measurement of GCF appears falsely

reduced, making believe that the patient has a disease or there is a

restriction does not exist.

forced expiratory volume in one second (FEV1)

This variable is the volume of exhaled air explosion in one second

the forced expiration maneuver. We recorded this measure flow, and

which relates the volume that loop in a given time, this measure

expressed in L or mL, but can also be expressed as a percentage

the theoretical reference value as the preceding variable.

It is considered a normal value when it is equal to or greater than 80% theoretical

reference. FEV1 is the advantage of being highly reproducible when performing

the maneuver correctly also has little variation between each

person, so it is one of the most efficient and appropriate parameters

follow the evolution of patients.

" In healthy individuals, the FEV1 grows from childhood to a maximum

to 25 years; From that moment, the FEV1 decreases at a rate of about 25

 Orellana Aguirre 21

ml each year. However, in some smokers, FEV1 can

decrease twice annually. " 12

For patients who have stopped smoking is useful to track the FEV1,

because when the snuff is suppressed, the annual loss of FEV1 is reduced to

get to be similar to that faced by nonsmokers.

FEV1 is one of the most important factors that we have today for

assess the prognosis in obstructive diseases such as COPD (Disease

chronic obstructive pulmonary).

" An annual reduction of more than 50 ml in FEV1 is considered criteria

accelerated disease progression indicated in FIG-1.2.8. On the other hand,

FEV1 less than 1000 ml is associated with a 50% survival at 5

years in patients with COPD. " 13

FEV1 is also used to determine the severity of the disease; in the

Table 1.1 may be different severity criteria based FEV1.

12 CIMAS, PEREZ, technique and interpretation of spirometry in primary care -Chapter-1.1, 29Consultado 23- January-2013.

13 CIMAS, PEREZ, technique and interpretation of spirometry in primary care -Chapter-1.1, 30Consultado 24- January-2013.
 Orellana Aguirre 22

Table 1.1 (Source: Cimas, Pérez, technique and interpretation of Spirometry in Primary Care

- Chapter-1.1, 29) - Accessed January 23, 2013-)

Figure-1.2.8- Fletcher and Peto diagram showing FEV1 decline after the

years, smoking and non Smoking Rooms1 (Source: Cimas, Pérez, Technical and Interpretation

Spirometry in Primary Care -Chapter-1.1, 29) - Accessed January 23, 2013-)

 Orellana Aguirre 23

FEV1 / FVC (FEV 1%)

" It is the percentage of the FVC that is exhaled during the first second of the

forced expiratory maneuver " 14. It is represented as FEV1% or FEV1 / FVC, and

It is calculated according to the following formula:

FEV1% = 100

It is an index which tells us that when there is a decrease implies that there

obstruction; for example in a basin which is filled with water, when opening the

plug for one second out an amount of water, but if the drain is one

little obstructed, when we open the cap for a second, water will most

slowly, this indicates that the percentage of the load to sink in

first second is lower than in normal conditions. The same applies in the

respiratory apparatus when performing the spirometric test; " in conditions

normal during the first second of forced exhalation is expelled 70-

75% of FVC. If the FEV1% is less than that percentage, it means that there

expiratory flow obstruction. " fifteen.

The FEV1 / FVC ratio varies with the course of the years, with a higher

young people than in older people. Young is considered normal

When this value was 75%, while the value must elderly

be 70%.

To give a diagnosis of a clog in the respiratory tract,

FEV 1% would have to be less than the area 70pero always taken into account

between 70% and 75%.

14 CIMAS, PEREZ, technique and interpretation of Spirometry in Primary Care-chapter-1, 29Consultado 25- January-2013.

fifteen CIMAS, PEREZ, technique and interpretation of Spirometry in Primary Care-chapter-1, 30Consultado 25- January-2013.
 Orellana Aguirre 24

forced between 25% and 75% of FVC (FEF25% -75%) expiratory flow

" It is expelled air flow between 25% and 75% CVF, it expressed in

liters / second and as a percentage of the theoretical reference value. is a

flow parameter ( "flow means" or "meso flows"); but also the name

peak flow meso-expiratory (MMEF, maximal expiratory flow-mid). " 16.

The FEF25% -75% reflects the status of the small airways, since these

They have a diameter less than 2 mm, and are from the eighth

Bronchial generation, these are the most sensitive to disease

obstruction. Then we say that altering the FEF25% -75% indicates

obstructive disease in early stages.

However, their interpretation is abnormal when FVC is complicated; Y

On the other hand, it has a great variability, making it difficult to establish

normal limits. It is now rarely used.

1.3 HOW TO PERFORM THE TEST SPIROMETRIC

To carry out this test should follow different rules and regulations as well

and analyze various types of parameters such as the physical space where it is to

performed, the instruments used and must possess technical training, to

Then explain each of them.

16 CIMAS, PEREZ, technique and interpretation of Spirometry in Primary Care-chapter-1, 30Consultado 26- January-2013.
 Orellana Aguirre 25

• Structural requirements

Physical space

Most of the teams that are now used are size reduced, of

so that you need not become available for large installations

placement. It is recommended that a small room where it can be taken

place a table to support the whole system to be used and chair for

the patient.

It would be best that the installation is acoustically well insulated and

exclusively dedicated to performing spirometry to avoid

distractions both technical and patient by external factors.

Figure 1.3.1-type place that was ideal for conducting indicated

spirometric test.

