ATS Pulmonary Function Laboratory Manual

ATS Pulmonary Function Laboratory Management & Procedure Manual | 3rd Edition

Table 6.3

Relative contraindications for spirometry Spirometry should not be performed within 1 month of a myocardial infarction (5) Conditions where suboptimal lung function results or test performance are likely (5): 1. Chest or abdominal pain 2. Oral or facial pain by mouthpiece 3. Stress incontinence 4. Dementia or confused state 5. In ability to follow instructions because of young age (e.g., < 6 years) Other contraindications and waiting period before spirometry testing include (15): 1. Recent eye surgery (1 week to 6 months depending on type of surgery) 2. Recent brain surgery or injury (3 to 6 weeks) 3. Pneumothorax (2 weeks) 4. Hemoptysis of unknown origin

6. Scales for measuring height, weight, tape measure for arm span 7. Metered dose inhaler (MDI), small-volume nebulizer with compressed gas source, and reservoir (spacer) for bronchodilator/challenge tests. Patient Preparation (Pre-Test Instructions) 1. The patient should refrain from smoking for at least 1 hour before the test (5). 2. The patient’s chest expansion should not be restricted by tight fitting clothing (e.g., belts or vests). 3. If reversibility testing is to be performed, the patient should withhold respiratory drugs (with permission of their physician) prior to testing. Guidelines for how long these medications should be withheld prior to reversibility testing include:

Bronchodilator Medication

Length of Abstention

Short-acting beta agonists (e.g., albuterol, salbutamol)

4–6 hours 6 hours 12 hours 24 hours

Ipratropium (Atrovent)

Long-acting beta agonists (e.g., formoterol, salmeterol) Ultra long-acting agents (e.g.,tiotropium, indacaterol, vilanterol)

When spirometry is done in follow-up to assess ongoing management, it is appropriate to instruct the patient to maintain their daily bronchodilator regimen. The clinician may still request post-bronchodilator testing to look for further acute reversibility. Time of prior dosing of all bronchodilator medications should be noted in the report. 4. A brief history should be obtained (16). Collection of clinical information will enhance the interpretation of spirometric data. The history might include questions about: • Breathlessness

• Cough and sputum production • Wheezing or symptoms of asthma

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