Easy Spirometry Interpretation Guide

The most important tools 5. A normal volume-time curve 7. Patients with symptoms and
for diagnosing COPD rises sharply from the baseline airway obstruction should receive
and asthma are medical and reaches a flat plateau. A a post-BD (bronchodilator)
history, physical examina- gradual curve that never plateaus spirometry test. After administra-
tion, and spirometry. suggests airway obstruction. tion of a bronchodilator (i.e.,
Interpreting your spirome- albuterol, 2-4 puffs of 90
try results correctly will Sample V/T curves
mcg/puff), allow 10-15 minutes
help assure an accurate prior to performing the post BD
diagnosis and disease spirometry test. An increase of
00 1 2 3 4 5 6 7 8

classification (severity). 12% (and more than 0.2 liters) in

Normal

the measured FEV1 suggests

Severe Obstruction

1. The first step is to make sure 1

reversible airways disease, such
that the quality of the spirometry FEV1=4.0 L
as asthma. COPD can be as
test is good. Poor quality tests
FEV1=1.8 L

much as 5-6% reversible, but not

can cause diagnostic misclassifi- 2
much more. For more informa-
cations. For more information, tion, see Differential Diagnosis on
see 10 Steps to Good Results on our website.
Time (sec)

our website.
8. In patients with intermittent
3

2. Look at the curve patterns respiratory symptoms and normal

and numbers to8 help guide your spirometry, consider performing a
olume (L) interpretation.
4

post-BD test to identify intermit-

4 5 6 7

3. A normal flow-volume curve tent or mild asthma which is con-

looks like a sail, rising rapidly to a firmed by a >12% improvement
5

peak then descending at about a in FEV1, despite normal pre-BD

spirometry results.
FVC=4.2 L FVC=5.0 L

45-degree angle.
4. A concave flow-volume curve 9. Adult onset airway obstruction
6
Volume (L)

suggests mild to moderate air- in the long-term smoker (>10 to

ways obstruction, while a pro- Note: If the effort stops before 6 20 pack year history) is usually
longed finish rats tail shape seconds in adults (3 seconds in
Normal due to COPD.
suggests severe obstruction. children) the FVC may be under- 10. Once a diagnosis of asthma
Moderate Obstruction

estimated. or COPD has been determined,

Severe Obstruction

Sample F/V curves

To view additional curve samples, disease classification and appro-
14
see Sample Spirometry Tracings priate treatment can be easily
on our website. established by utilizing the
13 00 1 2 3 4 5 6 7 8

corresponding tables on the

12 Normal

6. A low (< 70% pred) FEV1% following page.

11 Severe Obstruction
10

(FEV1/FVC) indicatesFEV1=1.8 L airway

1
9

obstruction. A low (< 80% pred) If a diagnosis is still uncertain,

FEV1=4.0 L
Flow (L/sec)

FVC and FEV1 with a normal consider referral to a specialist

7
2

for consultation or co-manage-

6

FEV1% suggests restriction with-

5

out obstruction. However, to ment.

Time (sec)

4
3 3

make a definitive diagnosis of

2

restrictive lung 4disease, the

1

patient should be referred to a

0
1 2 3 4 5 6 7 8

pulmonary lab for additional lung

Volume (L)

volume testing.
5
Jones Medical Instrument Company
FVC=4.2 L FVC=5.0 L 200 Windsor Drive, Oak Brook, IL 60523
(800) 323-7336 www.jonesmedical.com
6

2008 Jones Medical Instrument Company. All Rights Reserved.

Volume (L)
 Classification: First, identify the appropriate classification chart below. Then simply reference the
patients post-BD spirometry results to determine an accurate classification and treatment regimen.