Figure. 1.3.1 space provided for the practice of spirometry. (Source: Cimas, Pérez,

Technical and Interpretation of Spirometry in Primary Care-chapter-1.2, - having been consulted 24-

January 2013)
 Orellana Aguirre 26

Material

Apart from the spirometer and proper installation already described

above, it would be indispensable in the same installation of a

calibration syringe (Figure-1.3.2.2), bronchodilators, measuring rod,

a scale, a thermometer of ambient temperature and a barometer, and is

the apparatus and leads included. Furthermore, it should have various

containers for nozzles, disposable filters and nose clips for

conducting tests (Figure-1.3.2.1)

Figure-1.3.2.1 Nozzles and disposable filter. (Source: Cimas, Pérez, Technical and Interpretation

Spirometry in Primary Care-chapter-1.2, - having been consulted 24-Jan-2013)

Figure-1.3.2.2 Calibration Syringe (Source: Cimas, Pérez, Technical and Interpretation

Spirometry in Primary Care-chapter-1.2, - having been consulted 24-Jan-2013)

 Orellana Aguirre 27

• PRECONDITIONS

Prior Patient information

At the time of a test where the patient is in a state

liability should not give you much information, since only suffice

tell him to be quiet or be placed in any position; but in the case of

Spirometry is needed to make a great effort and collaborate throughout the

test, as well just we get acceptable values ​for their interpretation.

It is very important to weigh and measure the patient before taking any action,

then this must be previously informed about the technique of how it is done

test, what is the contribution that should the patient, the nature of

study and why it is requested to do so.

You should use simple language that is easily understood by the

patient, because from the moment the test starts will be instructed by the

doctor or the person who is in charge of the test until completion of same,

in order to achieve 100% cooperation of the patient.

Prerequisites to study

When lung function measurements are made must ensure that all

maneuvers meet similar conditions in their execution. The fact of

the patient is subjected to drug treatments or have smoked in

prior hours, among other factors, can cause measurements of values

different.
 Orellana Aguirre 28

There are several factors that alter bronchial dynamics, and therefore should be

taken into consideration:

• drugs: any drug that alters the dynamic bronchial (bronchodilator),

It is able to modify the values ​to be measured.

• Feeding: You do not need to fast before its completion, although it is

advisable to avoid heavy meals.

• Drinks: in the hours before should not be drinking beverages containing caffeine.

• Tobacco: It is one of the main factors causing effects via

Aerial. Specifically should avoid smoking before the maneuver to be a

irritant that causes broncho-constriction.

The technician

` ' In the regulations on spirometry published by the Society

Spanish Respiratory Diseases (SEPAR) is considered to training

minimum technician lung for laboratory of

Spirometry should be at least six months of supervised work,

instruction in biological fundamentals and expertise in pathology

Respiratory related. In addition, it is considered that to work with

autonomy and be able to detect errors in the procedure and the

operation of equipment is required at least one year of work '' 17

The technician must be adequately trained least a Diploma

Nursing college to enable it carry out the various

spirometry procedures, which involves having knowledge of

pathophysiological fundamentals of respiratory diseases, resources

technicians, the embodiment of the spirometric maneuver, calibration and

maintenance of equipment, and evaluation of results (standard

17 CIMAS, PEREZ, technique and interpretation of Spirometry in Primary Care-chapter-1.2, 6Consultado 27- January-2013.
 Orellana Aguirre 29

obstructive and nonobstructive). This should be complemented by skills

communication with the patient to get it properly collaborate

in implementation. Also, you must recognize the limitations of patients

single (higher or low intellectual capacity persons) or other

situations that could decisively influence the results.

The maneuver

First you should explain to the patient what they will do in the

spirometric test and how to do it because in the test, he is the one

It has the largest share and needs to blow a lot of effort into the mouthpiece

which is in the apparatus.

Then the patient will be identified. It will be collected and paid into the

apparatus date, sex, age, height and weight (without clothes and with the patient

barefoot), according to the rules of each spirometer, but most of them

state that they must comply with these.

In patients unable to take measurements of the size or if they have

spinal deformities, is used as the scale size (distance between the

tip of the third finger of both hands with arms extension), but

do this theoretical values ​rise slightly

Then they must make the patient sit in a correct posture, since this

depends on the success of explosive breath and test, because if there is a bad

stance, will produce interruptions, cough or incomplete inspiration. At the moment

Test the patient can also do standing, but it is advisable

sitting as the SEPAR standards. In (Figure-1.3.3) the positions indicated

acceptable and unacceptable.

 Orellana Aguirre 30

Figure-1.3.3-Postures Patient. (Source: Cimas, Pérez, Technical and Interpretation

I Spirometry in Primary Care-chapter-1.2, 8) - Accessed January-28-2013)

Then to position a nose clip (Figure-1.3.4) according to

patient size with comfortable sitting and checking that does not leak

air nose, then proceed to the positioning of the nozzle (Figure-1.3.5),

which it must be sealed on the outside by the patient's lips to avoid

there is no air leakage and simultaneously hold the teeth to be firm

and it will not fall.

Figure-1.3.4 nose clip placement. (Source: Cimas, Pérez, Technical and Interpretation

I Spirometry in Primary Care-chapter-1.2, 8) - Accessed January-28-2013)

 Orellana Aguirre 31

Figure-1.3.5-placement nozzle. (Source: Cimas, Pérez, Technical and Interpretation

I Spirometry in Primary Care-chapter-1.2, 8) - Accessed January-28-2013)

1. The patient performed a maximum inspiration. It is recommended that once

made this maxim inspiration not wait more than two seconds to run

exhalation, since the force of the elastic members are lung

time-dependent extension to remain. Performing the maneuver

immediately, somewhat higher flows if a pause is performed are achieved.

