Coaching patients during pulmonary function testing: A practical guide

Heidi J Cheung, Lawrence Cheung, Heidi J Cheung, Lawrence Cheung

Abstract

Pulmonary function tests are an important tool to assist in the diagnosis and management of patients with respiratory disease. Ensuring that the tests are of acceptable quality is vital. Acceptable pulmonary function test quality requires, among others, optimal patient performance. Optimal patient performance, in turn, requires adequate coaching from registered respiratory therapists (RRTs) and other pulmonary function laboratory personnel. The present article provides techniques and tips to help RRTs coach patients during testing. The authors briefly review the components of pulmonary function testing, then describe factors that may hinder a patient's performance, list common mistakes that patients make during testing, and provide tips that RRTs can use to help patients optimize their performance.

Keywords: Diffusion capacity; Flow volume loops; Nitrogen washout; Plethysmography; Quality control; Slow vital capacity.

References

    1. Raghu G, Collard HR, Egan JJ, et al. An Official ATS/ERS/JRS/ALAT Statement: Idiopathic pulmonary fibrosis: Evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788–824.
    1. Celli BR, MacNee W, Agusti A, et al. Standards for the diagnosis and treatment of patients with COPD: A summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932–46.
    1. Flume PA, O’Sullivan BP, Robinson KA, et al. Cystic fibrosis pulmonary guidelines. Am J Respir Crit Care Med. 2007;176:957–69.
    1. El-Sobkey SB, Gomaa M. Assessment of pulmonary function tests in cardiac patients. J Saudi Heart Assoc. 2011;23:81–6.
    1. Schroeder EB, Welch VL, Couper D, et al. Lung function and incident coronary heart disease. Am J Epidemiol. 2003;158:1171–81.
    1. Aboussouan LS. Respiratory disorders in neurologic diseases. Cleve Clin J Med. 2005;72:511–20.
    1. Redlich CA, Tarlo SM, Hankinson JL, et al. Official American Thoracic Society technical standards: Spirometry in the occupational setting. Am J Respir Crit Care Med. 2014;189:983–93.
    1. Crapo Pulmonary function testing. N Engl J Med. 1994;331:25–30.
    1. Daoussis D, Liossis SC, Tsamandas AC, et al. Effect of long-term treatment with rituximab on pulmonary function and skin fibrosis in patients with diffuse systemic sclerosis. Clin Exp Rheumatol. 2012;30(Suppl 71):S17–S22.
    1. Schmidt SL, Nambiar AM, Tayob N, et al. Pulmonary function measures predict mortality differently in IPF versus combined pulmonary fibrosis and emphysema. Eur Respir J. 2011;38:176–83.
    1. Harber P. Respiratory disability and impairment: What is new? Curr Opin Pulm Med. 2015;21:201–7.
    1. Cooksley NA, Atkinson D, Marks GB, et al. Prevalence of airflow obstruction and reduced forced vital capacity in an Aboriginal Australian population: The cross-sectional BOLD study. Respirology. 2015;20:766–74.
    1. Miller MR, Crapo R, Hankinson J, et al. General considerations for lung function testing. Eur Respir J. 2005;26:153–61.
    1. Miller MR, Hankison J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.
    1. Wanger J, Clausen JL, Coates A, et al. Standardisation of the measurement of lung volumes. Eur Respir J. 2005;26:511–22.
    1. MacIntyre N, Crapo RO, Viegi G, et al. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J. 2005;26:720–35.
    1. Ranu H, Wilde M, Madden B. Pulmonary function tests. Ulster Med J. 2011;80:84–90.
    1. Becklake MR. Concepts of normality applied to the measurement of lung function. Am J Med. 1986;80:1158–64.
    1. Eaton T, Withy S, Garret JE, Mercer J, Whitlock RML, Rea HH. Spirometry in primary care practice. Chest. 1999;116:416–23.
