Revised PCCP Spiro Consensus PDF

Philippine College of Chest Physician (PCCP):
Consensus Statement on the Performance

and Reporting of Spirometry Testing
Executive Summary
Report of the Council on Diagnostics and Therapeutics

Philippine College of Chest Physicians
Primary Investigator: Tim S. Trinidad, MD, FPCCP
Secondary Investigators: Ma. Janeth T. Samson, MD, FPCCP
Celeste Mae L. Campomanes, MD, FPCCP
Marites A. Tan- Ang, MD,FPCCP
Geraldine C. Garcia, MD, FPCCP
Maria Peachy Lara L. Villanueva,MD,FPCCP
Lolita Brigida V. Micu, MD, FPCP
Rachel M. Lee-Chua,MD, FPCP
Maria Piedad R. Natividad, MD, FPCCP
PROPONENTS:
Chair: Ma. Janeth T. Samson, MD, FPCCP
Advisers: Camilo C. Roa, MD,FPCCP
Tomas M. Realiza, MD, FPCCP
Vincent M. Balanag Jr.,MD, FPCCP
Benilda B. Galvez, MD, FPCCP
Jennifer Ann M. Wi, MD, FPCCP
Ricardo C. Zotomayor, MD, FPCCP
Consultative Groups:
All hospitals and individuals who have participated in the meetings and voting forms and
have commented in one way or another.
Chinese General Hospital: Eden D. Chua, MD, FPCCP

Shirley Jane Chua-Panganiban, MD, FPCCP
Lung Center of the Philippines: Luisito F. Idolor, MD, FPCCP
Augusto S. Sablan, Jr. MD, FPCP
Araceli Pascual, RT
Manila Doctors Hospital: Dennis C. Teo, MD, FPCCP
Aileen M. David-Wang, MD, FPCCP
Philippine Heart Center: Rodolfo E. Tamse, MD, FPCCP
Irenee Faustina J. Casio, MD, FPCP

i
St. Lukes Medical Center: Myrna N. Baares,MD, FPCCP

Raphael Ryan R. Zantua, MD, FPCCP
Ma. Janeth T. Samson, MD, FPCCP
University of Perpetual Help Medical Center: Ricardo M. Salonga, MD, FPCCP
Jose Edzel V. Tamayo, MD, FPCCP
Mary Leslee Tabi,RT
Nio Jessielito N. Doydora, MD

University of the Philippines Philippine General Hospital:
Ma. Bella R. Siasoco, MD, FPCCP
Jubert P. Benedicto, MD, FPCCP
University of Sto. Tomas Hospital: Tim S.Trinidad, MD, FPCCP
Apolonio G. Javier, JR., MD, FPCP
FPCCP
Veterans Memorial Medical Center: Eloisa S. De Guia, MD, FPCCP
PCCP- Central and North Luzon Chapter: Ruel G. Rivera, MD, FPCCP
PCCP-Cebu Chapter: Evan N. Mendoza,MD, FPCCP
PCCP-Iloilo Chapter: Malbar G. Ferrer, MD, FPCCP
PCCP-Negros Chapter: Ethel Marie B. Tangarorang-Lacson, MD, FPCCP
PCCP Northern Mindanao Chapter: Eileen G. Aniceto, MD, FPCCP
PCCP-Southern Mindanao Chapter: Romulo T. Uy, MD, FPCCP
PCCP- Southern Tagalog Chapter: Violeta C. Reyes, MD, FPCCP
Key Opinion Leaders

Camilo C. Roa, MD,FPCCP
Joven Q. Tanchuco, MD, FPCCP
Abundio A. Balgos, MD, FPCCP
Jennifer Ann M. Wi, MD, FPCCP
Ricardo C. Zotomayor, MD, FPCCP
Council of Diagnostics and Therapeutics Members

Caburnay, Eloise Arabelle, MD, FPCCP
Campomanes, Celeste Mae L.,MD, FPCCP
Chavez, Christine L., MD, FPCP
Chua-Panganiban, Shirley Jane, MD, FPCCP
Claveria, Angelica, MD, FPCCP
Cristobal- Aquino, Ma. Flordeliza, MD, FPCCP
ii
Dalupang, Julius, MD, FPCCP

Divinagracia, Charissa, MD, FPCCP
Elisterio, Helarose M., MD, FPCCP
Garcia, Geraldine, MD, FPCCP
Germar, Arnold G., MD, FPCCP
Gonzales, Andrew S.A., MD, FPCCP
Lee-Chua, Rachel, MD, FPCP
Llanes-Gracia, Liza, MD, FPCCP
Mapanao, Daisy, MD, FPCCP
Micu, Lolita Brigida, MD,FPCP
Mora, Czarina J., MD, FPCCP
Natividad, Ma. Piedad R., MD, FPCCP
Ogbac, William George, MD,FPCP
Peafiel, Alvin, MD, FPCCP
Reside, Evelyn Victoria E., MD, FPCCP
Reyes, Mary Jane, MD, FPCCP
Santos, Alfredo Romeo Q., MD, FPCCP
Tan, Marites, MD, FPCCP
Tan, Florita, MD, FPCCP
Samson, Lyndon H., MD, FPCCP
Trinidad, Tim S., MD, FPCCP
Valenzuela, Rosauro Vicente H. Jr.,MD, FPCCP
Villanueva, Anna Tessa, MD. FPCCP
Villanueva, Ma. Peachy Lara, MD, FPCCP
Villasanta, Edwin I.,MD,FPCCP
Zantua, Raphael Ryan R., MD, FPCCP
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Message from the PCCP President
Greetings from the Philippine College of Chest Physicians (PCCP) !

Spirometry is a useful tool in the assessment of lung function. National and
international guidelines like the Global Initiative for Chronic Obstructive Lung
Disease guidelines, recommend spirometry as the gold standard for accurate
measurement of lung function.
Spirometry has many clinical applications in assessing and managing
respiratory disease such as: detecting the presence of obstructive and restrictive
lung defects, determining the severity of lung disease, evaluation of patients with
unexplained respiratory symptoms, assessment of preoperative pulmonary risk,
disability testing, and screening people at risk in certain occupational environments.
However, despite the known usefulness of spirometry, it has remained underutilized
in clinical practice. No uniform way of reporting the interpretation of spirometry
results is also available in our country.
This spirometry manual was prepared by the PCCP Council on Diagnostics
and Therapeutics with the aim of providing standards on the performance and
reporting/interpretation of spirometry testing. It is meant to be a working reference
for chest specialists, internists, general practitioners, primary care physicians,
medical trainees and paramedical personnel.
On behalf of the PCCP Executive Board of Directors, I commend the Council
on Diagnostics and Therapeutics under the leadership of Dr. Ma. Janeth T. Samson,
for their hard work and dedication in preparing this manual.
I hope that all users of this manual will benefit greatly from it and promote the
use of spirometry more extensively.
BENILDA B. GALVEZ, MD, FPCCP

President (2012-2013)
Philippines College of Chest Physicians
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Message from the Council Chair
Greetings! The Council of Diagnostics and Therapeutics of the Philippine

College of Chest Physicians aims to promote awareness of the use of spirometry in
the diagnosis of pulmonary diseases as well as to measure lung wellness. The
under utilization of this diagnostic tool may be because of its unavailability in the
rural areas as well as the lack of understanding of the spirometry report among nonpulmonologist. This lack of understanding may stem from differences in the
interpretation of the values in the report or in the manner of reporting these
interpretations. It is our objective that by promoting uniformity in the conduct and
reporting of simple spirometry we will be able to create more understanding of the
report eventually increasing its use to improve the quality of patient care.
This project would not have been possible if not for the cooperation and
support of executive board, resource persons from training institutions, chapters and
key opinion leaders. Likewise, special thanks to the members of the council who
painstakingly contributed their efforts and support , spearheaded by Dr. Tim
Trinidad, in making this manuscript a reality.

Council Chair
PCCP Council of Diagnostics and Therapeutics
Table of Contents
Introduction --------------------------------------------------------------------------------
Methodology -------------------------------------------------------------------------------
Statements
Performance of the Test -------------------------------------------------------------
Quality Control -------------------------------------------------------------------------
Parameters Measured ---------------------------------------------------------------
Test Result Selection ----------------------------------------------------------------
Parts of the Report -------------------------------------------------------------------
General Data --------------------------------------------------------------------------
Technicians Comment --------------------------------------------------------------
Semantics in Interpretation ---------------------------------------------------------
Interpretation Algorithm --------------------------------------------------------------
Use of other Parameters Not in Algorithm --------------------------------------
Grading of Severity -------------------------------------------------------------------
Lower Limit of Normality ------------------------------------------------------------
Response to Bronchodilator --------------------------------------------------------
Statement on Need for Additional Test ------------------------------------------
Reference Equations -----------------------------------------------------------------
Comments on the Quality of the Test --------------------------------------------
10
Graphical Representation -----------------------------------------------------------
11
Results in Tabular Graph ------------------------------------------------------------
11
Interpreters Comments --------------------------------------------------------------
12
Final Interpretation --------------------------------------------------------------------
13
References ----------------------------------------------------------------------------------
13
Appendix -------------------------------------------------------------------------------------
14
vi
Philippine College of Chest Physician (PCCP):

Consensus Statement on the Performance and
Reporting of Spirometry Testing
Introduction
Spirometry testing is an underutilized ancillary procedure. There are numerous
reasons for this observation. Perhaps one of the reasons is the non-uniformity and
complexity of the reports generated. It is for reason the Philippine College of Chest
Physician (PCCP) Council of Diagnostics and Therapeutics (DATS) came out with this
consensus document. It is envisioned that with these recommendations, PCCP Pulmonary
Fellowship Training Institutions (PFTI) will be able to come up with a recommended generic
spirometry report that is of good quality and simple enough for both the pulmonary and nonpulmonary specialist (general practitioner) to use. (Kindly see appendix A).
Methodology & Results

Generation of the List of Statements for Voting
From September till December of 2011, the PCCP PFTI pulmonary function lab
directors or resource persons were requested to answer a survey questionnaire on
performance and reporting of spirometry testing in their respective institutions. They were
likewise requested to submit a sample of their reports that shows the following results:
normal, obstructive, possible restrictive and possible combined defect. The composition of
the PCCP-PFTI and their corresponding pulmonary function lab director/resource persons
can be seen in appendix B.
On January 9, 2012 and February 20, 2012, the collected survey forms were tallied
and analyzed by DATS. Specifically, DATS evaluated the uniformity of the performance and
reporting of spirometry testing. From the results and statements of American Thoracic
Society and European Respiratory Society Task Force on Standardization of Lung Function
Testing (ATS-ERS-TFLFT), DATS came out with a list of proposed recommendations for the
different PCCP-PFTI in the performance and reporting of spirometry testing.
The initial list of statements was presented and deliberated upon by the
representatives of PCCP-PFTI on March 2, 2012. A revised list was presented to the
members of the PCCP during its annual convention on March 14 & 16, 2012. The
statements were further modified based on the suggestions during the annual convention.
Method Used in Voting and Grading of Consensus Statements

On April 2, 2012, DATS deliberated on the penultimate statements. Thereafter the
penultimate document was distributed to the different 11 PCCP PFTI, 4 PCCP Chapters and
3 key opinion leaders for voting. The form used for voting and the list of those who voted
can be seen in appendix K & L respectively.
After the votes were tallied (this can be seen in appendix M), the statements were
classified according to the following level of consensus:
Perfect consensus is defined as 100% of the voters agreeing with the statement and
none of the voters chose option D.
Very good consensus is defined as 80 to 99% of the voters agreeing with the
statement and there are less than 20% of the voters who chose option D.
Good consensus is defined as either
80 to 99% of the voters agreeing with the statement with more than 20% of
the voters choosing option D
60 to 79% of the voters agreeing with the statement with less than 20% of the
voters choosing option D
Some consensus is defined as 51 to 59% of the voters agreeing with the statement
No consensus is defined as less than 50% of voters agreeing with the statement
The computation of the parameters needed for the level of consensus classification can
be seen in appendix N.
Based on the level of consensus, the statements were modified based on the modal
auxiliary verbs: must, should and may. Statements classified as having either a perfect or a
very good consensus used the modal auxiliary verb must. Must is used in the context that
personnel involved in spirometry testing has a responsibility or an obligation to follow the
statement. Statements classified as having a good consensus used the modal auxiliary verb
should. Should is used in the context that personnel involved in spirometry testing are
advised to follow the statement.
There are 22, 25 & 4 statements with perfect, very good and good consensus
respectively. None of the statements were classified as some or no consensus.
Spirometry Testing Consensus Statements

Performance of the Test
Statements:
(S1-1) Spirometry testing using the closed circuit technique must be performed based on
the standards set by the ATS-ERS-TFLFT1. Part of the procedure includes the
answering of the PCCP DATS Spirometry Testing Information Sheet. Kindly see
appendix I & J (very good consensus).
(S1-2) A referring physician must either request any of the following types of spirometry
testing (perfect consensus):
Simple spirometry
Spirometry with post bronchodilator study
Simple spirometry study with possible post bronchodilator study if initial result is
abnormal.
(S1-3) In a situation where in the referring physician requested only a simple spirometry
and it showed abnormal results, the technician in coordination with the doctor
(interpreter of the results) must try to seek permission from the referring physician to
proceed in performing a post bronchodilator study while the patient is still in the test site
(very good consensus) or may suggest Postbronchodilator study in the results.
Quality Control
Statements:
(S2-1) Daily instrument calibration must be done (very good consensus).
(S2-2) The interpreter (lab medical director or pulmonary consultant on deck) must
give a feedback to the technician with regards to the quality of the test (perfect
consensus).
(S2-3) A log book must be maintained. It must contain the following (very good
consensus):
1. Daily calibration results
2. Anomalous events or problems encountered with the system
3.Feedback of the interpreter to the technician
Parameters Measured
Statements:
(S3-1) The following must be measured and reported: FEV1/ FVC, FVC and FEV1
(perfect consensus).
(S3-2) If the spirometry machine is capable, the following should be measured and
reported (in order of decreasing importance) (very good consensus):
A. PEFR
B. FEF 25-75
C. FEF 75
D. MIF50/ MEF50
E. FEV1/FV6
F. MVV
G. MIF 50
H. MEF 50
I. FEV6
J. FEF 25
K. FEF 50
Test Result Selection
Statement:
(S4-1) Test result selection must be based on the recommendations set by the ATSERS-TFLFT1 (perfect consensus).
1. Report the highest FVC and FEV1 obtained.
2. The spirogram with the highest sum of FEV1 & FVC is chosen as the best trial.
3. The other parameters reported are obtained from the best trial.
Parts of the Report
Statements:
(S5-1) In the spirometry report, there must be 3 sections for the interpretation of the
results (perfect consensus):
A. Technicians Comments
B. Interpreters comments
C. Final Interpretation
(S5-2) Clinical correlation should not be incorporated in the final interpretation (good
consensus).
General Data
Statement:
(S6-1) The spirometry report must contain a section on general data which contains the
following information (very good consensus):
A. Name of patient
B. Age of patient
C. Gender of patient
D. Measured height
E. Measured weight
F. Race of patient
G. Date of procedure
H. Time of procedure
I. Room temperature at time of testing
J. Room atmospheric pressure at time of testing
K. Name of referring physician
L. Name of the laboratory
M. Phone number of laboratory
Components of the Report