CLASSIFYING ASTHMA SEVERITY IN CHILDREN 5 - 11 STEPWISE APPROACH FOR MANAGING ASTHMA IN

YEARS OF AGE CHILDREN 5 - 11 YEARS OF AGE
Assessing severity and initiating therapy in children who are not currently taking long-term control medication

Classification of Asthma Severity Intermittent Persistent Asthma: Daily Medication

Components of (5 - 11 years of age) Asthma Consult with asthma specialist if Step 4 care or higher is required.
Consider consultation at Step 3.
Severity Persistent
Step up if
Intermittent Mild Moderate Severe
Step 6 needed
Symptoms
2 days/week >2 days/week but Daily Throughout Step 5 (first, check
not daily the day
Preferred: adherence,
Nighttime 2x/month 3 - 4x/month >1x/week but Often 7x/week Step 4 Preferred: inhaler
awakenings not nightly High-dose ICS +
LABA + oral technique,
High-dose ICS +
Short acting Step 3 Preferred: LABA systemic environmental
beta2-agonist use for >2 days/week Several times corticosteroid control, and
symptom control (not 2 days/week Daily Medium-dose
but not daily per day Step 2 comorbid
prevention of EIB) Preferred: ICS + LABA Alternative:
Alternative: conditions)
Impairment Interference with Preferred: EITHER: High-dose ICS +
None Minor limitation Some limitation Extremely limited Alternative: either LTRA High-dose ICS +
normal activity Low-dose ICS +
Step 1 Low-dose ICS or Theophylline either LTRA
Normal FEV1
either LABA, Medium-dose or Assess
LTRA, or ICS + either
between Theophylline Theophylline + control
exacerbations Preferred: Alternative: LTRA or oral systemic
Lung function OR Theophylline corticosteroid
FEV1 >80% FEV1 = >80% FEV1 = 60-80% FEV1 <60% SABA PRN Cromolyn, LTRA,
predicted predicted predicted predicted Medium-dose Step down if
Nedocromil, or
Theophylline ICS possible
FEV1/FVC >85% FEV1/FVC >80% FEV1/FVC = 75-80% FEV1/FVC < 75%
(and asthma is
0 - 1/year 2/year well controlled
Exacerbations
requiring oral Consider severity and interval since last exacerbation. at least
Risk systemic
Each Step: Patient education, environmental control, and management of comorbidities. 3 months)
Frequency and severity may fluctuate over time for patients in any severity category.
corticosteroids Steps 2 - 4: Consider subcutaneous allergen immunotherapy for patients who have allergic asthma.
Relative annual risk of exacerbations may be related to FEV1.

Step 3, medium- Step 3, medium-dose Quick-Relief Medication for All Patients

Recommended Step for dose ICS option ICS option or Step 4
SABA as needed for symptoms. Intensity of treatment depends on severity of symptoms: up to 3 treatments
Step 1 Step 2
Initiating Therapy and consider short course of
at 20-minute intervals as needed. Short course of oral systemic corticosteroids may be needed.
oral systemic corticosteroids
Caution: Increasing use of SABA or use >2 days a week for symptom relief (not prevention of EIB) generally
ASTHMA2

In 2 - 6 weeks, evaluate level of asthma control that is achieved, indicates inadequate control and the need to step up treatment.
and adjust therapy accordingly

CLASSIFYING ASTHMA SEVERITY IN YOUTHS 12 YEARS OF AGE STEPWISE APPROACH FOR MANAGING ASTHMA IN
AND ADULTS YOUTHS 12 YEARS OF AGE AND ADULTS
Assessing severity and initiating treatment for patients who are not currently taking long-term control medications

