The peak expiratory flow (PEF), also called peak expiratory flow rate (PEFR) is a person's maximum speed of expiration, as measured with a peak flow meter, a small, hand-held device used to monitor a person's ability to breathe out air. It measures the airflow through the bronchi and thus the degree of obstruction in the airways.

When peak flow is being monitored regularly, the results may be recorded on a peak flow chart.

It is important to use the same peak flow meter every time.

wikipedia

A peak flow meter is a portable, easy-to-use device that measures how well your lungs are working. If you have asthma, your doctor may recommend that you use a peak flow meter to help track your asthma control.

In addition to watching for worsening signs and symptoms, such as wheezing or coughing, you can use a peak flow meter to help you decide when you need to act to keep your asthma under control. Regular use of your peak flow meter can give you time to adjust your medication or take other steps before your symptoms get worse. A peak flow meter can be useful for adults and children as young as preschool age.

How do I chart my peak flow ratesChart the HIGHEST of the three readings. This is called, "your personal best". The chart could include the date at the top of the page with AM and PM listed. The left margin could list a scale, starting with zero (0) liters per minute (L/min) at the bottom of the page and ending with 600 L/min at the top.

You could leave room at the bottom of the page for notes to describe how you are feeling or to list any other thoughts you may have.

What is a "normal" peak flow rate?A "normal" peak flow rate is based on a person's age, height, sex and race. A standardized "normal" may be obtained from a chart comparing the patient with a population without breathing problems.

A patient can figure out what is normal for them, based on their own peak flow rate. Therefore, it is important for you and your healthcare provider to discuss what is considered "normal" for you.

Once you have learned your usual and expected peak flow rate, you will be able to better recognize changes or trends in your asthma.

How can I determine a "normal" peak flow rate for me?Three zones of measurement are commonly used to interpret peak flow rates. It is easy to relate the three zones to the traffic light colors: green, yellow, and red. In general, a normal peak flow rate can vary as much as 20 percent.

Be aware of the following general guidelines. Keep in mind that recognizing changes from "normal" is important. Your healthcare provider may suggest other zones to follow.

Green Zone: 80 to 100 percent of your usual or "normal" peak flow rate signals all clear. A reading in this zone means that your asthma is under reasonably good control. It would be advisable to continue your prescribed program of management.

Yellow Zone: 50 to 80 percent of your usual or "normal" peak flow rate signals caution. It is a time for decisions. Your airways are narrowing and may require extra treatment. Your symptoms can get better or worse depending on what you do, or how and when you use your prescribed medication. You and your healthcare provider should have a plan for yellow zone readings.Red Zone: Less than 50 percent of your usual or "normal" peak flow rate signals a Medical Alert. Immediate decisions and actions need to be taken. Severe airway narrowing may be occurring. Take your rescue medications right away. Contact your healthcare provider now and follow the plan he has given you for red zone readings.

Some healthcare providers may suggest zones with a smaller range, such as 90 to 100 percent. Always follow your healthcare provider's suggestions about your peak flow rate.

http://www.lung.org/lung-disease/asthma/living-with-asthma/take-control-of-your-asthma/measuring-your-peak-flow-rate.html

ow to measure peak flow

Move the marker to the bottom of the numbered scale.

Stand up straight.

Take a deep breath. Fill your lungs all the way.

Hold your breath while you place the mouthpiece in your mouth, between your teeth. Close your lips

around it. Do not put your tongue against or inside the hole.

Blow out as hard and fast as you can in a single blow. Your first burst of air is the most important. So

blowing for a longer time will not affect your result.

Write down the number you get. But, if you coughed or did not do the steps right, do not write down the

number. Instead, do the steps over again.

Move the marker back to the bottom and repeat all these steps 2 more times. The highest of the 3

numbers is your peak flow number. Write it down in your log chart.

Many children under age 5 cannot use a peak flow meter very well. But some are able to. Start using peak flow

meters before age 5 to get your child used to them.