Technicians Comment
Statements:
(S7-1) The report must contain a section for the technicians comments. It should state
the indication for doing the test and the information about previous spirometry testing
(very good consensus).
(S7-2) The technicians comments must state if the test done satisfies the ATS-ERSTFLFT1 reproducibility criteria. If not, it must state which of the criteria was not satisfied
(S7-3) The technicians comments must state if conditions that may alter the results are
present or not (perfect consensus).
(S7-4) The technicians comments must state if the patient is on respiratory drug and if
so, when was the last intake (perfect consensus).
(S7-5) The technicians comments must state the patients smoking history particularly
the pack years and the last time the patient smoked cigarettes (perfect consensus).
For example:
Technicians Comments:
A spirometry test was done to confirm the diagnosis of COPD.
Patient has no history of previous spirometry testing.
The patient is a previous smoker who has a 20-pack year of smoking history.
His last intake of cigarette smoke was 10 years ago.
There were no conditions present in the check list which may alter the results
of this study.
The patient took his Indacaterol 16 hours prior to test
The test done satisfied the reproducibility criteria set by the ATS-ERS.
Semantics in Interpretation
Statement:
(S8-1) In the interpretation of the results, the report must use the phrase ventilatory
defect (not lung defect or ventilatory pattern) (very good consensus).
Interpretation Algorithm
Statement:
(S9-1) Spirometry results must be interpreted based on the ATS-ERS-TFLFT2
suggested algorithm.
Fig. 1 Interpretative strategies for lung function tests: R. Pellegrino, G. Viegi, V. Brusasco, et
al. Eur Respi Respi J 2005; 26: 948-968.
Use of other Parameters Not in the ATS-ERS-TFLFT Interpretation Algorithm

Statements:
(S10-1) The best trial flow volume (pre and post-bronchodilator if done) must be part of
the spirometry report (perfect consensus).
(S10-2) In cases of possible upper airway obstruction interpretation, all of the trial flow
volume loops must be reported. If the spirometry software is not capable, reproducibility
of the flow volume loop must be mentioned in the interpreters comments (very good
consensus).
Example:
Interpreters Comments:
1. The spirometry test is of good quality based on standards set by the ATSERS.
2. The FEV1/FVC is normal (using the 5th percentile of the predicted as the
lower limit of normality).
3. The FVC is normal (using the 5th percentile of the predicted as the lower
limit of normality).
4. Flow volume shows a plateau shape of the expiratory limb which is
reproducible in 3 acceptable trials. The MIF50/MEF50 is greater than one.
These are suggestive of a variable intra thoracic upper airway obstruction.
5. There is no significant response to bronchodilator.
6. The normality of the parameters is based on the Morris Polgar equation
Final Interpretation:
Probable variable intra-thoracic upper airway obstruction
Please correlate results with patients clinical data.
(S10-3) Slowing down of the terminal portion of spirogram must be described as
exaggerated concavity in the distal portion of the expiratory limb of the flow volume
loop. Use of the term scooping is discouraged (perfect consensus).
(S10-4) In cases where in the interpretation uses any of the following: flow volume
loops configuration, FEF25-75 and other spirometry parameters, it must be stated that
these parameters are suggestive but not definitive. Use of the term compatible is
discouraged (very good consensus).
Example:
4. There is (exaggerated) concavity of the flow volume loop. The FEF 25-75
and FEF 75 are low (using 65% of the predicted as the lower limit of
normality). These are suggestive of obstructive (small airways disease)
ventilatory defect.
5. The severity of the probable obstructive ventilatory defect is mild, based
on the post bronchodilator FEV1 % predicted of 80.
Probable mild obstructive ventilatory defect
Grading of Severity
Statements:
(S11-1) Grading of severity must be based on the criteria set by ATS-ERS-TFLFT2
(S11-2) FEV1% predicted (post bronchodilator value if available) must be used both for
obstructive and restrictive ventilatory defect (perfect consensus).
Table 1: Grading of Severity of Ventilatory Defect
Degree of Severity
FEV1 % Predicted (post bronchodilator if available)
Mild
70 & above
Moderate
60-69
Moderately Severe 50-59

Severe
35-49
Very Severe
<35
Lower Limit of Normality

Statements:
(S12-1) In the spirometry report, all parameters must have corresponding (perfect
consensus):
Actual value (in BTPS)
Predicted value
% Predicted
(S12-2) If the spirometer software is capable (optional), the value corresponding to the
95% CI of the predicted value must be written in the report (very good consensus).
(S12-3) If the spirometer software is capable (optional), values < 5th percentile of the
predicted should be flagged down (either a change of color or marked). If the
spirometer software is not capable, the technician or interpreter should derive this
value by manual computation or uses an online calculator at
http://www.dynamicmt.com/dataform3.html (good consensus).
(S12-4) The cut-off value for the FEV1/FVC ratio should be <5th percentile of predicted
value. If not available, it should be stated in the interpreters comments what cut off
value was used for the lower limit of normality (good consensus).
(S12-5) Cut off value for the lower limit of normality must be stated in the interpreters
comments (very good consensus).
Example 1:
2. Based on a low FEV1/FVC (using the 5th percentile of the predicted as the
lower limit of normality), there is an obstructive ventilatory defect.
3. The FVC is normal (using the 5th percentile of the predicted as the lower limit
of normality).
4. The severity of the obstructive ventilatory defect is moderately severe, based
on the post bronchodilator FEV1 % predicted of 50.
Moderately severe obstructive ventilatory defect with no significant response
to Bronchodilator
Example 2:
2. The FEV1/FVC is normal (using a fixed cut-off value of 0.70 as the lower
3. The FVC is low (using the 80% of the predicted as the lower limit of
normality) which is probably due to a restrictive ventilatory defect or
obstructive ventilatory defect (with residual volume hyperinflation).
4. The severity of the restrictive ventilatory defect is mild, based on the post
bronchodilator FEV1 % predicted of 70.
Probable mild restrictive ventilatory defect with no significant response to
bronchodilator.
We suggest requesting for a lung volume study to confirm presence of a
restrictive ventilatory defect and rule out obstructive ventilatory defect.
Response to Bronchodilator
Statements:
(S13-1) Performance of a post-bronchodilator study must be done based on the
recommendations of ATS-ERS-TFLFT2 (perfect consensus).
Procedure for Performance of Post-bronchodilator Study
1. Assess lung function at baseline
2. Administer salbutamol in four separate doses of 100 mg through a spacer
3. Re-assess lung function after 15 minutes. If you want to assess the
potential benefits of a different bronchodilator, use the same dose and the
same route as used in clinical practice. The wait time may be increased
for some bronchodilators
(S13-2) Interpretation of response to bronchodilator must be based on the criteria set
by the ATS-ERS-TFLFT2 (perfect consensus).
Criteria for Significant Response to Bronchodilator:
An increase in FEV1 or FVC > 12% of control and > 200 mL.
(S13-3) FEF 25-75 must not be used in the interpretation of the post bronchodilator
response (perfect consensus).
(S13-4) To standardize the semantics, response to bronchodilator must be labeled as
significant or no significant response to bronchodilator. The use of other terms such
as poor or good response to bronchodilator are discouraged (perfect consensus).
Statement on Need for Additional Test
Statement:
(S14-1) Interpretation must include suggestion/s on need for an additional test
if warranted (very good consensus).
Reference Equations
Statements:
(S15-1) In the section on Interpreters Comments the report must state what
reference equation was used in the interpretation of the results. Statement on the need
to correlate clinically should be written in the section on Final Interpretation (very
good consensus).
Example:
4. The severity of the obstructive ventilatory defect is moderately severe,
based on the post bronchodilator FEV1 % predicted of 50.
Final Interpretation
Moderately severe obstructive ventilatory defect with no significant response
to bronchodilator
(S15-2) A research study must be conducted by the Council of Diagnostics &
Therapeutics to determine which reference equation is best fitted for the local Filipino
population (very good consensus).
Comments on the Quality of the Test
Statements:
(S16-1) In the reports section on Interpreters Comments, it must be stated if the test
satisfies the reproducibility criteria set by the ATS-ERS-TFLFT1 or not (very good
consensus).
(S16-2) If the test does not satisfy one of the acceptability or reproducibility criteria, it
must state the consequences of this deficiency in the parameters (very good
consensus).
Example1.
Example 2:
1. Despite several attempts, the end of test criteria was not met. This may
underestimate the true FVC of the patient. The FEV1 is however
reproducible and therefore the patients FEV1/FVC may overestimate the
patients real FEV1/FVC
3. The FVC is low (using the 5th percentile of the predicted as the lower limit
of normality). This may be due to poor effort of the patient, obstructive
ventilatory (with residual volume hyperinflation) or a concomitant
restrictive ventilatory defect.
Moderately severe obstructive ventilatory defect with no significant
response to bronchodilator
10
Components of the Report: Graphical Representation

Statements:
(S17-1) The spirometry report must contain at least, the pre (and post-bronchodilator if
done) best trial flow volume loop/s (perfect consensus).
(S17-2) The spirometry report must contain the flow volume loops of all trials if an
interpretation of central airway obstruction (CAO) or upper airway obstruction (UAO) is
made. If the spirometry software is not capable, the reproducibility of the flow volume
loop must be stated in the section on Interpreters Comments (very good consensus).
Example:
3. The FVC is normal (using the 5th percentile of the predicted as the lower limit
of normality).
4. Flow volume shows a plateau shape of the expiratory limb which is
reproducible in 3 acceptable trials. The MIF50/MEF50 is greater than one.
These are suggestive of a variable intra thoracic upper airway obstruction.
Probable variable intra-thoracic upper airway obstruction
Components of the Report: Results in Tabular Graph
Statements:
(S18-1) The spirometry report must contain the measured parameters tabular
graph (very good consensus).
(S18-2) The first 3 rows of the tabular graph must be allotted for the most reliable
spirometry parameter (MRSP) in the following order: {This order will facilitate the
interpretation of the results based on the proposed algorithm of ATS-ERS-TFLFT2}
FEV1/FVC
FVC
FEV1
(S18-3) The succeeding rows maybe be allotted for the other parameters in the
following order of priority (very good consensus):
A. PEFR
B. FEF 25-75
11
C.
D.
E.
F.
G.
H.
I.
J.
K.
FEF 75
MIF50/ MEF50
FEV1/FV6
MVV
MIF 50
MEF 50
FEV6
FEF 25
FEF 50
(S18-4) In the tabular graph, each parameter must have its corresponding (perfect
consensus):
A. Actual Values (pre & post if done)
B. Predicted
C. 95% Confidence Interval Limit (if the spirometry software is capable)
D. % Predicted (pre & post if done)
E. % Change from baseline of post-bronchodilator measurement (if the
spirometry software is capable)
(S18-5) In the tabular graph (if the spirometry software is capable), each parameter
below the 5th percentile should be flagged down (good consensus).
Components of the Report: Interpreters Comments

Statements:
(S19-1) The report must contain a section for the interpreters comments (IC) of the
results (perfect consensus).
(S19-2) The IC section must state if the test satisfied the ATS-ERS-TFLFT1
reproducibility criteria. If the test did not satisfy the criteria, the interpreter must
state the consequences of this deficiency (very good consensus).
(S19-3) The IC section must also contain the basis for the interpretation.
Specifically it must apply, the ATS-ERS-TFLFT2 (very good consensus):
A. Interpretation algorithm
B. Criteria for Severity
C. Response to Bronchodilator
Example:
1. The spirometry test is of good quality based on standards
set by the ATS-ERS.
2. Based on a low FEV1/FVC (using the 5th percentile of the
predicted as the lower limit of normality), there is an
obstructive ventilatory defect.
3. The FVC is normal (using the 5th percentile of the predicted
as the lower limit of normality).
4. The severity of the obstructive ventilatory defect is
moderately severe, based on the post bronchodilator FEV1
% predicted of 50.
12
5.
6.
There is no significant response to bronchodilator.