2. The technician will give a strong and definitive order for the patient to start with

forced expiration. This will prevent early doubters that cause artifacts

affecting the measurement.

3. During exhalation strongly encourage technical and energy to the patient

(Perhaps with phrases like "siga, siga", "blow, blow", etc.) to keep blowing

all you can in order to get the maximum possible effort to avoid

an early interruption of the maneuver.

4. While encouraging, the technician must look at the display to assess the curve

It is drawing and check that the maneuver is correct. Expiratory time

forced should last much as possible (must be at least 6

seconds).
 Orellana Aguirre 32

5. If desired obtain a record of the inspiratory phase, the patient will say that,

Once you have finished exhalation without removing the mouthpiece from your mouth,

make the most rapid, strong and prolonged inspiration you can. Always be

They will make at least three satisfactory maneuvers. If not achieved,

They can be repeated up to a maximum of eight. From this number and since

is a dependent effort, testing the patient is exhausted and it is difficult to collaborate

repeating more times.

And so we concluded the realization of the spirometric test.

bronchodilator test

The bronchodilator test (PBD) in spirometry, is one of the

simple and useful tests which used to measure clinics

bronchial reversibility. It is very necessary to evaluate the processes that occur

with obstruction of the airway. This test is to measure changes

functional occurring following administration of a BD (bronchodilator)

Short acting, beyond spontaneous biologic variability and response

observed in healthy subjects.

Spirometry should be performed in a normal situation as if it were made to

any other patient after administering a BD action. The time allowed to

wait between inhalation BD short acting and post-BD spirometry

It depends on the drug being used. The best time to perform

PBD is in the early hours of the morning as spirometry

They are lower and you can get more and better response.

FEV1 is used to measure the valuation of the reversibility of obstruction

airway after administration of bronchodilators or after administration

corticosteroids that are inhaled or oral; it is considered that the reversibility is

positive if the FEV1 increased by 12% -15% and 200 ml.

 Orellana Aguirre 33

INTERPRETATION OF CURVES

The shape of the curve will inform us about the level of patient cooperation or

the presence of artifacts that affect the evaluation of the test. Then

introduce more errors that occur at the time of the test in the form

graph.

premature termination of the test

A good test performance lasts as minimum 6

seconds (Figure-1.3.6), as can be measured all parameters before

mentioned correctly, but when it is less than this time (Figure-1.3.7)

necessarily you have to repeat the process.

Figure-1.3.6- curve volume / time with adequate duration (more than 6 seconds)

(Source: Cimas, Pérez, technique and interpretation of Spirometry in Primary Care-chapter-

1.2, 14) - Accessed January 28, 2013-)

 Orellana Aguirre 34

Figure-1.3.7- curve volume / time with an incorrect duration (less than 6 seconds)

(Source: Cimas, Pérez, technique and interpretation of Spirometry in Primary Care-chapter-

1.2, 14) - Accessed January 28, 2013-)

When there is cough

The presence of cough in the first second interferes with the measurement of FEV1 and,

thus invalidates reading spirometry (Figure-1.3.8). Their presence in

other times as part of the completion of the test (Figure-1.3.9)

It is less important and could allow make reading but not so

accurate.

Figure-1.3.8-episodes of coughing in the volume / time curve during the first second (Source:

Cimas, Pérez, technique and interpretation of Spirometry in Primary Care-chapter-1.2, 14) -

Retrieved January 28, 2013-)

 Orellana Aguirre 35

Figure-1.3.9- coughing episodes in flow / volume at the completion of the test- (Source curve:

Cimas, Pérez, technique and interpretation of Spirometry in Primary Care-chapter-1.2, 15) -

Retrieved January 28, 2013-

There is no greater patient effort

When the patient is not adequately test effort will

premature termination, but in this case other than that there is a decrease

drastic volume (Figure-1.3.10), resulting in no test

satisfactory. In the other case we have to test the patient performs the same with

little effort, but unlike the other does all the time with

continuous movement, making the diagnosis appears normal curve

(Figure-1.3.11), but in reality is not.

 Orellana Aguirre 36

Figure-1.3.10-curved flow / volume effortlessly - (Fuent and: Cimas, Pérez, Technical and
Interpretation of Spirometry in Primary Care-chapter-1.2, 15) - having been consulted 28-January-

2013)

Figure-1.3.11- curve volume / time without effort but similar to normally curve (Fuent and:
Cimas, Pérez, technique and interpretation of Spirometry in Primary Care-chapter-1.2, 15) -

Retrieved January 28, 2013-)

 Orellana Aguirre 37

CHAPTER II

TYPES OF spirometers

There are a variety of spirometers today, with different sizes,

functions and applications, but these are divided only into 2 types indicated in

(Figure-2.1) can be seen below.

2.1 volume spirometers

Spirometers were the initial and still used as an element pattern

for calibrations. They are closed equipment, with a bell attached to the

air and sealed way by a container of water. The bell is connected to

one kymograph mounted on a registration system, which travels at a

known speed and allows the flow calculation derived from the signal

volume obtained.

These devices have been gradually replaced by piston systems or

bellows (dry spirometers) that allowed dispense water container and

make the process much simpler and laptop.

Many of these computers use a potentiometer to generate a signal

analog proportional to the displacement volume, and through a converter

analog-digital be stored on a computer.

2.2 Spirometer flow (pneumotachographs)

The operating principle on which is based pneumotachographs

measuring the air pressure difference before and after passing through a

known resistance. This pressure difference is directly proportional to

 Orellana Aguirre 38

air flow through the device. Once obtained flow,

microprocessor calculates the volumes by mathematical integration flow

function of time.

The main problem is that pneumotachographs may be affected by

condensation.