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000043.htm

SpirometryFrom Wikipedia, the free encyclopedia

Spirometry

Diagnostics

Flow-Volume loop showing successful FVC maneuver. Positive

values represent expiration, negative values represent inspiration.

At the start of the test both flow and volume are equal to zero

(representing the volume in the spirometer rather than the lung).

The trace moves clockwise for expiration followed by inspiration.

After the starting point the curve rapidly mounts to a peak (the

peak expiratory flow). (Note the FEV1 value is arbitrary in this

graph and just shown for illustrative purposes; these values must

be calculated as part of the procedure).

MeSH D013147

OPS-301 code 1-712

TLC Total lung capacity: the volume in the lungs at maximal

inflation, the sum of VC and RV.

TV Tidal volume: that volume of air moved into or out of

the lungs during quiet breathing (VT indicates a

subdivision of the lung; when tidal volume is precisely

measured, as in gas exchange calculation, the symbol

VT or VT is used.)

RV Residual volume: the volume of air remaining in the

lungs after a maximal exhalation

ERV Expiratory reserve volume: the maximal volume of air

that can be exhaled from the end-expiratory position

IRV Inspiratory reserve volume: the maximal volume that

can be inhaled from the end-inspiratory level

IC Inspiratory capacity: the sum of IRV and TV

IVC Inspiratory vital capacity: the maximum volume of air

inhaled from the point of maximum expiration

VC Vital capacity: the volume of air breathed out after the

deepest inhalation.

VT Tidal volume: that volume of air moved into or out of

the lungs during quiet breathing (VT indicates a

subdivision of the lung; when tidal volume is precisely

measured, as in gas exchange calculation, the symbol

VT or VT is used.)

FRC Functional residual capacity: the volume in the lungs at

the end-expiratory position

RV/TLC% Residual volume expressed as percent of TLC

VA Alveolar gas volume

VL Actual volume of the lung including the volume of the

conducting airway.

FVC Forced vital capacity: the determination of the vital

capacity from a maximally forced expiratory effort

FEVt Forced expiratory volume (time): a generic term

indicating the volume of air exhaled under forced

conditions in the first t seconds

FEV1 Volume that has been exhaled at the end of the first

second of forced expiration

FEFx Forced expiratory flow related to some portion of the

FVC curve; modifiers refer to amount of FVC already

exhaled

FEFmax The maximum instantaneous flow achieved during a

FVC maneuver

FIF Forced inspiratory flow: (Specific measurement of the

forced inspiratory curve is denoted by nomenclature

analogous to that for the forced expiratory curve. For

example, maximum inspiratory flow is denoted FIFmax.

Unless otherwise specified, volume qualifiers indicate

the volume inspired from RV at the point of

measurement.)

PEF Peak expiratory flow: The highest forced expiratory

flow measured with a peak flow meter

MVV Maximal voluntary ventilation: volume of air expired in

a specified period during repetitive maximal effort

Doing a spirometry

Spirometry (meaning the measuring of breath) is the most common of the pulmonary function tests(PFTs), measuring lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is an important tool used for generating pneumotachographs, which are helpful in assessing conditions such as asthma, pulmonary fibrosis, cystic fibrosis, and COPD.

Contents

1 Indications 2 Spirometry testing

2.1 Spirometer 2.2 Procedure 2.3 Limitations of test 2.4 Related tests

3 Parameters 3.1 Forced vital capacity (FVC) 3.2 Forced expiratory volume in 1 second (FEV1) 3.3 FEV1/FVC ratio (FEV1%) 3.4 Forced expiratory flow (FEF) 3.5 Forced inspiratory flow 25–75% or 25–50% 3.6 Peak expiratory flow (PEF) 3.7 Tidal volume (TV) 3.8 Total lung capacity (TLC) 3.9 Diffusing capacity (DLCO) 3.10 Maximum voluntary ventilation (MVV) 3.11 Static lung compliance (C st) 3.12 Others

