Uses of Spirometry in Clinical Practice - Essay Example

?Uses of Spirometry in Clinical Practice: Introduction: This paper is primarily based on contemplating the relevance of one of the most important andeffective investigations in the field of clinical medicine, spirometry and explaining myriad benefits offered by this investigation in diagnosing various ghastly diseases. The significance and critical importance of the advantages associated with spirometry are undeniably acclaimed all over the globe since it is considered to be the most common of all the pulmonary function tests (PFTs) by expert physicians and clinical medicine researchers. Basically, a spirometry investigation requires the patient to breath into a mouthpiece that is connected to the instrument called a spirometer. Accurate test measurements depend upon the effectiveness of the spirometer which measures the amount and rate of air breathed in and out over a set time period. As there are myriad indications for this imperative investigation, some of those require the patient to inhale quietly while others require forced inhalation or exhalation into the spirometer by the patient. The primarily important use of spirometry is measuring and recording the rate of how active an individual’s lung function is, while majorly focusing on the amount and rate of air flow in an out of the lungs. All the physicians profoundly depend on this investigation for diagnosing or assessing many important lung disorders like COPD, cystic fibrosis, or asthma. Spirometry is able to address a broad range of diseases: Based on the ability to measure the amount of air exhaled and the speed with which a person is able to exhale, spirometry is sufficiently able to assess a broad range of diseases. There are some diseases in which too much air is entrapped in the lungs like in emphysema and chronic bronchitis, while others bring on conditions in which the lungs get scarred and are reduced to a smaller size so that they contain too little air like in cystic fibrosis and asbestos. So, spirometry is unequivocally a valuable tool to address a broad range of lung diseases since knowing how much air is being inhaled/exhaled and the speed which the patient is able to maintain during respiration means a lot to the physician and helps him/her in reaching to the closest possible diagnosis. According to physicians and research studies, ensuring the availability of the primarily important investigatory machines and testing tools among testing equipment in the operation theatres has phenomenally impacted the environment and the way in which operation procedures are carried out. “With the availability of real-time intraoperative spirometry in the current generation of anesthesia machines, it has become possible to continuously monitor inspiratory and expiratory volumes, pressures, and flows.” (Slinger, 2011, p. 268). This shows that the role performed by spirometry in clinical practice is undeniably effective and important due to the fact that incorporation of this testing tool in the anesthesia machines makes the continuous reading of any change that may occur in the air volume, pressure, and airflow rate during anesthesia possible. Thus, keeping a record of the air volume and speed of airflow with the help of generating pneumotachographs seems to be the hallmark of spirometry, making it one of the most important PFTs currently in clinical practice. Valuable role of breath-by-breath intraoperative spirometry: There is a negative impact on expiratory airflow rate and volume in patients with diseased lung conditions like bronchospasm and COPD, and timely assessment of such negative impact without which grave consequences can be produced is critically important. Spirometry serves that purpose and in those persons who already have grave pulmonary disorders or are at risk of developing post-operative complications, breath-by-breath spirometry during anesthesia is capable of introducing widely acclaimed possibilities like radically reducing the incidence of lung injury during operation or providing guidance to the physician for timely detection of an incorrectly positioned double lung transplantation (DLT). This is a fact that a large number of patients develop complications like small airway dysfunction after lung transplantation. Defectively positioned DLT can lead the level of expiratory volume to decrease well below the level of inspired air volume, as shown by pressure-volume and flow-volume graphs which are3 generated by spirometry. Unintentional but wrong guidance of DLT in patients with preexisting pulmonary diseases produces characteristic changes on pneumotachographs. For foolproof DLT, breath-by-breath spirometry serves a critical function and informs the physician about any mistake he/she may commit during the highly sensitive surgical procedure. In an order to prevent the patients from developing a progressive deterioration in pulmonary function over time following lung transplant, every physician must take advantage of breath-by-breath intraoperative spirometry during surgeries. Similarly, ventilatory settings are individualized to respective patients and being able to expertly optimizing those settings hold critical importance. Intraoperative spirometry helps physicians in optimizing the ventilatory parameters in respect to each individual patient who has preexisting lung disorders. Spirometry