The normality of the parameters is based on the Morris
Polgar equation
Components of the Report: Final Interpretation

Statements:
(S20-1) The spirometry report must contain a section for the final interpretation (FI) of
the results (perfect consensus).
(S20-2) The FI must contain the following information (very good consensus):
Presence or absence of Obstructive Ventilatory Defect and severity if present

Presence or absence of probable Restrictive Ventilatory Defect and severity if
present
Significant or No Significant Response to Bronchodilator if done
Suggestion for specific additional test if indicated
A generic sentence Please correlate results with patients clinical data.
Printed Name and Signature of the Interpreter/s
Example
Probable mild restrictive ventilatory defect with no significant response to
bronchodilator.
We suggest requesting for a lung volume study to confirm presence of a
restrictive ventilatory defect and rule out obstructive ventilatory defect.
NB: Full document and Executive Summary of the PCCP: Consensus Statement of
Spirometry Testing can be down loaded at the PCCP website
http://www.philchest.org/
References:
1. American Thoracic Society/ European Respiratory Society. Stardization of
Spirometry: M.R. Miller, J. Hankinson, V. Brusasco, F. et al. Eur Respi Resepi J
2005; 26: 319-338.
2. American Thoracic Society/ European Respiratory Society. Interpretative
strategies for lung function tests: R. Pellegrino, G. Viegi, V. Brusasco, et al. Eur
Respi Respi J 2005; 26: 948-968.
13
Appendices
14
APPENDIX A
Name: Juan Cruz
Time of procedure: 10:00 AM
Age: 55
Room temperature: 30
Gender: Male
Room atmospheric: 760
Height (inch): 64
Referring physician: Dr. Pedro Andres
Weight (lbs): 135
Name of the laboratory: PCCP PFT Lab
Race: Asian
Phone number of laboratory: 723-30-80
Date: 11/20/09
Technicians Comments:
1. A spirometry test was done to confirm the diagnosis of COPD.
2. Patient has no history to previous spirometry testing.
3. The patient is a previous smoker who has a 20-pack year of smoking history. His
last intake of cigarette smoke was 10 years ago.
4. There were no conditions present in the check list which may alter the results of
this study.
5. The patient took his Indacaterol, 16 hours prior to test.
6. The test done satisfied the reproducibility criteria set by the ATS-ERS.
SGD Charlie Go, RT
1. The spirometry test is of good quality based on standards set by the ATS-ERS.
2. Based on a low FEV1/FVC (using the 5th percentile of the predicted as the lower
limit of normality), there is an obstructive ventilatory defect.
3. The FVC is normal (using the 5th percentile of the predicted as the lower limit of
normality).
4. The severity of the obstructive ventilatory defect is moderately severe, based on
the post bronchodilator FEV1 % predicted of 50.
5. There is no significant response bronchodilator response.
o Moderately severe obstructive ventilatory defect with no significant
o Please correlate results with patients clinical data.
Diego Tigas, MD
APPENDIX B
Institution
Chinese General Hospital
Lung Center of the Philippines
Manila Doctors Hospital

Philippine Heart Center
St. Lukes Medical Center
UP- Philippine General Hospital

University of Santo Tomas Hospital
University of Perpetual-H. D.
Medical Center
Veterans Memorial Medical Center
Resource Person
Eden D. Chua, MD, FPCCP
Shirley C. Panganiban Chua, MD, FPCCP
Luisito F. Idolor, MD, FPCCP
Augusto S. Sablan, Jr. MD, FPCP
Araceli Pascual, RT
Dennis Teo, MD, FPCCP
Aileen M. David-Wang, MD, FPCCP
Rodolfo E. Tamse, MD, FPCCP
Irenee Faustina J. Casio, MD, FPCP
Myrna N. Baares,MD, FPCCP
Raphael Ryan R. Zantua, MD, FPCCP
Ma. Bella R. Siasoco, MD, FPCCP
Jubert P. Benedicto, MD, FPCCP
Tim S.Trinidad, MD, FPCCP
Apolonio G. Javier, JR., MD, FPCP
FPCCP
Ricardo M. Salonga, MD, FPCCP
Jose Edzel V. Tamayo, MD, FPCCP
Mary Leslee Tabi,RT
Nio Jessielito N. Doydora, MD
Eloisa S. De Guia, MD, FPCCP
APPENDIX C
-1-
PCCP Council on Diagnostics

Descriptive Survey Form for Use and Reporting of Spirometry
Name of Institution: ______________________________
Equipment used (type and model): ________________________________
Please encircle your appropriate response. (NA means not at all times).
DO YOU INCLUDE THE FOLLOWING DETAILS IN YOUR REPORT?
I.
Patient preparation
A.
Patient Details
1)
2)
Name of patient
Patient Identifier (e.g. Date of birth, personal PIN)
YES
YES
NO
NO
NA
NA
3)
4)
Gender of patient
Age of patient
YES
YES
NO
NO
NA
NA
5)
6)
Measured (not stated) Height

Estimated Height of a patient with limb deformity
YES
YES
NO
NO
NA
NA
7)
8)
Measured (not stated) weight

Race of patient
YES
YES
NO
NO
NA
NA
YES
YES
NO
NO
NA
NA
YES
NO
NA
YES
YES
NO
NO
NA
NA
YES
NO
NA
Short acting B agonist (SABA) salmeterol, albuterol, etc

Inhaled long acting B agonist (LABA) (Salmeterol, formoterol)
YES
YES
NO
NO
NA
NA
Oral bronchodilator (Salbutamol, formoterol, theophyllines

Inhaled steroids (Flumetasone, budesonide)
Oral corticosteroids (prednisone, methylprednisolone, dexamethasone)
Antileukotrienes (Zafirllukast, montilukast)
Acute IgE antagonist (omalizumab)
4) Time the above medications were last taken
5) History of following particular symptoms
Chest or abdominal pain of any cause
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
NA
NA
YES
YES
NO
NO
NA
NA
Dementia or confusional status

6) Position of the patient while performing the test
YES
YES
NO
NO
NA
NA
7) Use of restrictive clothing during test

8) History of doing particular activities immediately prior to test
YES
YES
NO
NO
NA
NA
YES
YES
NO
NO
NA
NA
9) Name of Referring physician

10) Vital signs of patient (BP, CR, RR) prior to test
B.
Patient Considerations
1) Symptoms of the patient

2) Smoking history
-
Duration of smoking (# of pack years)

Smoking status (Current or former)
# of years stopped
3) Medicines taken by patient
-
Oral or facial pain exacerbated by mouthpiece

Stress maintenance
Smoking within 1 hour

Alcohol intake within 4 hours
APPENDIX C
-
Performing vigorous exercise within 30 minutes

Eating large meals within 2 hours
II. Methods
A. Procedure
Do you perform the following for recording Forced Vital Capacity:
1) Check the spirometer calibration
2) Explain the test
3) Prepare the subject
a. Ask about: Smoking history
Recent illness
Medication use
Reason for test
b. Measure weight and height without shoes
4) Instruct and demonstrate the test to the subject, to include
a. Correct posture with head slightly elevated
b. Inhale rapidly and maximally
c. Position of the mouthpiece
d. Exhale with maximal force
5) Maneuvers proper (closed-circuit method)
a. Have subject assume the correct posture
b. Attack nose clip, place mouthpiece in month and close lips around the
mouthpiece
c. Inhale completely and rapidly with a pause of <1 sec at TLC
d. Exhale maximally for <6 sec until no more air can be expelled while
maintaining an upright posture
e. Repeat instructions as necessary
f. Coach vigorously
g. Repeat for a minimum of 3 trials. No more than eight trials
h. Check for acceptability
i. Check for reproducibility
6) Perform maneuver (open circuit method)
a. Have subject assume the correct posture
b. Attack nose clip
c. Inhale completely and rapidly with a pause of <1 sect at >LC
d. Place mouthpiece in mouth and close lips around mouthpiece
e. Repeat instructions as necessary
f. Coach vigorously
g. Repeat for a minimum of 3 trials. No more than eight trials
h. Check for acceptability
i. Check for reproducibility
Do you check for the following?
* Acceptability Criteria
a. Spirograms are free from artifacts
st
Cough during 1 sec of exhalation
Glottis closure
Early termination
Submaximal effort
Leaks
Obstructed mouthpiece
b. Test results have good starts
Extrapolated volume <5% of FVC or 0.15 L, whichever is greater

c. Test shows satisfactory exhalation
Duration of 6s (3s for children) or a plateau in the volume-time

curve or if the subject cannot continue to exhale
Reproducibility Criteria
a. After 3 acceptable spirograms have been obtained, do you apply the
following?
The 2 largest values of FVC must be within 0.150 L of each other
The 2 largest values of FEV1 must be within 0.150 L of each other

b. If both criteria are meet, conclude test series
c. If both criteria are not met, continue testing until ..
Both criteria are met

OR
A total of eight test have been performed
Subject can no longer continue

d. Save, as a minimum, 3 satisfactory maneuver
-2YES
YES
NO
NO
NA
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
YES
YES
NO
NO
NA
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
YES
YES
NO
NO
NA
NA
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
NA
NA
APPENDIX C
Do you select
The largest FVC, and largest FEV1 of the same curve
The average of FVC and FEV1 even if the dont come from the same
curve
The maneuver with the largest sum of FVC and FEV1

Aside from FEV1, FVC and FEV1/FVC
Do you routinely determine the following
a. FEV6
b. FEV1 / FEV6
c. FEV1 / VC
d. FEF 25-75%
e. PEF
f. Maximal expiratory flow-volume loop
g. MVV
III. Interpretation and Reporting

Are the following data included in you report?
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
21)
22)
Graphical representation of the best trial flow volume loop

Graphical representation of all trials flow volume loop
Graphical representation of best trials flow volume loop
Graphical representation of all trials flow volume loop
Super imposed (overlay) graphical representation of pre and
post bronchodilator best trial
Graphical representation of MVV maneuver of best trial
Reference equation used in predicted values (ex. Roa, Crapo,
Knudson, etc)
Predicted, actual and % predicted of FEV1/FVC
Predicted, actual and % predicted of FEV1
Predicted, actual and % predicted of FVC
Predicted, actual and % predicted of FEV6
Predicted, actual and % predicted of FEF25
Predicted, actual and % predicted of FEF25-75
Predicted, actual and % predicted of MIF 50
Predicted, actual and % predicted of MEF 50
Predicted, actual and % predicted of MIF 50/ MEF 50
MVV (error code)
Tabulation of serial PTT (if with previous spirometry)
Technologist comments
Name of results interpreter
In the interpretation of results are the comments on the following included

Quality of the test
Ventilatory pattern of flow volume loop
Parameters which are abnormal
Type of ventilatory defect (objective, restrictive or mixed)
Severity of ventilatory defect
Response to bronchodilators
Need for additional test (LV, DLCO, post bronchodilator test serial testing)
Clinical correlation with patients signs and symptoms
Need to correlate with clinical data
Please tick the appropriate box and fill up the blank if needed
1) Is the format of results released to patient different from what is interpreted
by the physician?
2) What reference equation is your laboratory test result interpreter using for
classifying the normality or abnormality of the measured parameters? If
using a foreign equation, kindly state the correction factor that your
laboratory is using?
-3YES
YES
YES
YES
NO
NO
NO
NO
NA
NA
NA
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
YES
NO
NA
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
YES
YES
NO
NO
NA
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
YES
YES
YES
YES
NO
NO
NO
NO
NA
NA
NA
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
NA
NA
NA
YES
NO
NA
YES
NO
NA
APPENDIX C
-4-
[ ] We are using _____________________________________________ with a

correction factor of ___________________________
3) Was the decision of your laboratory interpreter in choosing your reference
equation based on a local study that you had done in your institution?
4) Does your laboratory results interpreter use only one reference equation for
all the measured parameters? If no, kindly explain.
[ ] if no, we use the following reference equations __________________
_______________________________________________________________
_______________________________________________________________
___________________________________________________
5) When does your laboratory results interpreter classify the FEV1/FVC,
FEV1/FEV6 as abnormal?
[ ] < 0.7
[ ] < 80% of the predicted
[ ] < percentile of the normal range
6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory test results
interpreter use the other parameters routinely (example FEF 25-75, MIF
50, MEF 50, MIF 50/MEF 50. FEV1/PEF and FEV1/FEV6
[ ] If yes. Which parameters? __________________________________
__________________________________________________________
7) Are the criteria that your laboratory results interpreter uses for a positive
(significant/good) response to a bronchodilator as follows: an increase in
FEV1 or FVC 12% and 200 ml increase from baseline value?
[ ] If not, kindly state the criteria your laboratory uses. ____________
_______________________________________________________________
_______________________________________________________________
___________________________________________________
8) Does your laboratory test result interpreter, routinely comments on the
MVV?
9) The criteria for the classification of ventilatory dysfunction suggested by the
ATS/ERS are tabulated below. Does your laboratory test interpreter follow
this classification?
Mild
Moderate
Moderately severe
Severe
Very severe
YES
NO
NA
YES
NO
NA
YES
NO
NA
YES
NO
NA
YES
NO
NA
YES
NO
NA
YES
NO
NA
FEV1 % Predicted
> 70
60 69
50 59
35 49
< 39
IV. Quality Control

A. Laboratory Details
1) Name of laboratory
2) Address of laboratory
3) Phone number of laboratory
4) Name of technician who conducted the test
5) Date of procedure
6) Time of procedure
7) Room temperature at time of testing
8) Room atmospheric pressure at time of testing
9) Indication for procedure
10) Possible order for undertaking lung function tests
B. Personal Qualifications
1) Who interprets the result
a) Pulmonary fellow
b) Pulmonary function laboratory director
c) Pulmonary consultant on deck
d) Patients attending pulmonary consultant
PFT techniques and Procedures
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
APPENDIX C
2) Do you have a manual of procedure which contain
the following:
- Calibration procedure
- Test performance procedures
- Calculations
Criteria
- Reference values source
- Action to be taken when panic values are
observed
3) Do you have a record which documents the
following?
- Schedule of instrument calibration
( daily, weekly, monthly, quarterly, others )
- Problems encountered with the system
- Correction action required
- Systems hardware and software upgrades
- Record of anomalous events involving either
patients / subjects or technicians and result of
subsequent evaluation and responses to event
- Record of continuing education of personnel
- Record of results of evaluation and feedback
provided by medical director
- Schedule and procedures for routine
maintenance of all equipment in the facility
- Record of contact phonee numbers of
appropriate maintenance personnel for each
equipment used in the facility
4) Is there a protocol and frequency for calibration?
5) Is there a protocol for testing standard subjects
monthly to supplement spirometry, LV and diffusing
capacity?
6) Is there a schedule for specific quality control
procedures for each procedure done?
7) Are tolerance limits deprived for quality control
checks for each procedure?
8) Is there a plan for corrective action when tolerance
limits are exceeded?
9) Are standard subjects tested monthly?
10) Is there evidence of review by medical director or
head of pulmonary laboratory?
11) Are manuals available for:
- Equipments
- Policies
- Procedures
- Safety
12) Are these manuals readily accessible?
-5-
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
YES
NO
NA
YES
YES
YES
YES
NO
NO
NO
NO
NA
NA
NA
NA
YES
YES
NO
NO
NA
NA
YES
NO
NA
YES
NO
NA
YES
YES
NO
NO
NA
NA
YES
NO
NA
YES
NO
NA
YES
NO
NA
YES
YES
NO
NO
NA
NA
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
V. Hygiene and Infection Control