Figure-2.1- Classification spirometer (Source: Carruso Mariano, spirometry Transducers

Flow, 4- Accessed 5-February-2013.)

2.1.1. Bell spirometers

This type is that even today is still used a few

variations spirometer water (Figure-2.1.1) is formed by a

plastic bell or a light metal is introduced into a

water container. The bell is balanced by a weight and

a pulley system.

When patient exhalation is performed, air is introduced under the hood,

it rises causing the weight down. When you are performing this

movement, this will recording by enroller is on a roll

of paper moving at a constant speed This instrument has the

kymograph name (Figura.2.1.2) The same is true when performing inspiration,

only movement is the opposite here the lower bell and the weight rises. East

type draws the known record spirometer lung volume. For

 Orellana Aguirre 39

register this movement, a potentiometer that transforms also used the

weight movement into an electrical signal.

Figure-2.1.1-spirometer Agua- (Source Carruso Mariano, spirometry Transducers

Flow 5) - Accessed February-June 2013).

Figure-2.1.2- Scheme Agua- spirometer (Source Carruso Mariano, Spirometry

Flow transducers, 6) - Accessed 6 February-2013).

 Orellana Aguirre 40

Advantage

• Easy to use

• dependable

• Precise

• Reproducible

• It provides hard copy

disadvantages

• Maintenance technicians

• Can not carry

• Difficult to clean if contaminated

• In some cases if you have no microprocessor calculations should be made

manually

2.1.2 Reciprocating Spirometers

Unlike the previous spirometer, this is a dry spirometer, ie

no water is sealed in (Figure-2.2.1).

This spirometer consists of a piston moving within a cylinder

because it is pushed by the patient's expired air, this movement

moved to a pen that records the movement on a paper moving to

a constant speed, thereby obtaining volume curves / pulmonary time

(Figure-2.2.2). It engageable a potentiometer as in the previous case

piston rod, to transform this movement in a signal

electrical and being connectable to a microprocessor.

 Orellana Aguirre 41

The piston-cylinder space is sealed by a flexible material that

let out the air.

Some spirometers piston allow registration of static volumes

simple spirometry; whereas in other models only allow the registration of the

forced expiratory maneuver.

Figure-2.2.1- spirometer piston (Source: Carruso Mariano, Transducers Spirometry

Flow, 7) - Accessed 6 February-2013)

Figure-2.2.2- Scheme spirometer piston. (Source: Carruso Mariano, spirometry

Flow transducers 8) - Accessed 6 February-2013)

 Orellana Aguirre 42

Advantage

• Easy to use

• dependable

• Precise

• Reproducible

• It provides hard copy

disadvantages

• Maintenance technicians

• Can not carry

• Difficult to clean if contaminated

• In some cases if you have no microprocessor calculations should be made

manually

• You can decalibrate if it moves

2.1.3. Bellow spirometers

This like the above is a dry spirometer. Its principle

operation consists in that when blowing the patient, the exhaled air "swells" one

bellows (which may be wedge-shaped or concertina) (Figure-2.3.1), and

this wall movement is recorded on a paper moving speed

constant. The curves are acquired are volume / time. It can be adapted

a potentiometer and a microprocessor to this spirometer as in cases

above, so that from the volume and time to calculate the

flows, thus enabling obtaining curves flow / volume.

 Orellana Aguirre 43

Before the onset of pneumotachographs, this was the spirometer

It extended and popularized the practice of spirometry, as it is more

that handy little water. Initially the paper only reached 6

second, although current models already recorded 12 seconds but

generally only records forced expiration.

Figure-2.3.1- spirometer Vitalografh- gaiter (Source: Carruso Mariano, Spirometry

Flow transducers, 9) - Accessed 10-February-2013).

Figure-2.3.2- Scheme Fuelle- spirometer (Source: Carruso Mariano, Spirometry

Flow transducers, 10) - having been consulted 10-February-2013).

 Orellana Aguirre 44

As for what concerns advantages and disadvantages it is the same as in the

Case spirometer piston.

2.2.1 Differential spirometer type Fleisch

The Fleisch (Figure-2.4.1) pneumotachograph consists of a set of

capillaries that supply a fixed resistance and small airflow.

Then small openings at each end of the capillary tubes are used for

measuring the pressure differential created when air flow passes through the

device.

This pressure difference is very small and is measured with a sensor

differential pressure output to an electrical signal from which

obtained flow values ​(Figure-2.4.3).

Figure-2.4.1- Fleisch spirometer type Vitalograph.- (Source Carruso Mariano, spirometry

Flow transducers, 17) - having been consulted 10-February-2013).

 Orellana Aguirre 45

Figure-2.4.2- spirometer Fleisch type head. (Source Carruso Mariano, spirometry

Flow transducers, 17) - having been consulted 10-February-2013).

Figure-2.4.3- Operating Principle Fleisch type spirometer. (Source Carruso Mariano,

Spirometry flow transducers, 17) - having been consulted 10-February-2013).

2.2.2 Differential Lilly type spirometer

Lilly pneumotachograph (Figure-2.5.1) it has a head (Figure-2.5.2) is

formed by a mesh or set of screens that are generally metal,

these provide a small air flow resistance and fixed, as is the

above, this small stream is recorded by a transducer (Figure-2.5.1).

 Orellana Aguirre 46

Figure-2.5.1- spirometer type Lilly- (Source: Carruso Mariano, Transducers Spirometry

Flow, 19- Accessed 16-February-2013.)

Figure-2.5.2 spirometer Lilly and pitot head. (Source: Carruso Mariano, spirometry

Flow transducers, 19- Accessed 16-February-2013.)