4 Technologies used in spirometers 5 See also

6 References 7 Further reading 8 External links

Indications

Spirometry is indicated for the following reasons:

to diagnose or manage asthma[1][2][3]

to detect respiratory disease in patients presenting with symptoms of breathlessness, and to distinguish respiratory from cardiac disease as the cause[4]

to measure bronchial responsiveness in patients suspected of having asthma[4]

to diagnose and differentiate between obstructive lung disease and restrictive lung disease [4]

to follow the natural history of disease in respiratory conditions[4]

to assess of impairment from occupational asthma [4] to identify those at risk from pulmonary barotrauma while scuba diving [4] to conduct pre-operative risk assessment before anaesthesia

or cardiothoracic surgery [4] to measure response to treatment of conditions which spirometry detects[4]

to diagnose the vocal cord dysfunction.

Spirometry testing

A modern USB PC-based spirometer.

Device for spirometry. The patient places his or her lips around the blue mouthpiece. The teeth go between the nubs

and the shield, and the lips go over the shield. A noseclip guarantees that breath will flow only through the mouth.

Screen for spirometry readouts at right. The chamber can also be used for body plethysmography.

Spirometer

The spirometry test is performed using a device called a spirometer, which comes in several different varieties. Most spirometers display the following graphs, called spirograms:

a volume-time curve, showing volume (liters) along the Y-axis and time (seconds) along the X-axis

a flow-volume loop, which graphically depicts the rate of airflow on the Y-axis and the total volumeinspired or expired on the X-axis

Procedure

The basic forced volume vital capacity (FVC) test varies slightly depending on the equipment used.

Generally, the patient is asked to take the deepest breath they can, and then exhale into the sensor as hard as possible, for as long as possible, preferably at least 6 seconds. It is sometimes directly followed by a rapid inhalation (inspiration), in particular when assessing possible upper airway obstruction. Sometimes, the test will be preceded by a period of quiet breathing in and out from the sensor (tidal volume), or the rapid breath in (forced inspiratory part) will come before the forced exhalation.

During the test, soft nose clips may be used to prevent air escaping through the nose. Filter mouthpieces may be used to prevent the spread of microorganisms.

Limitations of test

The maneuver is highly dependent on patient cooperation and effort, and is normally repeated at least three times to ensure reproducibility. Since results are dependent on patient cooperation, FVC can only be underestimated, never overestimated.

Due to the patient cooperation required, spirometry can only be used on children old enough to comprehend and follow the instructions given (6 years old or more), and only on patients who are able to understand and follow instructions — thus, this test is not suitable for patients who are unconscious, heavily sedated, or have limitations that would interfere with vigorous respiratory efforts. Other types of lung function tests are available for infants and unconscious persons.

Another major limitation is the fact that many intermittent or mild asthmatics have normal spirometry between acute exacerbation, limiting spirometry's usefulness as a diagnostic. It is more useful as a monitoring tool: a sudden decrease in FEV1 or other spirometric measure in the same patient can signal worsening control, even if the raw value is still normal. Patients are encouraged to record their personal best measures.

Example of a modern PC-based spirometer printout.

Related tests

Spirometry can also be part of a bronchial challenge test, used to determine bronchial hyperresponsiveness to either rigorous exercise, inhalation of cold/dry air, or with a pharmaceutical agent such as methacholineor histamine.

Sometimes, to assess the reversibility of a particular condition, a bronchodilator is administered before performing another round of tests for comparison. This is commonly referred to as a reversibility test, or apost bronchodilator test (Post BD), and is an important part in diagnosing asthma versus COPD.

Other complementary lung functions tests include plethysmography and nitrogen washout.

Parameters

The most common parameters measured in spirometry are Vital capacity (VC), Forced vital capacity (FVC), Forced expiratory volume (FEV) at timed intervals of 0.5, 1.0 (FEV1), 2.0, and 3.0 seconds, forced expiratory flow 25–75% (FEF 25–75)

and maximal voluntary ventilation (MVV),[5] also known as Maximum breathing capacity.[6] Other tests may be performed in certain situations.