Do you perform the following precautions when performing spirometry?
1) Strict hand washing in between patients
2) Wearing gloves when handling body fluids
3) Require suspected potential active infection patients tested on an
isolation room or negative pressure room
4) Prepare testing rooms with filtration or UV decontamination device
5) Require patients with suspected infection airborne disease to wear
barrier protection
6) Require technicians to wear barrier protection
7) Flushing of air in a volume displacement spirometer at least 5x in
between subjects
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
YES
YES
NO
NO
NA
NA
YES
YES
NO
NO
NA
NA
APPENDIX C
8) Require potentially infected patients with airborne disease be tested at
end of day or week
9) Require use of disposable mouthpiece of disinfection of tubing or any
parts that come into direct contact with subjects
10) Do you use an open circuit technique? (open circuit means no
rebreathing through mouthpiece of through breathing tube)
If answer is YES:
a) Do you change the mouthpiece between patients?
b) Do you change the breathing tube between patients?
11) Do you use the closed circuit technique (closed circuit means subject
rebreaths into the mouthpiece or through breathing tube and
spirometer)? If answer is YES
a) Do you dispose of or disinfect the mouthpiece between patients?
b) Do you dispose of or disinfect the breathing tube between patients?
12) Do you use a flow sensing system in which no breathing tube is
interposed between subject and device?
a) Is the flow sensing element and interior tubing disinfected between
patients?
b) Is inspiration from the device avoided?
13) Do you use in-line bacterial filters? If answer is yes
a) Do you calibrate machine with the filters?
b) Do you discard the filter after use on a single subject?
c) Do you still do regular cleaning and disinfection despite the filters?
-6YES
NO
NA
YES
NO
NA
YES
NO
NA
YES
YES
YES
NO
NO
NO
NA
NA
NA
YES
YES
YES
NO
NO
NO
NA
NA
NA
YES
NO
NA
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NA
NA
NA
NA
NA
NA
Comments:
_____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____
Completed by:
Noted by:
______________________________
Name and Position
Laboratory
______________________________
Head of the Pulmonary
Appendix D Tally of Responses to the Survey Questions

1 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry
2
SLMC CGH
UST
UP-PGH
Vmax
Jaeger- Vmax Spectra
3 Equipment
4 Do you include the following details in your report (Are
information about the following noted?)
5 Patient Preparation
6 Patient Details
7 1) Name of patient
8 2) Patient identifier
9 3) Gender of patient
10 4) Age of patient
11 5) Measured height
12 6) Estimated Height of a patient with limb deformity
13 7) Measured weight
14 8) Race of patient
15 9) Name of referring physician
16 10) Vitas signs of patient (BP, CR, RR) prior to test
17 Patient Considerations
18 1) Symptoms of the patient
19 2) Smoking history
20
21
Smoking status (current or former)
22
# of years stopped
23 3) Medicines taken by patient
24
Short acting B agonist
25
Inhaled long acting B agonist
26
Oral bronchodilator
27
Inhaled steroids
28
Oral corticosteroids
29
Antileukotrienes
30
Anti-IgE antagonist
31 4) Time the above medications were last taken
32 5) History of the following particular symptoms
33
LCP
PHC
VMMC
UPHDMC MDH
Viasys
Vmax
Spectra
Microloop
Vmax
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Spectra
Master
Screen
22
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
YES
YES
YES
NO
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
NO
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
YES
YES
YES
YES
YES
NO
NO
NO
YES
YES
YES
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
NO
NA
NA
NA
NA
NA
NA
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NA
NO
YES
YES
NO
YES
YES
YES
YES

1
2
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry
SLMC CGH
UST
UP-PGH
YES
NO
NO
NO
Stress incontinence
NA
NO
NO
NO
YES
NO
NO
NO
YES YES
NO
YES
7) Use of restrictive clothing during the test
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Performing vigourous exercise within 30 mins
YES
NO
YES
YES
YES
NO
YES
NO
Methods
Procedure
Do you perform the following for recording FVC
YES YES
YES
YES
2) Explain the test
YES YES
YES
YES
Ask about: Smoking history
YES YES
YES
YES
Recent illness
YES YES
YES
YES
Medication use
YES YES
YES
YES
Reason for test
YES YES
YES
YES
Measure weight and height without shoes
YES YES
YES
YES
Correct posture
YES YES
YES
Inhale rapidly and maximally
YES YES
YES
YES
Position of the mouthpiece
YES YES
YES
YES
Exhale with maximal force
YES YES
YES
YES
Have subject assume the correct posture
YES YES
YES
YES
Attach nose clip, place mouthpiece in mouth and close lips
YES YES
YES
YES
around the mouthpiece
63
Inhale completely and rapidly with a pause of <1sec at TLC
YES YES
YES
YES
64
Exhale maximally for <6secs until no more air can be expelled
YES YES
YES
YES
while maintaining an upright posture
LCP
NO
NO
NO
NO
NO
PHC
NO
NO
NO
NO
NO
VMMC
YES
YES
YES
YES
YES
UPHDMC MDH
YES
YES
YES
YES
YES
YES
YES
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES

1
2
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
SLMC CGH
UST
UP-PGH
Repeat instructions as necessary
YES YES
YES
YES
Coach vigorously
YES YES
YES
YES
Repeat for a minimum of 3 trials. No more than 8 trials
YES YES
YES
YES
Check for acceptability
YES YES
YES
YES
Check for reproducibility
YES YES
YES
YES
YES YES
YES
YES
Attach nose clip
YES YES
YES
YES
YES YES
YES
YES
Place mouthpiece in mouth and close lips around mouthpiece
YES YES
YES
YES
YES YES
YES
YES
Coach vigorously
YES YES
YES
YES
YES YES
YES
YES
YES YES
YES
YES
YES YES
YES
YES
Do you check the following
Acceptability Criteria
a) Spirograms are free from artifacts
Cough during 1st second of exhalation
YES YES
YES
YES
Glottis closure
YES YES
YES
YES
Early termination
YES YES
YES
YES
Submaximal effort
YES YES
YES
YES
Leaks
YES YES
YES
YES
Obstructive mouthpiece
YES YES
YES
YES
b) Test results have good starts
Extrapolated volume <5% of FVC or 0.15L, whichever is greater YES YES
YES
YES
91 c) Test shows satisfactory exhalation

92
Duration of >= 6 secs or a plateau in the volume-time curve or if
the subject cannot continue to exhale
93 Reproducibility Criteria
94 a) After 3 acceptable spirograms have been obtained, do you apply
the following?
YES
YES
YES
YES
YES
YES
YES
YES
LCP
YES
YES
YES
YES
YES
PHC
YES
YES
YES
YES
YES
VMMC
YES
YES
YES
YES
YES
UPHDMC MDH
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
NA
NA
NA
NA
NA
NA
NA
NA
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
YES
YES
YES
YES
NA
YES
YES
YES
YES
YES
YES
YES
YES

2
SLMC CGH
UST
UP-PGH
95
The 2 largest values of FVC must be within 0.150L of each other YES YES
YES
YES
LCP
YES
PHC
YES
VMMC
YES
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
The 2 largest values of FEV1 must be within 0.150L of each

other
b) If both criteria are met, conclude test series
c) If both criteria are not met, continue testing until
Both criteria are met OR
A total of eight tests have been performed
d) Save, as a minimum, 3 satisfactory maneuvers
Do you select (SELECT ONE ONLY)
The largest FVC and the largest FEV1 of the same curve
The average of FVC and FEV1 even if they don't come from the
same curve
Aside from FEV1, FVC and FEV1/FVC, do you routinely determine
the following
Aside from FEV1, FVC and FEV1/FVC, do you routinely determine
the following
a) FEV6
b) FEV1/FEV6
e) PEF
g) MVV
Are the following data included in your report?
1) Graphical representation of the best trial flow volume loop
2) Graphical representation of all trials flow volume loop
3) Graphical representation of best trials flow volume loop (SAME
AS #1)
3) Superimposed (overlay) graphical representation of pre and post
bronchodilator best trial
UPHDMC MDH
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
*
YES
NA
YES
YES
YES
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
NA
NO
NO
YES
NO
YES
YES
NO
NO
YES
YES
NO
NO
YES
YES
NO
NO
YES
YES
NO
NO
YES
YES
YES
NO
YES
YES
NO
NO
YES
YES
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
NO
YES
NO
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES

2
SLMC CGH
UST
UP-PGH LCP
121 4) Graphical representation of MVV maneuver of best trial
YES YES
YES
YES
YES
122 5) Reference equation used in predicted values (ex. Roa, Crapo,
YES YES
YES
NO
Knudson, etc)
123 6) Predicted, actual and % predicted of FEV1/FVC
YES YES
YES
YES
YES
124 7) Predicted, actual and % predicted of FEV1
YES YES
YES
YES
YES
125 8) Predicted, actual and % predicted of FVC
YES YES
YES
YES
YES
126 11) Predicted, actual and % predicted of FEF50
YES YES
YES
YES
127 12) Predicted, actual and % predicted of FEF75
YES YES
YES
YES
YES
128 13) Predicted, actual and % predicted of FEF25-75
YES YES
YES
YES
YES
129 14) Predicted, actual and % predicted of MIF50
YES YES
NO
YES
NO
130 15) Predicted, actual and % predicted of MEF50
YES YES
NO
NO
NO
131 16) Predicted, actual and % predicted of MIF50/MEF50
132 17) MVV (error code)
YES YES
YES
YES
YES
133 18) Tabulation of serial PTT (if with previous spirometry)
NO
NO
NO
NO
YES
134 In the interpretation of results are the comments on the following
included
135
Quality of test
YES
YES
YES
YES
136
YES YES
YES
YES
YES
137
Parameters which are abnormal
YES YES
YES
YES
YES
138
Type of ventilatory defect (obstructive, restrictive or mixed)
YES YES
YES
YES
YES
139
Severity of ventilatory defect
YES YES
YES
YES
YES
140
Resonse to bronchodilators
YES YES
YES
YES
YES
141
Need for additional test (LV, DLCO, postbronchodilator test
YES YES
YES
YES
YES
serial testing)
142
Clinical correlation with patients signs and symptoms
YES YES
NO
YES
NA
143
Need to correlate with clinical data
YES YES
YES
YES
NA
144 Please tick the appropriate box and fill up the blank if needed
145 1) Is the format of results released to patient different from what is
NO
NO
NO
NO
NO
interpreted by the physician?
Morris
ECCS
Morris
146 2) What reference equation is your laboratory test result interpreter Morris Morris
Polgar Polgar
Polgar
Polgar
using for classifying the normality or abnormality of the measured
parameters? If using a foreign equation, kindly state the correction
factor that your laboratory is using?
PHC
NO
YES
VMMC
YES
YES
UPHDMC MDH
NO
YES
YES
YES
YES
YES
NO
NO
YES
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
NA
NA
NA
NA
NA
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
ATS,
GOLD
NHANES,
0.88 OF
ABS
VALUE
ATS
Morris
Polgar
YES
NO

2
SLMC CGH
UST
UP-PGH
NO
NA
NO
YES
147 3) Was the decision of your laboratory interpreter in choosing your
reference equation based on a local study that you had done in
your institution?
148 4) Does your laboratory results interpreter use only one reference
YES YES
YES
YES
equation for all the measured parameters? If no, kindly explain.
149 5) When does your laboratory results interpreter classify the
FEV1/FVC, FEV1/FEV6 as abnormal?
150
<0.7
YES
151
<80% of predicted
152
< percentile of the normal range
153 6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory YES
test results interpreter use the "other parameters" routinely?
154 7) Is the criteria that your laboratory results interpreter uses for a
positive response to a bronchodilator as follows: an increase in
FEV1 or FVC >= 12% and 200 ml increase from baseline value
155 8) Does your laboratory test result interpreter routinely comment on
the MVV?
156 8) Does your laboratory test result interpreter routinely comment on
the MVV?
157 9) Is the criteria for the classification of ventilatory dysfunction
suggested by the ATS/ERS followed by your laboratory test
interpreter?
158 Quality Control
159 Laboratory Details
160 1) Name of laboratory
161 2) Address of laboratory
162 3) Phone number of laboratory
163 4) Name of techinican who conducted the test
164 5) Date of procedure
YES YES (0.75)

YES
LCP
NO
PHC
NO
VMMC
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
FEF25- FEF 25- FEF25- FEF 2575
75
75,
75, PEF,
FEF75FEF25,
85, FEF
FEF50,
200-1200
FEF75
YES
YES
YES
YES
UPHDMC MDH
NO
NO
YES
YES
YES
YES
NO
NO
YES
YES
YES
NO
YES
YES
YES
YES
YES
NO
NO
NA
NO
NO
NA
YES
YES
YES
NO
NO
NA
NO
NO
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES

1
2
165
166
167
168
169
170
171
172
173
174
175
SLMC CGH
UST
UP-PGH
6) Time of procedure
YES YES
YES
YES
7) Room temperature at time of testing
YES YES
YES
YES
8) Room atmospheric pressure at time of testing
YES YES
YES
YES
10) Possible sequence for undertaking lung function tests
YES YES
YES
Pulmonary fellow
YES YES
YES
YES
Pulmonary function laboratory director
NA
NO
YES
Pulmonary consultant on deck
YES YES
YES
YES
Patient's attending pulmonary consultant
YES YES
YES
YES
PFT Techniques and Procedures
2) Do you have a manual of procedure which contain the following
176
Calibration procedure
177
Test performance procedures
178
Calculations
179
Criteria
180
Reference values source
181
Action to be taken when "panic" values are observed
182 3) Do you have a record which documents the following
183
Schedule of instrument calibration
184
Problems encountered with the system
185
Correction action required
186
Systems hardware and software upgrades
187
Record of anomalous events involving either patients/subjects or
technicians and result of subsequent evaluation and responses to
event
188
Record of continuing eduction of personnel
189
Record of results of evaluation and feedback provided by
medical director
190
Schedule and procedures for routine maintenance of all
equipment in the facility
191
Record of contact phone numbers of appropriate maintenance
of all equipment in the facility
LCP
YES
NO
NO
YES
PHC
NO
NO
NO
NO
VMMC
YES
YES
NA
YES
UPHDMC MDH
YES
YES
YES
YES
NO
YES
YES
NO
YES
NO
YES
YES
NO
YES
NO
YES
YES
YES
YES
YES
NA
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
NO
YES
YES
YES
NO
YES
NO
NO
YES
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
YES
NO
NO
YES
YES
YES
YES
YES
NO
YES
NO
YES
NA
YES
YES
YES
YES
NO
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES

2
SLMC CGH
UST
UP-PGH
192 4) Is there a protocol and frequency for calibration?
YES YES
YES
YES
193 5) Is there a protocol for testing standard subjects monthly to
YES YES
NO
YES
supplement spirometry, LV and diffusing capacity?
194 6) Is there a schedule for specific quality control procedures for
YES YES
NO
YES
each procedure done?
195 7) Are tolerance limits derived for quality control checks for each
YES YES
NO
YES
procedure?
196 8) Is there a plan for corrective action when tolerance limits are
YES YES
NO
YES
exceeded?
197 9) Are standard subjects tested monthly?
YES
NO
YES
YES
198 10) Is there evidence of review by medical director or head of
NO
YES
NO
YES
pulmonary laboratory?
199 11) Are manuals available for
200
Equipments
YES YES
YES
YES
201
Policies
YES YES
YES
YES
202
Procedures
YES YES
YES
YES
203
Safety
YES YES
YES
YES
204 12) Are these manuals readily accessible?
YES YES
YES
YES
205 Hygine and Infection Control
206 Do you perform the following precautions when performing
spirometry?
207 1) Strict handwashing in between patients
YES YES
YES
YES
208 2) Wearing gloves by the technician when handling body fluids and YES YES
YES
YES
equipment
209 3) Require suspected potential active infection patients tested on an YES
NO
NO
YES
isolation room or negative pressure room
210 4) Prepare testing rooms with filtration or UV decontamination
NO
NO
NO
device
211 5) Require patients with suspected infectious airborne disease to
YES
NO
NO
YES
wear barrier protection
212 6) Require technicians to wear barrier protection
YES
NO
YES
YES
213 7) Flushing of air in a volume displacement spirometer at least 5x in YES
NO
NO
NO
between subjects
LCP
YES
YES
PHC
YES
NA
VMMC
YES
YES
UPHDMC MDH
NA
YES
NA
YES
YES
NO
YES
NA
YES
YES
YES
NO
NA
YES
YES
YES
NO
NA
YES
NA
YES
NO
NO
YES
YES
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
NO
NA
YES
YES
NO
NO
NO
NA
YES
YES
YES
NA
NA
YES
YES
YES
YES
YES
YES
NO
YES
NA
YES
YES

2
SLMC CGH
UST
UP-PGH
214 8) Require potentially infected patients with airborne disease to be
YES
NO
YES
YES
tested at the end of the day or week
215 9) Require use of disposable mouthpiece of disinfection of tubing or YES YES
YES
YES
any parts that come into direct contact with subjects
216 10) Do you use an open circuit technique? If yes,
YES
YES
217
Do you change the mouthpiece between patients?
YES YES
YES
YES
218
Do you change the breathing tube between patients?
NO
NO
YES
NO
219 11) Do you use the closed circuit technique? If yes,
YES YES
220
Do you dispose of or disinfect the mouthpiece between
YES YES
YES
YES
patients?
221
Do you dispose of or disinfect the breathing tube between
NO
NO
NO
NO
patients?
222 12) Do you use a flow sensing system in which no breathing tube is YES
NO
YES
interposed between subject and device?
223
Is the flow sensing element and interior tubing disinfected
NO
YES
NO
YES
between patients?
224
Is inspiration from the device avoided?
YES YES
NO
NO
225 13) Do you use in-line bacterial filters? If yes,
YES YES
YES
YES
226
Do you calibrate machine with the filters?
NO
NO
NO
YES
227
Do you discard the filter after use on a single patient?
YES YES
YES
NO
228
Do you still do regular cleaning and disinfection despite the
YES YES
YES
YES
filters?
LCP
YES
PHC
NA
VMMC
NA
UPHDMC MDH
NA
YES
YES
YES
YES
NO
NO
YES
YES
NO
YES
NO
YES
YES
YES
YES
YES
NO
YES
YES
NO
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
NO
YES
YES
YES
YES
YES
YES
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
NA
YES
YES
YES
YES
YES
YES
Appendix E Tally of Responses to the Survey Questions Rearranged

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Parameter
2) Explain the test
Ask about: Smoking history
Recent illness
Medication use
Reason for test
Correct posture
Inhale rapidly and maximally
Position of the mouthpiece
Exhale with maximal force
Attach nose clip, place mouthpiece in mouth and close lips around
the mouthpiece
Exhale maximally for <6secs until no more air can be expelled while
maintaining an upright posture
Coach vigorously
Attach nose clip
Place mouthpiece in mouth and close lips around mouthpiece
Coach vigorously
SLMC CGH
UST
UP-PGH LCP
PHC
VMMC
UPHDMC MDH
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
NA
NA
NA
NA
NA
NA
NO
NO
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES

1
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
Parameter
Do you check the following
Acceptability Criteria
a) Spirograms are free from artifacts
Cough during 1st second of exhalation
Glottis closure
Early termination
Submaximal effort
Leaks
Obstructive mouthpiece
b) Test results have good starts
Extrapolated volume <5% of FVC or 0.15L, whichever is greater
c) Test shows satisfactory exhalation
Duration of >= 6 secs or a plateau in the volume-time curve or if the
subject cannot continue to exhale
Reproducibility Criteria
a) After 3 acceptable spirograms have been obtained, do you apply the
following?
The 2 largest values of FVC must be within 0.150L of each other
The 2 largest values of FEV1 must be within 0.150L of each other
b) If both criteria are met, conclude test series
c) If both criteria are not met, continue testing until
Both criteria are met OR
A total of eight tests have been performed
d) Save, as a minimum, 3 satisfactory maneuvers
Pulmonary fellow
Pulmonary consultant on deck
Pulmonary function laboratory director
SLMC CGH
YES YES
YES YES
UST
YES
YES
UP-PGH LCP
YES
NA
YES
NA
PHC
NO
NO
VMMC
YES
YES
UPHDMC MDH
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
*
YES
NA
YES
YES
YES
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
NO
YES
YES
YES
YES
YES
NA
YES
YES
YES

1
65
66
67
68
69
Parameter
3) Do you have a record which documents the following
Schedule of instrument calibration
Problems encountered with the system
Record of anomalous events involving either patients/subjects or
technicians and result of subsequent evaluation and responses to event
70
Record of results of evaluation and feedback provided by medical

director
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91

6) Predicted, actual and % predicted of FEV1/FVC
8) Predicted, actual and % predicted of FVC
7) Predicted, actual and % predicted of FEV1
13) Predicted, actual and % predicted of FEF25-75
Aside from FEV1, FVC and FEV1/FVC, do you routinely determine the
following
e) PEF
g) MVV
11) Predicted, actual and % predicted of FEF50
12) Predicted, actual and % predicted of FEF75
Aside from FEV1, FVC and FEV1/FVC, do you routinely determine the
following
14) Predicted, actual and % predicted of MIF50
15) Predicted, actual and % predicted of MEF50
16) Predicted, actual and % predicted of MIF50/MEF50
a) FEV6
b) FEV1/FEV6
SLMC CGH UST

YES YES
YES
UP-PGH LCP
YES
YES
PHC
YES
VMMC
YES
UPHDMC MDH
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
NO
YES
YES
YES
NO
NO
NO
YES
YES
YES
YES
YES
YES
NO
YES
NO
YES
YES
NO
NO
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NA
NA
NA
YES
YES
NO
NO
YES
NO
NO
NO
NO
YES
NO
NO
NO

1
92
93
94
95
96
97
Parameter
SLMC CGH
6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory test YES YES
results interpreter use the "other parameters" routinely?

Do you select (SELECT ONE ONLY)
The largest FVC and the largest FEV1 of the same curve
The average of FVC and FEV1 even if they don't come from the
same curve
UST
NO
UP-PGH LCP
PHC
VMMC
FEF25- FEF 25- FEF25- FEF 2575
75,
75, PEF, 75
FEF75FEF25,
85, FEF
FEF50,
200-1200
FEF75
UPHDMC MDH
NO
NO
YES
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
YES
NO
NO
YES
98
YES
99
100 6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory test YES
results interpreter use the "other parameters" routinely?
YES
YES
YES
NA
NO
NO
YES
NO
FEF25- FEF 2575, PEF, 75

FEF25,
FEF50,
FEF75
FEF25- FEF 2575

75,
FEF7585, FEF
200-1200
NO
NO
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
NO
YES
NO
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
101
included
103
104
105 Are the following data included in your report?
106 1) Graphical representation of the best trial flow volume loop
107 2) Graphical representation of all trials flow volume loop
108
included
110 9) Is the criteria for the classification of ventilatory dysfunction
suggested by the ATS/ERS followed by your laboratory test interpreter?
111
YES
YES
YES

1
Parameter
112 5) When does your laboratory results interpreter classify the
FEV1/FVC, FEV1/FEV6 as abnormal?
113
<0.7
114
<80% of predicted
115
< percentile of the normal range
116
117 7) Is the criteria that your laboratory results interpreter uses for a
positive response to a bronchodilator as follows: an increase in FEV1 or
FVC >= 12% and 200 ml increase from baseline value
118
included
120
Need for additional test (LV, DLCO, postbronchodilator test serial
testing)
121
122 2) What reference equation is your laboratory test result interpreter
using for classifying the normality or abnormality of the measured
parameters? If using a foreign equation, kindly state the correction
factor that your laboratory is using?
123 3) Was the decision of your laboratory interpreter in choosing your
reference equation based on a local study that you had done in your
institution?
124
included
126
Quality of test
127
128 Do you include the following details in your report (Are information
about the following noted?)
129 Patient Details
130 1) Name of patient
131 2) Patient identifier
132 3) Gender of patient
133 4) Age of patient
SLMC CGH
UST
PHC
VMMC
UPHDMC MDH
YES
YES
YES
YES (0.75) YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Morris Morris Morris

Polgar Polgar Polgar
ECCS
Morris
Polgar
ATS,
GOLD
NO
NO
YES
YES
YES
YES
UP-PGH LCP
NA
NO
YES
NO
NO
NHANES, ATS
0.88 OF
ABS
VALUE
NO
NO
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Morris
Polgar

1
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
Parameter
5) Measured height
6) Estimated Height of a patient with limb deformity
7) Measured weight
8) Race of patient
9) Name of referring physician
10) Vitas signs of patient (BP, CR, RR) prior to test
Patient Considerations
1) Symptoms of the patient
2) Smoking history
Smoking status (current or former)
# of years stopped
3) Medicines taken by patient
Short acting B agonist
Inhaled long acting B agonist
Oral bronchodilator
Inhaled steroids
Oral corticosteroids
Antileukotrienes
Anti-IgE antagonist
4) Time the above medications were last taken
5) History of the following particular symptoms
Stress incontinence
7) Use of restrictive clothing during the test
Performing vigourous exercise within 30 mins
SLMC
YES
YES
YES
YES
YES
NO
CGH
YES
YES
YES
YES
YES
NO
UST
YES
YES
YES
YES
YES
NO
UP-PGH
YES
YES
YES
YES
YES
NO
LCP
YES
YES
YES
YES
YES
NA
PHC
YES
NO
YES
YES
YES
NO
VMMC
YES
YES
YES
YES
YES
YES
UPHDMC
YES
YES
YES
YES
YES
YES
MDH
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
NO
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NA
YES
YES
YES
YES
YES
NO
NO
NO
YES
YES
YES
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
YES
NO
YES
YES
YES
YES
YES
YES
YES
YES
NO
NA
NA
NA
NA
NA
NA
NA
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NA
YES
NA
YES
YES
YES
NO
NO
NO
NO
YES
NO
YES
NO
NO
NO
NO
YES
YES
NO
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
YES
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
YES
YES
YES
YES
NO
NO
NO
NO
YES
YES
YES
YES
NO
NO
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Appendix F: Sample PFT reports from PCCP PFTI
APPENDIX G
Terms Used by PCCP-PFTI in the Interpretation of Spirometry Results
1
Chinese General Hospital

Normal
Comments:
Patient performed the test maximally on standing position.
Nebulization of 5 cc distilled water was given for modified
bronchoprovocation test
Interpretation
Normal spirometry study
Bronchoprovocation showed no reduction in post FEV1 values
Probable Restrictive Ventilatory Defect
Comments
1 neb of ventolin was given for post bronchodilator test
Interpretation
Normal FEV1/FVC and FEV1.
Decreased FVC.
There is probable restriction. Suggest lung volume studies if clinically
indicated.
There is no significant response to bronchodilator.
Please correlate clinically.
Obstructive with probable Restrictive Ventilatory Defect
Comments
1 neb of ventolin was given for post bronchodilator test
Interpretation
There is moderate obstructive lung defect with significant response to
bronchodilator.
FVC is reduced probably due to obstructive defect and/ or restrictive lung
defect. Suggest lung volume studies if clinically indicated.
Lung Center of the Philippines

Normal
Comments and Interpretation
Normal spirometry
Obstructive Ventilatory Defect
Spirometry shows a severe obstructive ventilatory pattern with significant
Spirometry shows a mild restrictive ventilatory pattern.
Spirometry shows severe obstructive ventilatory pattern with significant
bronchodilator response with moderate restrictive ventilatory pattern.
Suggest post bronchodilator and lung volume studies.
Manila Doctors Medical Center
Normal
Comments:
FVC and FV1 are normal; FEV1/ FVC ratio is normal
There is no acute bronchodilator response
Able to do 6 seconds test. MVV is normal.
Interpretation:
PFT suggest normal ventilatory pattern
There is no significant bronchodilator response
APPENDIX G

Comments
FVC, FEV1 and FEV1/FVC ratio are decreased. Normal MVV
No airway resistance exam done. DLCO is decreased
There is significant bronchodilator response.
Interpretation
PFT showed severe obstructive ventilatory pattern with significant
bronchodilator response.
There is mild diffusion limitation to CO.
Suggest lung volume study if clinically indicated.
Comments
Spirometry shows low FEB1 and FVC while FEV1/FVC ratio, MVV and
flow rates are within normal range.
There is no significant acute bronchodilator response noted.
Lung volume shows low TLC and RV, DLCO is normal.
Interpretation
PFY is consistent with moderate restrictive ventilatory pattern with normal
DLCO.
St. Lukes Medical Center Quezon City
Normal
Comments & Interpretation
Normal Spirometric Study
There is a mild obstructive lung defect
Suggest post-bronchodilator study if clinically indicated.
There is no obstructive lung defect.
Post-bronchodilator study showed a 22% improvement in the FEF25-75
Please correlate clinically
There is moderate obstructive lung defect with significant response to
bronchodilator.
FVC is reduced probably due to underlying obstructive lung defect and or
concomitant restrictive defect. Suggest lung volume study if clinically
indicated.
University of Philippines- Philippine General Hospital
Normal
Comments and Findings
The FEV1/FVC, FEV1, FVC, FEF 25-75 values are within normal limits.
There is no scooping of the expiratory curve.
There is no acute bronchodilator response
Interpretation & Recommendation
Normal Spirometry Findings
The FEV1/FVC, FEF 25-75, FEV1, FVC values are low.
There is scooping of the expiratory curve
There is an acute bronchodilator response
Spirometric findings are consistent with a severe obstructive ventilatory
defect with acute bronchodilator response.
In view of the smoking history of the patient, he maybe labeled at risk for
COPD.
APPENDIX G