Classification of Asthma Severity Persistent Asthma: Daily Medication

Intermittent
Components of 12 years of age Asthma Consult with asthma specialist if Step 4 care or higher is required.
Consider consultation at Step 3.
Severity Persistent
Intermittent Mild Moderate Severe Step 6 Step up if
2 days/week >2 days/week but Daily Throughout Step 5 needed
Symptoms not daily the day Preferred:
Preferred: (first, check
Nighttime >1x/week but Step 4 High-dose ICS + adherence,
2x/month 3 - 4x/month Often 7x/week
awakenings not nightly High-dose ICS + LABA + oral
Preferred: environmental
Step 3 LABA corticosteroid
Short acting >2 days/week control, and
Impairment beta2-agonist use for
2 days/week
but not daily, and
Daily Several times Preferred:
Medium-dose
comorbid
symptom control (not not more than per day Step 2 ICS + LABA AND AND
prevention of EIB) 1x on any day Low-dose conditions)
Normal FEV1/FVC: Preferred: ICS + LABA Consider Consider
8 - 19 yr 85% Interference with Alternative: Omalizumab for Omalizumab for
None Minor limitation Some limitation Extremely limited Low-dose ICS OR
20 - 39 yr 80% normal activity patients who patients who
40 - 59 yr 75% Step 1 Medium-dose
Medium-dose have allergies have allergies Assess
60 - 80 yr 70% Normal FEV1 ICS + either
Preferred: Alternative: ICS LTRA, control
between
exacerbations Cromolyn, LTRA, Theophylline,
FEV1 >60%, but FEV1 <60% SABA PRN Alternative: or Zileuton
Lung function Nedocromil, or
FEV1 >80% FEV1 >80% <80% predicted predicted
predicted predicted Theophylline Low-dose ICS + Step down if
FEV1/FVC FEV1/FVC either LTRA, possible
FEV1/FVC normal FEV1/FVC normal reduced 5% reduced >5% Theophyline, or
Zileuton (and asthma is
Exacerbations 0 - 1/year 2/year
well controlled
requiring oral Consider severity and interval since last exacerbation. at least
Risk systemic Frequency and severity may fluctuate over time for patients in any severity category. Each Step: Patient education, environmental control, and management of comorbidities.
corticosteroids 3 months)
Relative annual risk of exacerbations may be related to FEV1. Steps 2 - 4: Consider subcutaneous allergen immunotherapy for patients who have allergic asthma.

Step 3 Step 4 or 5 Quick-Relief Medication for All Patients

Recommended Step for Step 1 Step 2
Initiating Therapy and consider short course of SABA as needed for symptoms. Intensity of treatment depends on severity of symptoms: up to 3 treatments
oral systemic corticosteroids at 20-minute intervals as needed. Short course of oral systemic corticosteroids may be needed.
Use of SABA >2 days a week for symptom relief (not prevention of EIB) generally indicates inadequate control and
In 2 - 6 weeks, evaluate level of asthma control that is achieved,
and adjust therapy accordingly the need to step up treatment.

Visit the Links page on our website for complete

COPD CLASSIFICATION AND TREATMENT

versions of the asthma and COPD guidelines.

I: Mild II: Moderate III: Severe IV: Very Severe

Note: This information is intended to augment,

FEV1/FVC < 0.70

not replace, a physicians independent

FEV1 < 30% predicted
FEV1/FVC < 0.70 or FEV1 < 50%
predicted plus chronic

professional judgment.
FEV1/FVC < 0.70
30% FEV1 < 50% respiratory failure
FEV1/FVC < 0.70
50% FEV1 < 80%
predicted
predicted
1

FEV1 80% predicted

COPD

Active reduction of risk factor(s); influenza vaccination 1

NHLBI/WHO. GOLD COPD Guidelines; 2006 Revised
Add short-acting bronchodilator (when needed) 2
NHLBI. Guidelines for the Diagnosis and Management of Asthma:
Add regular treatment with one or more long-acting bronchodilators
Expert Panel Report 3: 2007
(when needed); Add rehabilitation

Add inhaled glucocorticosteroids if

repeated exacerbations

Add long-term oxygen if

chronic respiratory
failure. Jones Medical Instrument Company
Consider surgical
treatments 200 Windsor Drive, Oak Brook, IL 60523
(800) 323-7336 www.jonesmedical.com

2008 Jones Medical Instrument Company. All Rights Reserved.