Results are usually given in both raw data (litres, litres per second) and percent predicted—the test result as a percent of the "predicted values" for the patients of similar characteristics (height, age, sex, and sometimes race and weight). The interpretation of the results can vary depending on the physician and the source of the predicted values. Generally speaking, results nearest to 100% predicted are the most normal, and results over 80% are often considered normal. Multiple publications of predicted values have been published and may be calculated online based on age, sex, weight and ethnicity. However, review by a doctor is necessary for accurate diagnosis of any individual situation.

A bronchodilator is also given in certain circumstances and a pre/post graph comparison is done to assess the effectiveness of the bronchodilator. See the example printout.

Functional residual capacity (FRC) cannot be measured via spirometry, but it can be measured with a plethysmograph or dilution tests (for example, helium dilution test).

Average values for forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and forced expiratory

flow 25–75% (FEF25–75%), according to a study in the United States 2007 of 3,600 subjects aged 4–80 years. [7] Y-axis

is expressed in litres for FVC and FEV1, and in litres/second for FEF25–75%.

Forced vital capacity (FVC)

Forced vital capacity (FVC) is the volume of air that can forcibly be blown out after full inspiration,[8] measured in liters. FVC is the most basic maneuver in spirometry tests.

Forced expiratory volume in 1 second (FEV1)

FEV1 is the volume of air that can forcibly be blown out in one second, after full inspiration.[8] Average values for FEV1 in healthy people depend mainly on sex and age, according to the diagram at left. Values of between 80% and 120% of the average value are considered normal.[9]Predicted normal values for FEV1 can be calculated online and depend on age, sex, height, mass and ethnicity as well as the research study that they are based on.

FEV1/FVC ratio (FEV1%)

FEV1/FVC (FEV1%) is the ratio of FEV1 to FVC. In healthy adults this should be approximately 75–80%. In obstructive diseases (asthma, COPD, chronic bronchitis, emphysema) FEV1 is diminished because of increased airway resistance to expiratory flow; the FVC may be decreased as well, due to the premature closure of airway in expiration, just not in the same proportion as FEV1 (for instance, both FEV1 and FVC are reduced, but the former is more affected because of the increased airway resistance). This generates a reduced value (<80%, often ~45%). In restrictive diseases (such as pulmonary fibrosis) the FEV1 and FVC are both reduced proportionally and the value may be normal or even increased as a result of decreased lung compliance.

A derived value of FEV1% is FEV1% predicted, which is defined as FEV1% of the patient divided by the average FEV1% in the population for any person of similar age, sex and body composition.

Forced expiratory flow (FEF)

Forced expiratory flow (FEF) is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration. It can be given at discrete times, generally defined by what fraction remains of the forced vital capacity (FVC). The usual intervals are 25%, 50% and 75% (FEF25, FEF50 and FEF75), or 25% and 50% of FVC. It can also be given as a mean of the flow during an interval, also generally delimited by when specific fractions remain of FVC, usually 25–75% (FEF25–75%). Average ranges in the healthy population depend mainly on sex and age, with FEF25–75% shown in diagram at left. Values ranging from 50-60% and up to 130% of the average are considered normal.[9] Predicted normal values for FEF can be calculated online and depend on age, sex, height, mass and ethnicity as well as the research study that they are based on.

MMEF or MEF stands for maximal (mid-)expiratory flow and is the peak of expiratory flow as taken from the flow-volume curve and measured in liters per second. It should theoretically be identical to peak expiratory flow (PEF), which is, however, generally measured by a peak flow meter and given in liters per minute.[10]

Recent research suggests that FEF25-75% or FEF25-50% may be a more sensitive parameter than FEV1 in the detection of obstructive small airway disease.[11]

[12] However, in the absence of concomitant changes in the standard markers, discrepancies in mid-range expiratory flow may not be specific enough to be useful, and current practice guidelines recommend continuing to use FEV1, VC, and FEV1/VC as indicators of obstructive disease.[13][14]

More rarely, forced expiratory flow may be given at intervals defined by how much remains of total lung capacity. In such cases, it is usually designated as e.g. FEF70%TLC, FEF60%TLC and FEF50%TLC.[10]

Forced inspiratory flow 25–75% or 25–50%

Forced inspiratory flow 25–75% or 25–50% (FIF 25–75% or 25–50%) is similar to FEF 25–75% or 25–50% except the measurement is taken during inspiration.