The FEV1/FVC is normal
FEV1& FVC values are low.
There is no significant acute bronchodilator effect.
There is no scooping in the expiratory curve.
Spirometric findings are consistent with a moderate restriction in the
volume expansion of the lungs.
Suggest total lung volume studies with DLCO and or clinical correlation for
further evaluation especially if a restrictive lung disease secondary to ILD
is considered.
Philippine Heart Center
Normal
Normal spirometry study
Obstructive Ventilatory Defect (To be submitted)
FEV1/FVC ratio is normal. FEV1 and FVC are reduced indicative of mild
restriction of the volume excursion of the lung.
FEV1/FVC ratio, FEV1 and FVC are low indicative of severe obstructive
lung defect.
Post-bronchodilator study showed no significant reversibility.
FVC is reduced probably due to underlying obstructive defect and/ or
concomitant restrictive lung defect. Suggest lung volume studies if clinical
indicated.
University of Perpetual Health Medical Center
Normal
Interpretation
Normal Spirometry
Interpretation
Severe obstructive ventilatory pattern with significant post bronchodilator
response.
Interpretation
Restrictive Ventilatory Pattern
Please Correlate Clinically
Suggest Body Phlethysmography
Interpretation
Combined restrictive and obstructive ventilatory pattern due to low FVC
and FEF25-75 in the background of inadequate of expiratory maneuver
Suggest body phlethysmography.
Veterans Memorial Medical Center
Normal
FEV1/FVC is normal. FEV1 is normal. FVC is normal.
FEV1 has no significant improvement after bronchodilator administration.
FVC has no significant improvement after bronchodilator administration.
Normal Spirometric Studies
APPENDIX G

FEV1/FVC is low. FEV1 is low and there is an exaggerated concavity in
the distal portion of the expiratory limb.
FVC is low. FEV1 has significant improvement after bronchodilator
administration. FVC has no significant improvement after post
bronchodilator studies. These findings are suggestive of Moderately
Obstructive Ventilatory Defect. Post bronchodilator study showed a
significant degree of reversibility.
FEV/FVC is normal. FEV1 is normal. FVC is low. FEV1 has no significant
improvement after bronchodilator administration. FVC has no significant
improvement after bronchodilator administration.
These findings are suggestive of a restrictive ventilatory impairment
For lung volume studies if clinically indicated
University of Santo Tomas Hospital
Normal
Interpretation
Based on FEV1/FVC, FEV1, FVC there is no ventilatory defect
The predicted values are based on Morris and Polgar. Kindly correlate
clinically.
Interpretation
Based on a low FEV1/FVC and FEV1, there is a severe obstructive
ventilatory defect.
Based on a 51% change in FEV1, there is a good response to
bronchodilator
The predicted values are based on Morris and Polgar. Kindly correlate
clinically.
Interpretations
Based on the FEV1/FVC ratio there is no obstructive ventilatory defect.
The FVC is low which maybe due to a restrictive ventilatory defect. For
verification, we suggest lung volume studies.
The predicted values are based on Morris Polgar. Kindly correlate with
clinical data.
Based on the low FEV1/FVC and FEV1, there is a moderately severe
obstructive ventilatory defect. Based on the 12% (120ml) change in FEV1,
there is a poor response to bronchodilator. The FVC is low which maybe
due to a concomitant restrictive ventilatory defect or RV hyperinflation. To
verify the cause of the low FVC we suggest a lung volume study. The
predicted values are based on Morris Polgar. Kindly correlate with clinical
data.
APPENDIX H
Definition of Terms/ Abbreviations
Definition of Terms
Closed Circuit Method Spirometry Testing: method of conducting spirometry

wherein the volume is measured indirectly by a device which either measure
a pressure drop across a fixed resistance or flow via means of a propeller.
Most Reliable Spirometry Parameters (MRSP): refers to the spirometry
parameters used in the American Thoracic Society European Respiratory
Society Task Force on Lung Function Testing suggested algorithm for the
interpretation of lung function testing. These parameters are FEV1/FVC,
FEV1 and FVC.
Open Circuit Method Spirometry Testing: method of conducting spirometry
wherein the volume is measured by a wedge bellows, bell, water seal or
rolling seal cylinder/ piston.
Other Spirometry Parameters (OSP): refers the spirometry parameters not
used in the American Thoracic Society European Respiratory Society Task
Force on Lung Function Testing suggested algorithm for the interpretation of
lung function testing. These parameters are FEV1/FVC, FEV1 and FVC.
Simple spirometry: a type spirometry testing wherein only a prebronchodilator study is done.
Spirometry with post-bronchodilator study: a type of spirometry testing
wherein a pre-bronchodilator and post bronchodilator study is done.
Abbreviations
ATS-ERS-TFLFT: American Thoracic Society Task Force on Lung Function

Testing
CAO: Central airway obstruction
DATS: Philippine College of Chest Physician Council on Diagnostics and
Therapeutic
FEV1: Forced expiratory volume in one second
FEF 25-75: Mean forced expiratory flow between 25% and 75% of FVC
FEF50: Instantaneous expiratory flow when 50% of the FVC has been
expired
FEF75: Instantaneous expiratory flow when 75% of the FVC has been
expired
FVC: Forced vital capacity
FVC6: Forced expiratory volume in 6 seconds
MIF50: Maximum inspiratory flow at 50% of the FVC
MEF50: Maximum expiratory flow at 50% of the FVC
MRSP: Most reliable spirometry parameters
MVV: Maximum voluntary ventilation
OSP: Other spirometry parameters
PCCP PFTI: Philippine College of Chest Physicians Pulmonary Fellowship
Training Institution
PEF: Peak expiratory flow
PEFR: Peak expiratory flow rate
UAO: Upper airway obstruction
Appendix I
Procedural Steps for Spirometry testing
(using closed circuit method)
o
o
o
o
o
o
o
o
o
Calibrate the spirometer and record

Explain the test
Secure a written consent
Answer the PCCP Spirometry Testing Information Sheet (Appendix J)
Wash hands
Instruct and demonstrate the test to the subject, this includes
Proper posture
Rapid and complete inhalation
Proper use of mouthpiece
Rapid and maximally forceful expiration
Perform maneuver
Assist the to assume the correct posture
Attach the nose clip
Place the mouthpiece and ask patient to close lips around the
mouthpiece
Ask the patient to inhale completely and rapidly with a pause of 0.1 s at
TLC
Instruct the patient to exhale maximally until no more air can be expelled
while maintaining an upright posture
Repeat instructions as necessary, coaching vigorously
Repeat the test until any of the following
The reproducibility criteria is met (see below)
The patient cannot continue
A maximum of 8 maneuvers is obtained
Save at least the best 3 spirograms
Completes the answering of the PCCP Spirometry Testing information sheet
Spirogram Reproducibility Criteria
There is at least 3 acceptable spirogram
The two largest values of FVC are within 0.150 L of each other
The two largest values of FEV1 are within 0.150 L of each other
Spirogram Acceptability Criteria
o It is free from artifacts
Cough during the first second of exhalation
Glottis closure that influences the measurement
Early termination or cut-off
Effort that is not maximal throughout
Leak
Obstructed mouthpiece
o It shows a good start
Extrapolated volume 0.5% of FVC or 0.15 L, whichever is greater
o It shows satisfactory exhalation
Duration of 6 seconds
A plateau in the volumetime curve
APPENDIX J
PCCP Council of Diagnostic & Therapeutic Spirometry Testing Information Sheet
1. Name: __________________________________Age: _________
2. Gender: _________ Height: ____________ Weight: ______________
3. Race of patient: ___________________
4. Date of procedure: _________________Time of procedure: ___________
5. Room temperature: __________Atmospheric pressure: _________
6. Name of referring physician: __________________________
7. Smoking History: Status (Never, Current or Previous): __________________
Pack years: __________________ Last Intake: __________________
8. Working Diagnosis/ Reason for Testing: ____________________
9. Date of Previous Spirometry Testing: _________________
10. Conditions that may influence the results (Place a check if present or x if absent)
Chest or abdominal pain of any

cause
Oral or facial pain exacerbated
by mouthpiece
Stress incontinence
Non standing position of the
patient while performing the test
Use of restrictive clothing during

the test
Alcohol/ Caffeinated drink intake
within 4 hours prior to testing
Vigorous exercise within 30 mins
prior to testing
Eating large meals within 2
hours prior to testing
11. Intake of the following respiratory drugs prior to testing

Medicine
Trade Name
Dosage
Last Intake (Hours prior to testing)
Salbutamol
Terbutaline
Formoterol
Indacaterol
Salmeterol
Ipratropium Bromide
Tioptropium
Methylxanthines
Formoterol/
Budesonide
Salmeterol/
Fluticasone
Oral Steroid
Roflumilast
Please use the back page for additional listing of medicines if needed
12. Were the ATS/ERS reproducible criteria satisfied? _________________________

_____________________________________________________________________
Appendix K: Forms Used for Voting of the Statements/ Recommendations - 1 Name of Institution/ Chapter/ Key Opinion Leader: ____________________________
Name of Person Answering in behalf of Institution/ Chapter: ____________________
For each of the 51 recommendations, kindly write the letter corresponding to your answer/
vote. The choices are
A. We disagree with the recommendation.
B. We agree with recommendation and are, in fact, already instituting this.
C. We agree with the recommendation, and we will institute measures to implement
this.
D. We agree with the recommendation but will have a hard time implementing this in the
near future.
_____ 1
(R1-1) Spirometry testing using the closed circuit technique should be

performed based on the standards set by the ATS-ERS-TFLFT (1). Part of the
procedure includes the answering of the PCCP DATS Spirometry Testing
Information Sheet. Kindly see appendix I & J.
_____ 2
(R1-2) A referring physician can either request any of the following types of
spirometry testing: simple spirometry, spirometry with post bronchodilator study
and simple spirometry study with possible post bronchodilator study if initial
result is abnormal
_____ 3
(R1-3) In a situation wherein the referring physician requested only a simple

spirometry and it showed abnormal results, the technician in coordination with
doctor (interpreter of the results) should try to ask permission from the
referring physician to proceed in performing a post bronchodilator study while
the patient is still in the test site.
_____ 4
(R2-1) Daily instrument calibration should be done.
_____ 5
(R2-2) The interpreter (lab medical director or pulmonary consultant on deck)

should give a feedback to the technician with regards the quality of the test.
_____ 6
(R2-3) A log book should be maintained. It should contain the following: daily
calibration results, anomalous events or problems encountered with the system
and feedback of the interpreter to the technician.
_____ 7
(R3-1) The following should be measured and reported FEV1/ FVC, FVC and
FEV1.
_____ 8
(R3-2) If the spirometry machine is capable, the following should be measured

and reported (in order of decreasing importance): PEFR, FEF 25-75, FEF 75,
MIF50/ MEF50, FEV1/FV6, MVV, MIF 50, MEF 50, FEV6, FEF 25 and FEF 50
_____ 9
(R4-1) Test result selection should be based on the recommendations set by

the ATS-ERS-TFLFT (1).
_____ 10
(R5-1) In the spirometry report, there should be 3 sections for the interpretation
of the results: technicians comments, interpreters comments and final
interpretation.
_____ 11
(R5-2) There is no need to give a clinical correlation.
Appendix K: Forms Used for Voting of the Statements/ Recommendations - 2 -
For each of the 51 recommendations, kindly write the letter corresponding to your answer/
this.
near future.
_____ 12
(R6-1) The spirometry report should contain a section on general data which
contains the following information: name of patient, age of patient, gender of
patient, measured height, measured weight, race of patient, date of procedure,
time of procedure, room temperature at time of testing, room atmospheric
pressure at time of testing, name of referring physician, name of the laboratory
and phone number of laboratory
_____ 13
(R7-1) The report should contain a section for technician comments.
_____ 14
(R7-2) The technician comments should state if the test done satisfies the
ATS-ERS-TFLFT (1) reproducibility criteria. If not, it should state which of the
criteria was not satisfied.
_____ 15
(R7-3) The technician comments should state if conditions that may alter the
results are present or not.
_____ 16
(R7-4) Technician comments should state if the patient is on respiratory drug

and if so when was the last intake.
_____ 17
(R7-5) Technician comments should state the patients smoking history

particular the pack years and the last time when the patient smoked cigarettes.
_____ 18
(R8-1) In the interpretation of the results, the report should use the phrase
ventilatory defect (not lung defect or ventilatory pattern).
_____ 19
(R9-1) Spirometry results should be interpreted based on the ATS-ERS-TFLFT

suggested algorithm.
_____ 20
(R10-1) The best trial flow volume (pre and post-bronchodilator if done) should
be part of the spirometry report.
_____ 21
(R10-2) In cases of possible upper airway obstruction interpretation, all trials

flow volume loop should be reported. If the spirometry software is not capable,
reproducibility of the flow volume loop should be mentioned in the interpreters
comments.
_____ 22
(R10-3) Slowing down of the terminal portion of spirogram should be described

as exaggerated concavity in the distal portion of the expiratory limb of the flow
volume loop. Use of the term scooping is discouraged.
_____ 23
(R10-4) In cases wherein the interpretation uses any of the following: flow
volume loops configuration, FEF25-75 and other spirometry parameters, it
should be stated that these parameters are suggestive but not definitive. Use
of the term compatible is discouraged.
Appendix K: Forms Used for Voting of the Statements/ Recommendations - 3 For each of the 51 recommendations, kindly write the letter corresponding to your answer/
this.
near future.
_____ 24
(R11-1) Grading of severity should be based on the criteria set by ATS-ERSTFLFT (2).
_____ 25
(R11-2) FEV1% predicted (post bronchodilator value if available) is used both

for obstructive and restrictive ventilatory defect.
_____ 26
(R12-1) In the spirometry report, all parameters should have corresponding

actual value (in BTPS), predicted value and % predicted.
_____ 27
(R12-2) If the spirometer software is capable (optional), the value

corresponding to the 95% CI of the predicted value should be written in the
report.
_____ 28
(R12-3) If the spirometer software is capable (optional), values < 5th percentile
of the predicted should be flagged down (either a change of color or marked).
If the spirometer software is not capable, it is encouraged that the technician or
interpreter derived this value by manual computation or use an online
calculator at http://www.dynamicmt.com/dataform3.html.
_____ 29
(R12-4) The cut-off value for the FEV1/FVC ratio should be <5th percentile of
predicted value. If not available, it should stated in the interpreters comments
what cut off value was used for the lower limit of normality.
_____ 30
(R12-5) Cut off value for the lower limit of normality should be stated in the
interpreters comments.
_____ 31
(R13-1) Performance of a post-bronchodilator study should be done based on

the recommendations of ATS-ERS-TFLFT (2).
_____ 32
(R13-2) Interpretation of response to bronchodilator should be based on the

criteria set by the ATS-ERS-TFLFT (2).
_____ 33
(R13-3) FEF 25-75 should not be used in the interpretation of the post
_____ 34
(R13-4) To standardize the semantics, response to bronchodilator will either be

labeled as significant or no significant response to bronchodilator {as used by
the ATS-ERS-TFLFT (2)}. Uses of other terms such as poor or good response
to bronchodilator are discouraged.
_____ 35
(R14-1) Interpretation should include suggestion/s on need for additional test if

warranted.
_____ 36
(R15-1) In the section on Interpreters Comments the report should state what
reference equation was used in the interpretation of the results. Statement on
the need to correlate clinically should be written in the final interpretation.
this.
near future.
_____ 37
(R15-2) A research study will be conducted by the Council of Diagnostics &