Figure-2.5.3- Operating Principle spirometer Lilly and Pitot type. (Source:

Carruso Mariano, spirometry flow transducers, 19- Accessed 16-February-2013.)

 Orellana Aguirre 47

2.2.3 pitot or differential type disposable spirometer

It is basically a type lilly head, are identical in physical form and

operation, but in this case the mesh material is disposable

(Figure-2.5.1). This head whole discarded after use with each patient,

and substituting one for every patient who needs it.

Advantages of pneumotachographs

• Easy to use.

• They are very reliable in terms of data acquisition.

• Highly reproducible.

• Modern spirometers are therefore their size is reduced.

• For their size they are easy to transport.

Disadvantages of pneumotachographs

• The air temperature has to leave the body affects the measurement and

I could be condensation.

• They require a printer or be connected to a computer to display

curves.

• For cleaning, it is done in the most careful manner and following the rules

of each manufacturer.

2.3. Spirometer Turbine

Such spirometer based its operating principle (Figure-2.6.1) in

an airflow that moves a sensitive propeller with thin blades that

moderate flow, the helix is ​supported by a shaft in the middle and end to

end and is in the head. The way the flow is recorded

passing through the head by two infrared laser is found

the beginning and end of the head (Figure-2.6.2), whenever the laser are

interrupted by the movement of the propeller flow records, depending on the

 Orellana Aguirre 48

speed at which the propeller will flow to move, this tells us that they are

directly proportional. The information is sent to a microprocessor

where then it can be viewed on the device. One of the features we

presents this spirometer is that we can give the speed and direction that the

air is flowing.

Some spirometers turbine (Figure-2.6.3) have more than two laser for

measuring airflow and more accurately, but only two suffice for

have proper operation.

Advantage

• Easy in handling.

• Very reproducible.

• modern spirometers, have a small size and are light.

• As their size is reduced they are easy to transport.

• Cleaning is simple.

• Cheap compared to other types of spirometers they are.

disadvantages

• If the design of the device is bad, the measures may be underestimating or

supraestimar.

• As we stroll pneumotachographs not to display a screen

curves, so you need a computer or printer, but there is one new already

It has screen.

• Due to the sensitivity of the helix I could decalibrate and measures do not always

they will be accurate.

 Orellana Aguirre 49

Figure-2.6.1- Operating Principle spirometer Turbine (Source: Carruso Mariano,

Spirometry flow transducers, 45) - having been consulted 16-February-2013).

Figure-2.6.2- spirometer head turbine (Source: Carruso Mariano, Spirometry

Flow transducers, 46) - having been consulted 16-February-2013).

Figure-2.6.3- spirometer Turbine Cosmed Pony Graphics (Source: Tops, Pérez, Technical and

Interpretation of Spirometry in Primary Care-chapter-1.1, 18) - having been consulted 17-February-

2013.)
 Orellana Aguirre 50

2.4 spirometer Hot Wire

This spirometer bases its principle (Figure 2.7.1) in which the air flow

enters the head, a wire cools is usually platinum or

tungsten is within the same. This thread is a

constant temperature because an electronic circuit heats, but

when this is being cooled by the airflow, the circuit has

to provide more current to the wire so that it remains his tempera. In

we conclude that the current drawn by the circuit is directly

proportional to the airflow, as when more flow exists, the yarn is cooled

plus.

These types of spirometers are not widely used giving the case in Europe

nobody uses it.

Advantage

• Its handling is very easy.

• At the time of testing results they are very reproducible and reliable.

• Because of its technology they are very light and small, facilitating

transport.

• Easy in its keeping, cleaning and calibration.

• They are relatively inexpensive compared to other spirometers.

disadvantages

• Due to the type of wire sensor gives an output with the same

polarity, so we limited to unidirectional flows.

• It affects measurements due to temperature.

• You need a printer or computer graphics.

• It is not always accurate.

 Orellana Aguirre 51

Figure-2.7.1- diagram of a spirometer Hot Wire (Source: Tops, Pérez, Technical and

Interpretation of Spirometry in Primary Care-chapter-1.1, 19) - having been consulted 17-February-

2013.)

Figure-2.7.2- spirometer Hot Wire CMS (Source: Types of Spirometers,

http://es.aliexpress.com/item/hot-selling-spirometer-multi-function-1-8-160x128-TFT-display-

LED-backlight-Light-weight-and-portable / 455902218.html) - Accessed 20-February-2013).

2.5 spirometer Ultrasound

They are expensive but spirometers are efficient and accurate, the principle of

operation (Figure-2.8.1) is based on ultrasonic waves That

located inside the head, these waves form an angle

due to the direction of airflow. The difference between the waves that go into the
 Orellana Aguirre 52

same direction as the flow with which go in the opposite direction gives us the

speed and direction of flow.

Advantage

• Easy to handle.

• They have accurate and reproducible.

• They are lightweight and small size so its transportation is easy too.

• Easy to clean.

• No moving parts.

disadvantages

• They need printer or computer for printing of curves.

• They are the most expensive in the world.

Figure-2.8.1- Operating Principle Ultrasound spirometer (Source: Types

Spirometers, http://es.aliexpress.com/item/hot-selling-spirometer-multi-function-1-8-160x128-

TFT-display-LED-backlight-Light-weight-and-portable / 455902218.html) - 20-February-Accessed

2013.)
 Orellana Aguirre 53

Figure-2.8.2- spirometer Ultrasound EASYONE - (Source: Spirometer Ultrasound,

Accessed http://www.henryschein.com/us-es/images/Medical/spirometry_0410_01.jpg)- 20-

February 2013.)
 Orellana Aguirre 54

CHAPTER III

MAINTENANCE AND SELECTION OF spirometers

3.1 Maintenance and calibration Spirometer

Maintenance

Spirometers maintenance is very important, people

perform this work should take into account specific instructions of the steps to

follow since this depends on the perfect working of the device.