Peak expiratory flow (PEF)

Normal values for peak expiratory flow (PEF), shown on EU scale.[15]

Peak expiratory flow (PEF) is the maximal flow (or speed) achieved during the maximally forced expiration initiated at full inspiration, measured in liters per minute or in liters per second.

Tidal volume (TV)

Tidal volume is the amount of air inhaled and exhaled normally at rest

Total lung capacity (TLC)

Total lung capacity (TLC) is the maximum volume of air present in the lungs

Diffusing capacity (DLCO)

Diffusing capacity (or DLCO) is the carbon monoxide uptake from a single inspiration in a standard time (usually 10 seconds). Since air consists of very minute or trace quantities of CO, 10 seconds is considered to be the standard time for inhalation, then rapidly blow it out (exhale). The exhaled gas is tested to determine how much of the tracer gas was absorbed during the breath. This will pick up diffusion impairments, for instance in pulmonary fibrosis.[16] This must be corrected for anemia (because rapid CO diffusion is dependent on hemoglobin in RBC's; a low hemoglobin concentration, anemia, will reduce DLCO) and pulmonary hemorrhage (excess RBC's in the interstitium or alveoli can absorb CO and artificially increase the DLCO capacity). Atmospheric pressure and/or altitude will also affect measured DLCO, and so a correction factor is needed to adjust for standard pressure. Online calculators are available to correct for hemoglobin levels and altitude and/or pressure where the measurement was taken.

Maximum voluntary ventilation (MVV)

Maximum voluntary ventilation (MVV) is a measure of the maximum amount of air that can be inhaled and exhaled within one minute. For the comfort of the patient this is done over a 15 second time period before being extrapolated to a value for one minute expressed as liters/minute. Average values for males and females are 140–180 and 80–120 liters per minute respectively.

Static lung compliance (Cst)

When estimating static lung compliance, volume measurements by the spirometer needs to be complemented by pressure transducers in order to simultaneously measure the transpulmonary pressure. When having drawn a curve with the relations between changes in volume to changes in transpulmonary pressure, Cst is the slope of the curve during any given volume, or, mathematically, ΔV/ΔP.[17] Static lung compliance is perhaps the most sensitive parameter for the detection of abnormal pulmonary mechanics.[18] It is considered normal if it is 60% to 140% of the average value in the population for any person of similar age, sex and body composition.[9]

In those with acute respiratory failure on mechanical ventilation, "the static compliance of the total respiratory system is conventionally obtained by dividing the tidal volume by the difference between the "plateau" pressure measured at the airway opening (PaO) during an occlusion at end-inspiration and positive end-expiratory pressure (PEEP) set by the ventilator".[19]

Others

Forced Expiratory Time (FET)Forced Expiratory Time (FET) measures the length of the expiration in seconds.

Slow vital capacity (SVC)Slow vital capacity (SVC) is the maximum volume of air that can be exhaled slowly after slow maximum inhalation.

Maximal pressure (Pmax and Pi)Pmax is the asymptotically maximal pressure

that can be developed by the respiratory muscles at any lung volume and Pi is the maximum inspiratory pressure that can be developed at specific lung volumes.[20] This measurement also requires pressure transducers in addition. It is considered normal if it is 60% to 140% of the average value in the population for any person of similar age, sex and body composition.[9] A derived parameter is the coefficient of retraction (CR) which is Pmax/TLC .[10]

Measurement

Approximate value

Male Female

Forced vital capacity (FVC) 4.8 L 3.7 L

Tidal volume (Vt) 500 mL 390 mL

Total lung capacity (TLC) 6.0 L 4.7 L

Mean transit time (MTT)Mean transit time is the area under the flow-volume curve divided by the forced vital capacity.[21]