Therapeutics to determine which reference equation is best fitted for the local
Filipino population.
_____ 38
(R16-1) In the reports section on Interpreters Comments, it should be stated

if the test satisfies the reproducibility criteria set by the ATS-ERS-TFLFT (1) or
not.
_____ 39
(R16-2) It the test does not satisfy one of the acceptability or reproducibility
criteria, it should state the consequences of this deficiency in the parameters.
_____ 40
(R17-1) The spirometry report should contain at least, the pre (and postbronchodilator if done) best trial flow volume loop/s
_____ 41
(R17-2) The spirometry report should contain all trials flow volume loops if an
interpretation of CAO or UAO made. If the spirometry software is not capable,
the reproducibility of the flow volume loop should be stated in the section on
Interpreters Comments.
_____ 42
(R18-1) The spirometry report should contain the measured parameters tabular
graph.
_____ 43
(R18-2) The first 3 rows of should be allotted for the MRSP in the following
order: FEV1/FVC, FVC and FEV1.
_____ 44
(R18-3) The succeeding rows maybe be allotted for the other parameters in
the following order of priority: PEFR, FEF 25-75, FEF 75, MIF50/ MEF50,
FEV1/FV6, MVV, MIF 50, MEF 50, FEV6, FEF 25 and FEF 50
_____ 45
(R18-4) In the tabular graph, each parameter should have its corresponding
actual values (pre & post if done), predicted, 95% confidence interval limit (if
the spirometry software is capable), % predicted (pre & post if done) and %
change from baseline of post-bronchodilator measurement.
_____ 46
(R18-5) In the tabular graph (if the spirometry software is capable), each
parameter below the 5th percentile should be flagged down.
_____ 47
(R19-1) The report should contain a section for the interpreters comments (IC)
of the results.
_____ 48
(R19-2) The IC section should state if the test satisfied the ATS-ERS-TFLFT
(1) reproducibility criteria. If the test did not satisfy the criteria, the interpreter
should state the consequences of this deficiency.
_____ 49
(R19-3) The section should contain the basis for the interpretation. Specifically
it should apply, the ATS-ERS-TFLFT (2) interpretation algorithm, criteria for
severity and response to bronchodilator
this.
near future.
_____ 50
(R20-1) The spirometry report should contain a section for the final
interpretation (FI) of the results.
_____ 51
(R20-2) The FI should contain the following information: presence or absence

of obstructive ventilatory defect and severity if present, presence or absence of
probable restrictive ventilatory defect and severity if present, positive or
negative response to bronchodilator if done, suggestion for specific additional
test if indicated, a generic sentence Please correlate results with patients
clinical data. and printed name plus signature of the interpreter/s
Appendix L
List of Voters
Philippine College of Chest Physicians Accredited Training Institutions

1. Chinese General Hospital and Medical Center (CGH)
2. Chong Hua Hospital (CHH)
3. Lung Center of the Philippines (LCP)
4. Makati Medical Center (MMC)
5. Manila Doctors Hospital (MDH)
6. Philippine Heart Center (PHC)
7. St. Lukes Medical Center (SLMC)
8. University of Perpetual Help Dalta Medical Center (UPHM)
9. University of the Philippines - Philippine General Hospital (UP-PGH)
10. University of Santo Tomas Hospital (UST)
11. Veterans Memorial Medical Center (VMMC)
Philippine College of Chest Physicians Chapters

1.
2.
3.
4.
Southern Tagalog
Northern Mindanao
Negros
Mindanao
Key Opinion Leaders

1. Dr. Camilo Roa
2. Dr. Jennifer Wi
3. Dr. Ric Zotomayor
Appendix M: Tally of Votes

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
(R1-1) Spirometry testing

using the closed circuit
technique should be
performed based on the
standards set by the ATSERS-TFLFT (very good
consensus)
(R1-2) A referring physician

can either request any of
the following types of
spirometry testing: simple
spirometry, spirometry with
post bronchodilator study
and simple spirometry
study with possible post
bronchodilator study if initial
result is abnormal. (perfect
consensus)
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
Mindanao S. Tagalog N. Mindanao Negros

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
(R1-3) In a situation
wherein the referring
physician requested only a
simple spirometry and it
showed abnormal results,
the technician in
coordination with doctor
(interpreter of the results)
should try to ask
permission from the
referring physician to
proceed in performing a
post bronchodilator study
while the patient is still in
the test site. (very good
consensus)
(R2-1) Daily instrument

calibration should be done.
(very good consensus)
(R2-2) The interpreter (lab

medical director or
pulmonary consultant on
deck) should give a
feedback to the technician
with regards the quality of
the test. (perfect
consensus)

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
(R2-3) A log book should

be maintained. It should
contain the following: daily
calibration results,
anomalous events or
problems encountered with
the system and feedback of
the interpreter to the
technician. (very good
consensus)
(R3-1) The following should

be measured and reported
FEV1/ FVC, FVC and
FEV1. (perfect consensus)
(R3-2) If the spirometry

machine is capable, the
following should be
measured and reported (in
order of decreasing
importance): PEFR, FEF 2575, FEF 75, MIF50/ MEF50,
FEV1/FV6, MVV, MIF 50,
MEF 50, FEV6, FEF 25 and
FEF 50 (very good
consensus)
B O ANSW

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
(R4-1) Test result selection

should be based on the
recommendations set by
the ATS-ERS-TFLFT (1).
(perfect consensus)
(R5-1) In the spirometry

report, there should be 3
sections for the
interpretation of the results:
technicians comments,
interpreters comments and
final interpretation. (perfect
consensus)
(R5-2) There is no need to

give a clinical correlation.
(good consensus)
O ANSW
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
(R6-1) The spirometry

report should contain a
section on general data
which contains the following
information: name of
patient, age of patient,
gender of patient,
measured height,
measured weight, race of
patient, date of procedure,
time of procedure, room
temperature at time of
testing, room atmospheric
pressure at time of testing,
name of referring physician,
name of the laboratory and
phone number of laboratory
(R7-1) The report should

contain a section for
technicians comments. It
should state the indication
for doing the test and the
information about previous
spirometry testing. (very
good consensus)
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
(R7-2) The technician

comments should state if
the test done satisfies the
ATS-ERS-TFLFT (1)
reproducibility criteria. If
not, it should state which of
the criteria was not
satisfied. (perfect
consensus)
(R7-3) The technicians
conditions that may alter
the results are present or
not. (perfect consensus)
(R7-4) Technicians
the patient is on respiratory
drug and if so when was
the last intake. (perfect
consensus)
(R7-5) Technicians
comments should state the
patients smoking history
particularly the pack years
and the last time when the
patient smoked cigarettes.
(perfect consensus)
SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
(R8-1) In the interpretation

of the results, the report
should use the phrase
ventilatory defect (not lung
defect or ventilatory
pattern). (very good
consensus)
(R9-1) Spirometry results

should be interpreted based
on the ATS-ERS-TFLFT
suggested algorithm. (very
good consensus)
(R10-1) The best trial flow

volume (pre and postbronchodilator if done)
should be part of the
spirometry report. (perfect
consensus)
(R10-2) In cases of
possible upper airway
obstruction interpretation,
all of the trials flow volume
loop should be reported. If
the spirometry software is
not capable, reproducibility
of the flow volume loop
should be mentioned in the
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
(R10-3) Slowing down of

the terminal portion of
spirogram should be
described as exaggerated
concavity in the distal
portion of the expiratory
limb of the flow volume
loop. Use of the term
scooping is discouraged.
(perfect consensus)
(R10-4) In cases wherein

the interpretation uses any
of the following: flow
volume loops configuration,
FEF25-75 and other
spirometry parameters, it
should be stated that these
parameters are suggestive
but not definitive. Use of the
term compatible is
discouraged. (very good
consensus)
(R11-1) Grading of severity

criteria set by ATS-ERSTFLFT. (perfect consensus)

SLMC
CGH
VMMC
LCP
(R11-2) FEV1% predicted

(post bronchodilator value if
available) is used both for
obstructive and restrictive
ventilatory defect. (perfect
consensus)
(R12-1) In the spirometry

report, all parameters
should have corresponding
actual value (in BTPS),
predicted value and %
predicted. (perfect
consensus)
(R12-2) If the spirometer

software is capable
(optional), the value
corresponding to the 95%
CI of the predicted value
should be written in the
report. (very good
consensus)
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
C/B

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
(R12-3) If the spirometer

software is capable
(optional), values < 5th
percentile of the predicted
should be flagged down
(either a change of color or
marked). If the spirometer
software is not capable, it is
encouraged that the
technician or interpreter
derives this value by
manual computation or
uses an online calculator at
http://www.dynamicmt.com/
dataform3.html. (good
consensus)
(R12-4) The cut-off value

for the FEV1/FVC ratio
should be <5th percentile of
predicted value. If not
available, it should be
stated in the interpreters
comments what cut off
value was used for the
lower limit of normality.
(good consensus)
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
C/B

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
(R13-2) Interpretation of
criteria set by the ATS-ERSTFLFT. (perfect consensus)
(R13-3) FEF 25-75 should

not be used in the
interpretation of the post
(perfect consensus)
(R12-5) Cut off value for

the lower limit of normality
should be stated in the
(R13-1) Performance of a
post-bronchodilator study
should be done based on
the recommendations of
ATS-ERS-TFLFT (2).
(perfect consensus)
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
B/C
ANSW

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
(R13-4) To standardize the

semantics, response to
bronchodilator will either be
labeled as significant or no
significant response to
bronchodilator {as used by
the ATS-ERS-TFLFT (2)}.
Uses of other terms such
as poor or good response
to bronchodilator are
discouraged. (perfect
consensus)
(R14-1) Interpretation
should include suggestion/s
on need for additional test if
warranted. (very good
consensus)
(R15-1) In the section on

Interpreters Comments
the report should state what
reference equation was
used in the interpretation of
the results. Statement on
the need to correlate
clinically should be written
in the final interpretation
C/B
C/B
A/B

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
Y/A
Y/A
Y/A
Y/A
N/D
Y/A
Y/A
Y/A
Y/A
Y/A
Y/A
Y/A
Y/A
(R15-2) A research study

will be conducted by the
Council of Diagnostics &
Therapeutics to determine
which reference equation is
Y/A
best fitted for the local
Filipino population. (For
this item, kindly just state
of your agree or disagree)
(R16-1) In the reports
section on Interpreters
Comments, it should be
stated if the test satisfies
the reproducibility criteria
set by the ATS-ERS-TFLFT
(1) or not. (very good
consensus)
(R16-2) It the test does not
satisfy one of the
acceptability or
reproducibility criteria, it
should state the
consequences of this
deficiency in the
parameters. (very good
consensus)
Y/A
Y/A
Y/A

report should contain at
least, the pre (and postbronchodilator if done) best
trial flow volume loop/s.
(perfect consensus)
report should contain the
flow volume loops of all
trials, if an interpretation of
CAO or UAO made. If the
spirometry software is not
capable, the reproducibility
of the flow volume loop
should be stated in the
section on Interpreters
Comments. (very good
consensus)
report should contain the
measured parameters
tabular graph. (very good
consensus)
(R18-2) The first 3 rows of
the tabular graph should be
allotted for the MRSP in the
following order: FEV1/FVC,
FVC and FEV1. (very good
consensus)
SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
A/C
(R18-3) The succeeding

rows maybe be allotted for
the other parameters in
the following order of
priority: PEFR, FEF 25-75,
FEF 75, MIF50/ MEF50,
FEV1/FV6, MVV, MIF 50,
MEF 50, FEV6, FEF 25 and
FEF 50. (very good
consensus)
(R18-4) In the tabular
graph, each parameter
should have its
corresponding actual
values (pre & post if done),
predicted, 95% confidence
interval limit (if the
spirometry software is
capable), % predicted (pre
& post if done) and %
change from baseline of
post-bronchodilator
measurement. (perfect
consensus)
(R18-5) In the tabular graph
(if the spirometry software
is capable), each parameter
below the 5th percentile
should be flagged down.
(good consensus)
SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi

SLMC
CGH
VMMC
LCP
UP-PGH
MMC
(R19-3) The IC section

should also contain the
basis for the interpretation.
Specifically it should apply,
the ATS-ERS-TFLFT (2)
interpretation algorithm,
criteria for severity and
response to bronchodilator.

