ATS Pulmonary Function Laboratory Manual

chapter  6

• Smoking history, including years of smoking, packs per day, and current smoking status • Known lung disease, chest injuries, and chest operations • Work history, including occupational exposure to dust, and respiratory irritants • Current medications, dosages, and time last taken. 5. Measure the patient’s height in centimeters (cm) to nearest 0.5 cm, or in inches (in) to nearest 0.25 inch while he/she is standing erect, bare-footed or in stocking feet, with their head looking straight ahead. A stadiometer is the ideal device for height measurement. 5.1. If the patient is unable to stand, or has marked spinal deformity (e.g., kyphoscoliosis), an arm span measurement may be used to estimate standing height. Have the patient stretch the arms in opposite directions and attain the maximal distance between the tips of the middle fingers. For Caucasian men, height = arm span/1.03; for African-American men, height = arm span/1.06; and for women, height = arm span/1.01 (24). 6. The patient’s weight should be measured using an accurate scale; weight is not required for most reference values for spirometry but may be useful for interpretive purposes. Weight may be recorded in kilograms (kg) to nearest 0.5 kg, or in pounds (lb) to the nearest lb. 7. The patient’s age should be recorded in years as their age on day of testing. Comparison to reference data is more accurate if age is entered by birthday (and converted by software to days to date of test) or years to 0.1 years; this is especially true for children who can have rapid growth (18). 8. Spirometry may be performed with the patient sitting or standing (6). Sitting is preferable for safety rea- sons to avoid falling due to syncope. If the sitting position is used, the patient should sit up straight and have both feet on the floor. If the standing position is used, a chair with arms and without wheels should be positioned near the patient so they can be quickly and easily eased into a sitting position if he/she becomes light-headed during the testing. The position used for testing should be recorded on the report, and longitu- dinal studies should consider using the same test position each time. Assessment of Patients 1. Assess each patient for oxygenation status and tolerance to room air if they arrive on supplemental oxygen. 2. Assess each patient for physical and developmental status to determine their ability to perform the test(s) and if special arrangements are required. If there is a language barrier, an interpreter will be used. 3. Record whether or not the patient has complied with the preparation criteria, including: 3.1. If they have recently smoked, and if so, when; 3.2. The time of their last meal; 3.3. Current use of pulmonary medications, dosage, and number of hours taken before the start of testing. 4. Postponement may be necessary if the patient has not complied with the preparation criteria. The ordering physician is to be contacted to determine if rescheduling is necessary. 4.1. In the event the ordering physician cannot be contacted, the laboratory medical director (or designee) should determine if testing should proceed. 5. Optimally, relevant clinical information including the clinical indication for ordering the test should be provided in writing by the ordering physician.

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