during anesthesia reduces the risk of surgical complications: Another highly important function served by intraoperative spirometry is reducing the incidence of surgical complications by identification of auto-PEEP (persistent end-expiratory flow) especially during anesthesia with OLV (one-lung ventilation). Like misguidance during DLT can lead to progressive pulmonary damages, occult auto-PEEP exposes the patient to many bizarre conditions like hemodynamic instability, baroreceptor trauma, hyperinflation, and increased exertion during breathing for patients with COPD. Occult auto-PEEP is one of the leading causes of death during surgical operations all around the globe. Incorrect measurement of auto-PEEP and maximal inspiratory pressure during surgical anesthesia is profoundly capable of marring the effectiveness of pressure-support ventilation (PSV). Measurement of auto-PEEP is profoundly important during surgeries since PSV allows the patient to master even breathing while reducing the work of breathing for him/her. PSV is a critically useful ventilation strategy which offers huge clinical benefits during surgical anesthesia when spontaneous breathing is required from the patient so that workload of breathing could be decreased. When physicians do not take care to correctly measure auto-PEEP with the help of intraoperative spirometry, there is hyperinflation and increased work of breathing for the patients apart from detrimental effects on hemodynamics and hyperinflation. (Slutsky and Brochard, 2004, p. 371). Measuring respiratory system resistance and a person’s vital capacity are two other important facilities made possible by spirometry. In chronically obstructed patients like in COPD, correct and timely evaluation of airway resistance is highly important. Similarly, spirometry also allows measuring vital capacity of a patient which refers to the maximum amount of air or air volume that can be inhaled or exhaled. This measurement is an essential requirement in clinical practice for assessing the condition of COPD in a patient. Thus, TLC measurement with the help of spirometry helps the physicians in confirming the nature or spread of an obstructive disease. Role of siprometry in pulmonary diseases with obstructive pattern: Considering the above discussion related to various functions performed by spirometry, contemplating the worth of those functions is important because despite all the essential measurements it is capable of performing, spirometry still remains an underutilized tool especially in underdeveloped countries according to clinical medicine research studies. Many doctors in India, for instance, are still not fully aware of the benefits associated with practicing spirometry in their offices thinking this investigatory tool should be used only in big hospital setups, which is a misconception. By incorporating spirometry testing tool in offices, doctors can readily arm themselves with a highly sensitive evaluating tool that is acclaimed for being capable of detecting any change that may occur because of pulmonary diseases with obstructive pattern. National Lung Health Education Program is the name of an effective effort to raise awareness among the public and physicians about PFTs and spirometry specifically. (Leader, 2011). The primary mission of the people working under this program is to raise the number of physicians who rely on spirometry in general practice for diagnosing COPD, as research studies report that no more than 30% doctors around the globe presently use spirometry in general practice. Diagnosing COPD or evaluating the rate of pulmonary destruction caused by this disease remains incomplete or incredible without relying on spirometry. In all the pulmonary diseases with obstructive pattern like asthma or COPD, both FEV1 (forced expiratory volume in one second) and FVC (forced vital capacity) are reduced which serves as the basis of diagnosis and this is confirmed by taking advantage of the spirometry test. Knowing exactly how much air is being expelled from the lungs during the first second of expiration (FEV1) holds utmost importance for judging the severity of many pulmonary diseases and evaluating the rate of this expirated air volume is unable without using spirometry as an investigatory tool, because this investigation shows FEV1 to be markedly reduced in COPD, as already mentioned. Conclusion: Summing up, this remains a fact that though spirometry may be an underutilized investigatory tool in the underdeveloped countries presently, the benefits associated with this testing tool from assessing the severity of a disease to measuring and optimizing myriad important ventilatory parameters are undeniably critical and widely acclaimed in clinical practice. Therefore, discussing the uses of spirometry in clinical practice is highly important for assessing the severity of pulmonary diseases. A physician must get acknowledged with the specific rate of airway resistance in a patient and air volume that is inspired or expired by using spirometry before initiating the surgical procedure. References: Leader, D 2011, “Pulmonary Function Tests”, viewed 06 September, 2011, < http://copd.about.com/od/copd/a/pfts.htm> Slinger, P 2011, Principles and Practice of Anesthesia for Thoracic Surgery, Illustrated, Springer, Canada. Slutsky, AS and Brochard, L 2004, Mechanical Ventilation, Illustrated, Springer, NYC. Read More