    1. Peyton JWR, editor. Teaching and Learning in Medical Practice. Rickmansworth: Manticore Europe Limited; 1998.
    1. Gagne RM, Wager WW, Golas K, Keller JM. Principles of Instructional Design. 5th edn. Belmont: Wadsworth Publishing; 2004.
    1. Andreacci JL, LeMura LM, Cohen SL, Urbancky EA, Chelland SA, Von Duvillard SP. The effects of frequency of encouragement on performance during maximal exercise testing. J Sports Sci. 2002;20:345–52.
    1. Society American Thoracic . Patient Information Series: Pulmonary Function Tests. American Thoracic Society; 2007.
    1. Goldstein R. What is spirometry? A simple breathing test. [You tube video] 2010. [cited 2015 February 27. < > (Accessed February 27, 2015).
    1. Enright PL. How to make sure your spirometry tests are of good quality. Respir Care. 2003;48:773–6.
    1. Mottram CD. Chapter 1: Indications for pulmonary function testing. In: Mottram CD, editor. Manual of Pulmonary Function Testing. Maryland Heights: Elsevier Mosby; 2013. pp. 1–37.
    1. Standardization of spirometry 1994 update. Am J Respir Crit Care Med. 1995;152:1107–36.
    1. Clayton N. Assessing lung size. Chron Respir Dis. 2007;4:151–7.
    1. Chhabra SK. Forced vital capacity, slow vital capacity, or inspiratory vital capacity: Which is the best measure of vital capacity? J Asthma. 1998;35:361–5.
    1. Cohen J, Postma DS, Vink-Klooster K, et al. FVC to slow inspiratory vital capacity ratio: A potential marker for small airways obstruction. Chest. 2007;132:1198–203.
    1. Barros AR, Pires MB, Raposo NM. Importance of slow vital capacity in the detection of airway obstruction. J Bras Pneumol. 2013;39:317–22.
    1. Coates AL, Graham BL, McFadden RG, et al. Spirometry in primary care. Can Respir J. 2013;20:13–22.
    1. Coates AL, Desmond KJ, Demizio D, Allen PD. Sources of variation in FEV1. Am J Respir Crit Care Med. 1994;149:439–43.
    1. Mottram CD. Chapter 3: Diffusing capacity tests. In: Mottram CD, editor. Ruppel’s Manual of Pulmonary Function Testing. Maryland Heights: Elsevier Mosby; 2013. p. 80.
    1. Graham BL, Dosman JA, Cotton DJ. A theoretical analysis of the single breath diffusing capacity for carbon monoxide. IEEE Trans Biomed Eng. 1980;27:221–7.
    1. Johnson DC. Importance of adjusting carbon monoxide diffusing capacity (DLCO) and carbon monoxide transfer coefficient (KCO) for alveolar volume. Respir Med. 2000;94:28–37.
    1. Jensen RL, Crapo RO. Diffusing capacity: How to get it right. Respir Care. 2003;48:777–82.
    1. Smith TC, Rankin J. Pulmonary diffusing capacity and the capillary bed during Valsalva and Muller maneuvers. J Appl Physiol. 1969;27:826–33.
    1. Coates AL, Peslin R, Rodenstein D, Stocks J. Measurement of lung volumes by plethysmography. Eur Respir J. 1997;10:2174–85.
    1. Rodenstein D, Stanescu D. Frequency dependence of plethysmography volume in healthy and asthmatic patients. J Appl Physiol. 1983;54:159–65.
    1. Shore SA, Huk O, Mannix S, Martin JG. Effect of panting frequency on the plethysmographic determination of thoracic gas volume in chronic obstructive pulmonary disease. Am Rev Respir Dis. 1983;128:54–9.
    1. O’Donnell CR, Bankier AA, Stiebellehner L, Reilly JJ, Brown R, Loring SH. Comparison of plethysmographic and helium dilution lung volumes. Which is best for COPD? Chest. 2010;137:1108–15.
    1. Kaminsky DA. Chapter 4: Lung volumes, airway resistance, and gas distribution tests. In: Mosby, editor. Ruppel’s Manual of Pulmonary Function Testing. 10th edn. Maryland Heights: Elsevier; 2013. pp. 110–1.
    1. Licskai CJ, Sands TW, Paolatto L, Nicoletti I, Ferrone M. An analysis of spirometry test quality in a regional primary care asthma program. Can Respir J. 2012;19:249–54.

Source: PubMed

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