First you must have the operating manual spirometer

It is being used to solve a problem or consult any doubt.

Secondly you must have a book maintenance by the

user, scoring her date each event or problem caused

by the spirometer. This book must contain notes:

• How to perform the test

• Record of how the calibration was performed

• Registry cleaning

• Mistakes

• Maintenance

Calibration

Calibration of spirometers is also a very important part of

the diagnostic test process since this depends on the correct

operation of the apparatus and test results.

All types of spirometers we've seen before have the same

type of calibration, according to ATS and SEPAR must be calibrated daily

machine before any test with a syringe containing

at least one volume of 3 liters in the case of pneumotachographs and the

spirometers Volumetric should be performed weekly calibration.

 Orellana Aguirre 55

The calibration of all spirometers be performed using instructions

established by each manufacturer, but all consist of passing a

certain volume of air through the nozzle seeing that there exists

no obstruction and verify that the delivered volume is the same as

the device registers.

To do this a syringe 1, 3 or 5 (3.1.2- used Figures-

3.1.3) is liters and the air enters the nozzle with a hose through a

plunger having the nozzle (Figure-3.1.1). First with a volume

we fixed in air with different flows and checking that the device

record the volume is supplied, this allows us to verify linearity

apparatus. Secondly it is performed by varying the volume of the syringe

to check the accuracy of the device. Third we make the income

air explosively with any type of volume to simulate

forced and verify that the device correctly register the spirometry

maneuver.

In modern spirometers calibration is done automatically and

device will indicate the steps to do it, but others are performed

manually.

It is important that the moment is to calibrate the apparatus, the air

syringe should be at the same temperature and atmospheric pressure is the

apparatus. Check that the syringe does not leak.

Figure-3.1.1 Calibration Connection (Source: Carruso Mariano, CALIBRATION

Spirometers, 2) -having been consulted in April-May-2013)

 Orellana Aguirre 56

Figure-3.1.2- Calibration syringe 3 liters. This model has a graduated piston which can

vary the volume- (Source: Cimas, Pérez, technique and interpretation of spirometry in Care

Primary-chapter-3) -having been consulted 5-March-2013)

Figure-3.1.3- Calibration syringe 1 liter (Source: Cimas, Pérez, Technical and Interpretation

Spirometry in Primary Care-chapter-4) -having been consulted 5-March-2013)

3.2 Cleaning spirometer

To clean these devices is made the same way for everyone,

except that in the pneumotachographs have to perform a clean

special and more delicate because it has sensors. Then

describe how cleaning components spirometers,

followed by cleaning pneumotachographs.

• nozzles: as it is seen previously in conducting the test

spirometric each patient is provided a disposable mouthpiece for each

test; but if this were not the case of disposable mouthpieces, you will have to
 Orellana Aguirre 57

washing it with water and detergent and then disinfected with glutaraldehyde

2% for 15 minutes minimum.

• Pipes and fittings: cleaning of these parts must be carried out not

daily or after each test as in the nozzles, simply

do it once a week also with water and detergent. It is recommended

leaving parts removed so that the steam that is in the evaporate

inside the instrument.

• nose clips: disinfection is not necessary as the other parties, suffice

to spend a little alcohol or placing gauze pads between the

clip and nose to avoid any contact.

• antibacterial filters: It is not obliged to use since there have been no tests

any infection, but its use is recommended to prevent aspiration of

secretions deposited in the system.

Thus clearing all spirometers is done because they have the

all same parts, and then continue with the cleaning heads

the pneumotachographs spirometers.

• Turbine transducer type: most of these types of spirometers

removing allow the turbine head, then be immersed in soapy water

tibia or any substance that is bactericidal for disinfection, turbine

must be submerged at maximum about 15 minutes, then remove it for

immersing in cold distilled water and finally allowed to dry at temperature

ambient. It must be very careful about the cleanliness of the sensor and

it is highly sensitive and may be damaged, for which it is recommended when

to clean the turbine can not shake in the water or passing

jets within it, when dry not do it with any

instrument such as a dryer or torch, and not use any solution as

 Orellana Aguirre 58

Pervinox, or alcohol. It is always recommended to follow the instruction manual

User type spirometer.

• Fleisch Transducer type: as in the turbine type can remove

pneumotachograph head core and separate it from the housing heating if

there. Then the sensor is immersed in soapy water or a

bactericide substance as (diethylenetriamine or sodium dichloroisocyanurate) for

sanitize, when you are in either of these two substances

is the stirred within them to clean its hair and likewise in the

previous case dipping into clean distilled water; for the drying is done

room temperature but if necessary can be the air or torching

oxygen to remove water found in their hair. Must be

be careful not to introduce any object into the capillaries of the core, or

sopletearlo when you are inside the head, scraping or cones

Linearisers or front core, using the substances set by the

no other manufacturer as solvents or abrasives as they may damage the core.

• Pitot transducer type: these spirometers can be removed completely

sensor, when cleaning is the same way as does the type Fleisch,

shaking them in hot water, then put in distilled water and finally drying

at room temperature, in this case use compressed air to remove the

air inside the mesh as well as the manufacturer recommends. Likewise is

Care should be taken to torching the pneumotachograph when this is found

placed or placing wet and dry heat ever.