Maximal inspiratory pressure (MIP) MIP, also known as negative inspiratory force (NIF), is the maximum pressure that can be generated against an occluded airway beginning at functional residual capacity (FRC). It is a marker of respiratory muscle function and strength.[22] Represented by centimeters of water pressure (cmH2O) and measured with a manometer. Maximum inspiratory pressure is an important and noninvasive index of diaphragm strength and an independent tool for diagnosing many illnesses.[23] Typical maximum inspiratory pressures in adult males can be estimated from the equation, MIP = 142 - (1.03 x Age) cmH2O, where age is in years.[24]

Technologies used in spirometers

Volumetric Spirometers Water bell Bellows wedge

Flow measuring Spirometers Fleisch-pneumotach Lilly (screen) pneumotach Turbine /Stator Rotor (normally incorrectly referred to as a turbine.

Actually a rotating vane which spins because of the air flow generated by the subject. The revolutions of the vane are counted as they break a light beam)

Pitot tube Hot-wire anemometer Ultrasound

See also

Peak flow meter Nitrogen washout

References

1. Jump up ̂ American Academy of Allergy, Asthma, and Immunology, Five Things Physicians and Patients Should Question, Choosing Wisely: an initiative of the ABIM Foundation (American Academy of Allergy, Asthma, and Immunology), retrieved 14 August 2012

2. Jump up ̂ Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (NIH Publication Number 08-5846 ed.). National Institutes of Health. 2007.

3. Jump up ̂ Bateman, E. D.; Hurd, S. S.; Barnes, P. J.; Bousquet, J.; Drazen, J. M.; Fitzgerald, M.; Gibson, P.; Ohta, K.; O'Byrne, P.; Pedersen, S. E.; Pizzichini, E.; Sullivan, S. D.; Wenzel, S. E.; Zar, H. J. (2008). "Global strategy for asthma management and prevention: GINA executive summary". European Respiratory Journal 31 (1): 143–178. doi:10.1183/09031936.00138707. PMID 18166595.

4. ^ Jump up to: a b c d e f g h Pierce, R. (2005). "Spirometry: An essential clinical measurement". Australian family physician 34 (7): 535–539. PMID 15999163.

5. Jump up ̂ surgeryencyclopedia.com > Spirometry tests. Retrieved 14 March 2010.6. Jump up ̂ MVV and MBC7. Jump up ̂ Stanojevic S, Wade A, Stocks J, et al. (February 2008). "Reference Ranges for Spirometry Across

All Ages: A New Approach". Am. J. Respir. Crit. Care Med. 177 (3): 253–60. doi:10.1164/rccm.200708-1248OC. PMC 2643211. PMID 18006882.

8. ^ Jump up to: a b Perez, LL (March–April 2013). "Office spirometry". Osteopathic Family Physician 5 (2): 65–69. doi:10.1016/j.osfp.2012.09.003.

9. ^ Jump up to: a b c d LUNGFUNKTION — Practice compendium for semester 6. Department of Medical Sciences, Clinical Physiology, Academic Hospital, Uppsala, Sweden. Retrieved 2010.

10. ^ Jump up to: a b c Interpretation model — compendium at Uppsala Academic Hospital. By H. Hedenström. 2009-02-04

11. Jump up ̂ Simon, Michael R.; Chinchilli, Vernon M., Phillips, Brenda R., Sorkness, Christine A., Lemanske Jr., Robert F., Szefler, Stanley J., Taussig, Lynn, Bacharier, Leonard B., Morgan, Wayne (1 September 2010). "Forced expiratory flow between 25% and 75% of vital capacity and FEV1/forced vital capacity ratio in relation to clinical and physiological parameters in asthmatic children with normal FEV1 values". Journal of Allergy and Clinical Immunology 126 (3): 527–534.e8.doi:10.1016/j.jaci.2010.05.016.