report should contain a
section for the final
interpretation (FI) of the
results. (perfect consensus)
(R19-1) The report should

contain a section for the
interpreters comments (IC)
of the results. (perfect
consensus)
(R19-2) The IC section
should state if the test
satisfied the ATS-ERSTFLFT (1) reproducibility
criteria. If the test did not
satisfy the criteria, the
interpreter should state the
consequences of this
deficiency.(very good
consensus)
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
(R20-2) The FI should

contain the following
information: presence or
absence of obstructive
ventilatory defect and
severity if present,
presence or absence of
probable restrictive
ventilatory defect and
severity if present,
significant or no significant
if done, suggestion for
specific additional test if
indicated, a generic
sentence Please correlate
results with patients clinical
data. and printed name
plus signature of the
interpreter/s. (very good
consensus)
SLMC
CGH
VMMC
LCP
UP-PGH
MMC
CHH MDH
UST
PHC
UPHM
Dr. Roa
Dr. Zotomayor
Dr. Wi
Appendix N: Computation of the Parameters Needed for the Level of Consensus Classification
(R5-2) There is no need to give a clinical correlation. (good consensus)
11
(R12-3) If the spirometer software is capable (optional), values < 5th

percentile of the predicted should be flagged down (either a change
of color or marked). If the spirometer software is not capable, it is
1
encouraged that the technician or interpreter derives this value by
manual computation or uses an online calculator at
http://www.dynamicmt.com/dataform3.html. (good consensus)
(R12-4) The cut-off value for the FEV1/FVC ratio should be <5th
percentile of predicted value. If not available, it should be stated in
1
the interpreters comments what cut off value was used for the lower
limit of normality. (good consensus)
(R18-5) In the tabular graph (if the spirometry software is capable),
each parameter below the 5th percentile should be flagged down.
(good consensus)
(R1-2) A referring physician can either request any of the following
types of spirometry testing: simple spirometry, spirometry with post
bronchodilator study and simple spirometry study with possible post
bronchodilator study if initial result is abnormal. (perfect consensus)
(R2-2) The interpreter (lab medical director or pulmonary consultant
on deck) should give a feedback to the technician with regards the
quality of the test. (perfect consensus)
(R3-1) The following should be measured and reported FEV1/ FVC,
FVC and FEV1. (perfect consensus)
(R4-1) Test result selection should be based on the
recommendations set by the ATS-ERS-TFLFT (1). (perfect
consensus)
(R5-1) In the spirometry report, there should be 3 sections for the
interpretation of the results: technicians comments, interpreters
comments and final interpretation. (perfect consensus)
% of those who Agreed
% of those who answered D
Level of Consensus
64.7
0.0
94.4
47.1
10
94.4
23.5
100.0
23.5
15
100.0
0.0
15
100.0
0.0
100.0
0.0
18
17
100.0
0.0
11
100.0
0.0
A
(R7-2) The technician comments should state if the test done

satisfies the ATS-ERS-TFLFT (1) reproducibility criteria. If not, it
should state which of the criteria was not satisfied. (perfect
consensus)
(R7-3) The technicians comments should state if conditions that
may alter the results are present or not. (perfect consensus)
(R7-4) Technicians comments should state if the patient is on
respiratory drug and if so when was the last intake. (perfect
consensus)
(R7-5) Technicians comments should state the patients smoking
history particularly the pack years and the last time when the patient
smoked cigarettes. (perfect consensus)
(R10-1) The best trial flow volume (pre and post-bronchodilator if
done) should be part of the spirometry report. (perfect consensus)
(R10-3) Slowing down of the terminal portion of spirogram should be
described as exaggerated concavity in the distal portion of the
expiratory limb of the flow volume loop. Use of the term scooping
is discouraged. (perfect consensus)
(R11-1) Grading of severity should be based on the criteria set by
ATS-ERS-TFLFT. (perfect consensus)
(R11-2) FEV1% predicted (post bronchodilator value if available) is
used both for obstructive and restrictive ventilatory defect. (perfect
consensus)
(R12-1) In the spirometry report, all parameters should have
corresponding actual value (in BTPS), predicted value and %
predicted. (perfect consensus)
(R13-1) Performance of a post-bronchodilator study should be done
based on the recommendations of ATS-ERS-TFLFT (2). (perfect
consensus)
Level of Consensus
11
100.0
0.0
11
100.0
0.0
12
100.0
0.0
100.0
0.0
17
100.0
0.0
13
100.0
0.0
17
100.0
0.0
100.0
0.0
17
16
100.0
0.0
16
100.0
0.0
A
(R13-2) Interpretation of response to bronchodilator should be

based on the criteria set by the ATS-ERS-TFLFT. (perfect
consensus)
(R13-3) FEF 25-75 should not be used in the interpretation of the
post bronchodilator response. (perfect consensus)
(R13-4) To standardize the semantics, response to bronchodilator
will either be labeled as significant or no significant response to
bronchodilator {as used by the ATS-ERS-TFLFT (2)}. Uses of other
terms such as poor or good response to bronchodilator are
discouraged. (perfect consensus)
(R17-1) The spirometry report should contain at least, the pre (and
post-bronchodilator if done) best trial flow volume loop/s. (perfect
consensus)
(R18-4) In the tabular graph, each parameter should have its
corresponding actual values (pre & post if done), predicted, 95%
confidence interval limit (if the spirometry software is capable), %
predicted (pre & post if done) and % change from baseline of postbronchodilator measurement. (perfect consensus)
(R19-1) The report should contain a section for the interpreters
comments (IC) of the results. (perfect consensus)
(R20-1) The spirometry report should contain a section for the final
interpretation (FI) of the results. (perfect consensus)
(R1-1) Spirometry testing using the closed circuit technique should
be performed based on the standards set by the ATS-ERS-TFLFT
(R1-3) In a situation wherein the referring physician requested only a
simple spirometry and it showed abnormal results, the technician in
coordination with doctor (interpreter of the results) should try to ask
1
permission from the referring physician to proceed in performing a
post bronchodilator study while the patient is still in the test site.
15
Level of Consensus
100.0
0.0
12
100.0
0.0
15
100.0
0.0
17
100.0
0.0
17
100.0
0.0
15
100.0
0.0
100.0
0.0
100.0
5.6
VG
94.4
0.0
VG
18
15
10
(R2-1) Daily instrument calibration should be done. (very good

consensus)
(R2-3) A log book should be maintained. It should contain the
following: daily calibration results, anomalous events or problems
encountered with the system and feedback of the interpreter to the
technician. (very good consensus)
(R3-2) If the spirometry machine is capable, the following should be
measured and reported (in order of decreasing importance): PEFR,
FEF 25-75, FEF 75, MIF50/ MEF50, FEV1/FV6, MVV, MIF 50, MEF
50, FEV6, FEF 25 and FEF 50 (very good consensus)
Level of Consensus
14
94.4
11.8
VG
11
100.0
5.6
VG
12
94.4
0.0
VG
94.4
0.0
VG
10
100.0
5.6
VG
11
94.4
0.0
VG
13
100.0
5.9
VG
10
100.0
5.6
VG
(R6-1) The spirometry report should contain a section on general

data which contains the following information: name of patient, age
of patient, gender of patient, measured height, measured weight,
race of patient, date of procedure, time of procedure, room
temperature at time of testing, room atmospheric pressure at time of
testing, name of referring physician, name of the laboratory and
phone number of laboratory (very good consensus)
(R7-1) The report should contain a section for technicians
comments. It should state the indication for doing the test and the information
about previous spirometry testing. (very good consensus)
(R8-1) In the interpretation of the results, the report should use the
1
phrase ventilatory defect (not lung defect or ventilatory pattern).
(R9-1) Spirometry results should be interpreted based on the ATSERS-TFLFT suggested algorithm. (very good consensus)
(R10-2) In cases of possible upper airway obstruction interpretation,
all of the trials flow volume loop should be reported. If the spirometry
software is not capable, reproducibility of the flow volume loop
should be mentioned in the interpreters comments. (very good
consensus)
A
(R10-4) In cases wherein the interpretation uses any of the

following: flow volume loops configuration, FEF25-75 and other
spirometry parameters, it should be stated that these parameters
are suggestive but not definitive. Use of the term compatible is
discouraged. (very good consensus)
(R12-2) If the spirometer software is capable (optional), the value
corresponding to the 95% CI of the predicted value should be
written in the report. (very good consensus)
(R12-5) Cut off value for the lower limit of normality should be stated
1
in the interpreters comments. (very good consensus)
(R14-1) Interpretation should include suggestion/s on need for
additional test if warranted. (very good consensus)
(R15-1) In the section on Interpreters Comments the report should
state what reference equation was used in the interpretation of the
2
results. Statement on the need to correlate clinically should be
written in the final interpretation (very good consensus).
(R15-2) A research study will be conducted by the Council of
Diagnostics & Therapeutics to determine which reference equation
is best fitted for the local Filipino population. (For this item, kindly
just state of your agree or disagree) (very good consensus)
(R16-1) In the reports section on Interpreters Comments, it should
be stated if the test satisfies the reproducibility criteria set by the
ATS-ERS-TFLFT (1) or not. (very good consensus)
(R16-2) It the test does not satisfy one of the acceptability or
reproducibility criteria, it should state the consequences of this
deficiency in the parameters. (very good consensus)
Level of Consensus
100.0
5.6
VG
10
100.0
5.6
VG
11
94.4
11.1
VG
16
100.0
5.6
VG
10
88.2
6.7
VG
0.0
0.0
VG
94.4
0.0
VG
100.0
11.1
VG
10
A
(R17-2) The spirometry report should contain the flow volume loops
of all trials, if an interpretation of CAO or UAO made. If the
spirometry software is not capable, the reproducibility of the flow
volume loop should be stated in the section on Interpreters
Comments. (very good consensus)
(R18-1) The spirometry report should contain the measured
parameters tabular graph. (very good consensus)
(R18-2) The first 3 rows of the tabular graph should be allotted for
the MRSP in the following order: FEV1/FVC, FVC and FEV1. (very
good consensus)
(R18-3) The succeeding rows maybe be allotted for the other
parameters in the following order of priority: PEFR, FEF 25-75, FEF
75, MIF50/ MEF50, FEV1/FV6, MVV, MIF 50, MEF 50, FEV6, FEF
25 and FEF 50. (very good consensus)
(R19-2) The IC section should state if the test satisfied the ATSERS-TFLFT (1) reproducibility criteria. If the test did not satisfy the
criteria, the interpreter should state the consequences of this
deficiency.(very good consensus)
(R19-3) The IC section should also contain the basis for the
interpretation. Specifically it should apply, the ATS-ERS-TFLFT (2)
interpretation algorithm, criteria for severity and response to
bronchodilator. (very good consensus)
(R20-2) The FI should contain the following information: presence or
absence of obstructive ventilatory defect and severity if present,
presence or absence of probable restrictive ventilatory defect and
severity if present, significant or no significant response to
bronchodilator if done, suggestion for specific additional test if
indicated, a generic sentence Please correlate results with patients
clinical data. and printed name plus signature of the interpreter/s.
100.0
17.6
Level of Consensus
VG
15
100.0
11.1
VG
100.0
5.6
VG
100.0
5.6
VG
10
100.0
11.1
VG
100.0
5.6
VG
15
100.0
5.6
VG
Appendix O
PCCP-DATS Committee on Spirometry Consensus
Chair: Ma. Janeth T. Samson, MD, FPCCP
Council of Diagnostics and Therapeutics Members

Caburnay, Eloise Arabelle, MD, FPCCP
Campomanes, Celeste Mae L.,MD, FPCCP
Chavez, Christine L., MD, FPCP
Chua-Panganiban, Shirley Jane, MD, FPCCP
Claveria, Angelica, MD, FPCCP
Cristobal- Aquino, Ma. Flordeliza, MD, FPCCP
Dalupang, Julius, MD, FPCCP
Divinagracia, Charissa, MD, FPCCP
Elisterio, Helarose M., MD, FPCCP
Garcia, Geraldine, MD, FPCCP
Germar, Arnold G., MD, FPCCP
Gonzales, Andrew S.A., MD, FPCCP
Lee-Chua, Rachel, MD, FPCP
Llanes-Gracia, Liza, MD, FPCCP
Mapanao, Daisy, MD, FPCCP
Micu, Lolita Brigida, MD,FPCP
Mora, Czarina J., MD, FPCCP
Natividad, Ma. Piedad R., MD, FPCCP
Ogbac, William George, MD,FPCP
Peafiel, Alvin, MD, FPCCP
Reside, Evelyn Victoria E., MD, FPCCP
Reyes, Mary Jane, MD, FPCCP
Santos, Alfredo Romeo Q., MD, FPCCP
Tan, Marites, MD, FPCCP
Tan, Florita, MD, FPCCP
Samson, Lyndon H., MD, FPCCP
Trinidad, Tim S., MD, FPCCP
Valenzuela, Rosauro Vicente H. Jr.,MD, FPCCP
Villanueva, Anna Tessa, MD. FPCCP
Villanueva, Ma. Peachy Lara, MD, FPCCP
Villasanta, Edwin I.,MD,FPCCP
Zantua, Raphael Ryan R., MD, FPCCP

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Philippine College of Chest Physician (PCCP):

Consensus Statement on the Performance

Report of the Council on Diagnostics and Therapeutics

Chinese General Hospital: Eden D. Chua, MD, FPCCP

Philippine Heart Center: Rodolfo E. Tamse, MD, FPCCP

Irenee Faustina J. Casio, MD, FPCP

St. Lukes Medical Center: Myrna N. Baares,MD, FPCCP

Nio Jessielito N. Doydora, MD

Key Opinion Leaders

Council of Diagnostics and Therapeutics Members

Dalupang, Julius, MD, FPCCP

Message from the PCCP President

Greetings from the Philippine College of Chest Physicians (PCCP) !

BENILDA B. GALVEZ, MD, FPCCP

Message from the Council Chair

Greetings! The Council of Diagnostics and Therapeutics of the Philippine

Ma. Janeth T. Samson, MD, FPCCP

Quality Control -------------------------------------------------------------------------

Parameters Measured ---------------------------------------------------------------

Test Result Selection ----------------------------------------------------------------

Parts of the Report -------------------------------------------------------------------

General Data --------------------------------------------------------------------------

Technicians Comment --------------------------------------------------------------

Semantics in Interpretation ---------------------------------------------------------

Interpretation Algorithm --------------------------------------------------------------

Use of other Parameters Not in Algorithm --------------------------------------

Grading of Severity -------------------------------------------------------------------

Lower Limit of Normality ------------------------------------------------------------

Response to Bronchodilator --------------------------------------------------------

Statement on Need for Additional Test ------------------------------------------

Reference Equations -----------------------------------------------------------------

Comments on the Quality of the Test --------------------------------------------

Graphical Representation -----------------------------------------------------------

Results in Tabular Graph ------------------------------------------------------------

Interpreters Comments --------------------------------------------------------------

Final Interpretation --------------------------------------------------------------------

Philippine College of Chest Physician (PCCP):

Methodology & Results

Method Used in Voting and Grading of Consensus Statements

Spirometry Testing Consensus Statements

Components of the Report

Use of other Parameters Not in the ATS-ERS-TFLFT Interpretation Algorithm

FEV1 % Predicted (post bronchodilator if available)

Moderately Severe 50-59

Lower Limit of Normality

Statement on Need for Additional Test

Comments on the Quality of the Test

Components of the Report: Graphical Representation

Components of the Report: Interpreters Comments

There is no significant response to bronchodilator.

Components of the Report: Final Interpretation

Presence or absence of Obstructive Ventilatory Defect and severity if present

Name: Juan Cruz

Time of procedure: 10:00 AM

Room atmospheric: 760

Referring physician: Dr. Pedro Andres

Weight (lbs): 135

Name of the laboratory: PCCP PFT Lab

Phone number of laboratory: 723-30-80

Manila Doctors Hospital

UP- Philippine General Hospital

PCCP Council on Diagnostics

Measured (not stated) Height