• Lilly transducer type: You can remove the core of the entire system and

the previous case and form cleaning is almost the same, with the difference that these are

They will be brushed with a toothbrush gently without performing a pressure

excessive. These should be careful to place the mesh in any order

and any face

 Orellana Aguirre 59

It is recommended to perform routine daily maintenance of equipment and

Keep it in perfect condition and have good durability. Calibration

You must do more frequently and before any suspicion of any foreign

data collected by the apparatus, there is stop and check its operation. And the

most important for any calibration, maintenance or cleaning

any team is to follow the recommendations set by each manufacturer.

3.3 Indications and Contraindications

3.3.1 Indications

The indications for spirometry are:

• When a patient develops symptoms related to breathing and coughing,

dyspnea, wheezing, among others, is necessary to evaluate the respiratory capacity

spirometric test.

• Assess the impact that produce diseases other organs or systems

(Heart disease, renal, hepatic, etc.) with breathing.

• For patients with asthma, COPD or other respiratory diseases is

need to be follow up for diagnosis and treatment of their

disease.

• Assessing the risk of surgical procedures.

• Epidemiological studies that include respiratory disease.

• By supplying drugs or drug clinical trials see

therapeutic response in the patient.

• Immediately detect respiratory consequences of patients

They are exposed to snuff, labor agents, allergic processes, etc.)

 Orellana Aguirre 60

Contraindications 3.3.2-

As regards the contraindications in spirometry are

all clinical situations or circumstances advise against the

conducting a physical effort in which the patient's clinical status

It may worsen or can give results in poor performance of the

test. The main causes of these problems are as follows.

• Lack of understanding and collaboration at the time of testing.

• Diseases that cause unstable chest pain.

• recent hemoptysis.

• thoracic aneurysm or brain

• recent myocardial

• Retinal or recent cataract surgery.

• When some teeth missing this causes tracheostomy.

It should be noted that everything mentioned above is relative ie

depending on the circumstance in which it is and for each patient.

3.4- Requirements for choosing a spirometer

As we saw earlier there are two major types of spirometers,

Volumetric and flowmetry, but now the Volumetric have been

displaced by these second and having a sensor that registers the volume

air with the time it takes a patient to do so and its electrical signal is

represented as a stream and then sent to a microprocessor which

calculates volumes. The reliability of spirometers are concentrated in these

last two parts which are the most important as the flow sensor and

microprocessor, which must meet established requirements.

 Orellana Aguirre 61

• Minimum requirements

one. Volume : the spirometer must be able to measure volumes between 0.6 and 8 liters,

with flow between 0 and 14 liters / second minimum detectable volume 30 ml.

2. Inertia and resistance: should be less than 1.6 cm H two O / l / sec at a flow

air 12 liters / second.

3 . Determination of time zero: for those computer systems and

end of time, start of the test should be determined by a

retrograde extrapolation.

4 . Reading time of 16 seconds.

5. Correction BTPS : the instrument or operator must have a way to turn

values ​BTPS (Body Temperature Pressure Saturated with water and steam)

that is how to measure a volume of gas at body temperature (37 "C),

ambient atmospheric pressure and water vapor pressure at body temperature

(PH two O = 47 mmHg). This factor corrects for differences in temperature and

saturation of water vapor between the lung of the subject and the external environment, for

determine the actual volume of air exhaled. All spirometric values

They must be registered with BTPS correction.

6 . Availability of appropriate reference values ​and the possibility of selection

the technician.

7. Quality of results: validation by an independent laboratory . FVC and

FEV, must be measured with an accuracy within ± 3% or ± 60 ml. To the

check the calibration volume , It should achieve an accuracy within ± 3%

or ± 60 ml. Flow measurements accurate to within ± 6% or one 200

ml / s I econd.
 Orellana Aguirre 62

8 . Ability to store electrical signal 24 curves flow / volume .

9. They must have the ability to visualize on screen , in real time, values ​and

graphics throughout spirometry maneuver. also must

have warning notes on compliance or non-compliance

acceptability and reproducibility criteria for selection of the best curves.

10. Possibility of printing the results (numerical and graphic) test.

11. Calibration using 3-liter syringe and verification of results.

12. Ease of cleaning and disinfection of the exposed parts. There must be

possibility of using antibacterial filters.

• Other important requirements to consider.

one. Portability and ease of use.

two. And intuitive software environment possible connection to a computer.

3. Changeable final report as required.

Four. visual incentive for patients to get the best maneuver.

5. Availability of a user manual.

6. service accessible, easy and economical maintenance team.

 Orellana Aguirre 63

3.4- Choice of spirometer

Then we will see areas where you can perform spirometry and

the spirometer we might recommend depending on location.

• Hospital: as it is for the hospital setting, it is usual for

spirometry, as it provides important services for

people, having dedicated only for conducting the test sites

spirometry, the same is also done in laboratories function

lung in inpatient units, outpatient clinics, or

places that meet the above indications.

In a hospital it is very important that a good kind of is have available

spirometer, which does not have flaws and that is durable with correct data and

the least fault in cost can dispense as any

hospital may include the price of this device, the spirometer recommend

As for the specifications that owns and for the needs of this unit

It would be the Ultrasound spirometer, since this despite having a high

cost can give us assurance on the results, and does not need

a rigorous calibration and comparing the other sensors

spirometers the ultra sound is less failures may occur and the

durable, thus justifying their cost and to obtain curves this

spirometer can stay connected to a command and a printer. As

we reviewed earlier simple tests are also performed in which

you do not need as much precision as only the volume is measured, so

I would also recommend having a Water spirometer which it is reliable in that

measurement and cheap cost. As for the size would not be worrying and

a hospital can have a big spirometric room.