12. Jump up ̂ Ciprandi, Giorgio; Cirillo, Ignazio (1 February 2011). "Forced expiratory flow between 25% and 75% of vital capacity may be a marker of bronchial impairment in allergic rhinitis". Journal of Allergy and Clinical Immunology 127 (2): 549–549. doi:10.1016/j.jaci.2010.10.053.

13. Jump up ̂ Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, Coates A, van der Grinten CP, Gustafsson P, Hankinson J, Jensen R, Johnson DC, MacIntyre N, McKay R, Miller MR, Navajas D, Pedersen OF, Wanger J (November 2005). "Interpretative strategies for lung function tests". The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology 26 (5): 948–68. doi:10.1183/09031936.05.00035205. PMID 16264058.

14. Jump up ̂ Kreider, Maryl. "Chapter 14.1 Pulmonary Function Testing". ACP Medicine. Decker Intellectual Properties. Retrieved 29 April 2011.

15. Jump up ̂ Nunn AJ, Gregg I (April 1989). "New regression equations for predicting peak expiratory flow in adults".BMJ 298 (6680): 1068–70. doi:10.1136/bmj.298.6680.1068. PMC 1836460. PMID 2497892. Adapted by Clement Clarke for use in EU scale — see Peakflow.com ⇒ Predictive Normal Values (Nomogram, EU scale)

16. Jump up ̂ MedlinePlus Encyclopedia Lung diffusion testing17. Jump up ̂ George, Ronald B. (2005). Chest medicine: essentials of pulmonary and critical care medicine.

Lippincott Williams & Wilkins. p. 96. ISBN 978-0-7817-5273-2.18. Jump up ̂ Sud, A.; Gupta, D.; Wanchu, A.; Jindal, S. K.; Bambery, P. (2001). "Static lung compliance as an

index of early pulmonary disease in systemic sclerosis". Clinical rheumatology 20 (3): 177–180. doi:10.1007/s100670170060. PMID 11434468.

19. Jump up ̂ Rossi A, Gottfried SB, Zocchi L, et al. (May 1985). "Measurement of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation. The effect of intrinsic positive end-expiratory pressure". The American review of respiratory disease 131 (5): 672–7. PMID 4003913.

20. Jump up ̂ Lausted, C.; Johnson, A.; Scott, W.; Johnson, M.; Coyne, K.; Coursey, D. (2006). "Maximum static inspiratory and expiratory pressures with different lung volumes". Biomedical engineering online 5 (1): 29. doi:10.1186/1475-925X-5-29. PMC 1501025. PMID 16677384. [1]

21. Jump up ̂ Borth, F. M. (1982). "The derivation of an index of ventilatory function from spirometric recordings using canonical analysis". British Journal of Diseases of the Chest 76: 400–756. doi:10.1016/0007-0971(82)90077-8.

22. Jump up ̂ Page 352 in: Irwin, Richard (2008). Procedures, techniques, and minimally invasive monitoring in intensive care medicine. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 078177862X.

23. Jump up ̂ Sachs MC, Enright PL, Hinckley Stukovsky KD, Jiang R, Barr RG, Multi-Ethnic Study of Atherosclerosis Lung Study (2009). "Performance of maximum inspiratory pressure tests and maximum inspiratory pressure reference equations for 4 race/ethnic groups.". Respir Care 54 (10): 1321–8. PMID 19796411.

24. Jump up ̂ [2] "Predicted normal values for maximal respiratory pressures in caucasian adults and children", SH Wilson, NT Cooke, RHT Edwards, SG Spiro

Further reading

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J (July 2005). "General considerations for lung function testing". European Respiratory Journal 26 (1): 153–161. doi:10.1183/09031936.05.00034505. PMID 15994402.

External links

Wikimedia Commons

has media related

to Spirometry.

Detailed information on spirometric testing, interpretation and physiology at spirxpert.com

General information on spirometry at spirometry.guru Detailed information on interpretation of flow-volume curves including

examples General information on spirometers and spirometry American Thoracic Society (ATS) European Respiratory Society (ERS) General Practice Airways Group

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