 Orellana Aguirre 64

• Ambulance: with respect to the outpatient setting is needed quickly and

portability at the time of the test, as they may arise

emergency and serious incidents can usually spend, in addition to

at that time is added important information tracking

chronic susceptible control processes. Seeing all this the spirometer

I can recommend would be the Spirometer Turbine, You need a good

calibration but only once a day, is reliable but like all in their

cost is cheap for the qualities that have and are easy to use and can

solve any problems which may arise at that time, as well as in the

Today these spirometers have a printer in the same apparatus

obtaining curves and is very useful for the subsequent diagnosis in

hospital, the only problem so to speak having is that the turbine has

inside is very sensitive and if you do not have the proper care can

decalibrate damaged or at any time, with the consequence one

error in data collection.

• Home: for the future is being planned to incorporate equipment

portable and are easy to handle, and for the transmission of

test information reaches the technician or doctor for diagnosis, can

do with telephone transmission of computer signals. But for the moment

for monitoring disease such as asthma, or any doubt

onset of respiratory failure, such as smoking, workplace, etc.,

want to do at home, we could use a Hilo spirometer

Hot, because although it is not always accurate in data acquisition as

the rest of the other spirometers is the cheapest of all in the market,

may be buying this for any user accessible.

 Orellana Aguirre 65

CONCLUSIONS AND RECOMMENDATIONS

Having done this work, we can say that spirometry is

a very important part to be adapted to our life as it is of great

utility at the time of control, diagnosis, monitoring and

treatment of respiratory function. In the case of the bronchodilator test

We is helpful for people who were born or acquired some kind of

respiratory disease, since a large control over them is needed to

observe the evolution of the disease and how does the drug effect was

It is supplied.

As she discussed above in the work, the lung function of all

People are different, because they depend on factors that apparently did not seem

important, but they really are as age, sex, height, weight, race, in

the latter has been demonstrated by studies in the GCF is black

10% less than whites.

For good data acquisition must be followed strictly all

steps previously studied at the time of the test, as well as

ensure technical knowledge is adequate so that it can

solve any problems when presented.

Possess all knowledge about the functionality and parties

are all types of spirometers allow solving problems

occur when conducting the test with the best efficiency and

simplest form, plus it can be perform calibration,

maintenance and cleaning of the apparatus, thereby giving high durability.

For choosing a spirometer it is very important to review all

features it has, the same as must have been approved by

any institution such as pulmonary respiration SEPAR, for

They are validated as a spirometer and can be used.

 Orellana Aguirre 66

In the case of type spirometer that can be used in different places

as a hospital, ambulance and home, I recommend the following as it has been

reviewing its functionality, advantages and price of the function wants

perform there and the difficulty of using:

Hospital: Ultrasound and spirometer spirometer Water, owning both.

Ambulance: spirometer turbine.

Home: Hot Wire spirometer.

 Orellana Aguirre 67

BIBLIOGRAPHY

• BARBERÁ, BURGOS, CASAN, Giner, ProcedimientosEspirometria SEPAR Manual, Edited

and coordinated by Luzan 5, SA de Ediciones for Novartis Pharmaceuticals SA 2009.
Accessed 21-Feb-2013.

• Presentations Mariano- Carruso Calibrating Spirometers. Buenos Aires

- Argentina - Postgraduate course - Specialization Electromedicina. 2012.

Accessed April-March-2013.

• Presentations Mariano- Carruso -Espirometria flow transducers.

Buenos Aires - Argentina - Postgraduate course - Specialization

Electromedicina. 2012. Accessed 5-Feb-2013.

• Carruso Mariano- Presentations Introduction to spirometry. good ones

Aires - Argentina - Postgraduate course - Specialization Electromedicina.

2012. Accessed 20-January-2013.

• CIMAS, PÉREZ, technique and interpretation of Spirometry in Primary Care

- Chapter-1.1, 2009. Accessed 23-January-2013.

• DE VITO Eduardo Luis, history of spirometry, Buenos Aires - Argentina -

Postgraduate course - Specialization Electromedicina. 2012. Accessed

16-Jan-2013.

• DE VITO Eduardo Luis, labneumo@lanari.fmed.uba.ar , Accessed March 10

2013. Accessed 15-January-2013.

• Orlando Lopez, Quality Control spirometer - Protocols and resultados.2005. First edition.
Accessed 1-March-2013.
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• Mazzei, NAZARIO, MONGE, Respiratory. Buenos Aires -

Argentina - Postgraduate course - Specialization Electromedicina. 2012.

Accessed 10-January-2013.

• NEUMOSUR, SAMFyC and SEMERGEN-Andalusia Consensus Paper

Spirometry in Andalusia 2010. Accessed 20-January-2013.

ELECTRONICS REFERENCES

• I spirometer Hilo hot- http://es.aliexpress.com/item/hot-selling-

spirometer-multi-function-1-8-160x128-TFT-display-LED-backlight-Light-

weight-and-portable / 455902218.html . Accessed March 20, 2013.

• spirometers of Ultrasound, http://www.henryschein.com/us-

com / images / Medical / spirometry_0410_01.jpg) - having been consulted 20-February-2013.

• Calibration syringe 3 liters http://tienda.fisaude.com/jeringa-calibracionp-2898.html .

Accessed March 10, 2013.

• Types of Spirometers,
http://es.aliexpress.com/item/hot-selling-spirometermulti-function-1-8-160x128-TFT-display-led-backlight-Light-weig
Consulted 20-February-2013. Accessed 28-February-
2013.