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Technical terms you may hear after spirometry tests

FEV1 or Forced Expiratory Volume 1

  • The maximum volume of air forced out from your lungs in 1 second (from full deep breath in).

FVC or Forced Vital Capacity

  • The FVC is measured by taking your biggest breath in (total lung capacity) and blowing out as fast as possible until you cannot breathe out any more.

Spirometry tests show the amount of air that comes out in the first second (FEV1) as a percentage of the total volume air blown out.(FVC)

The two results together (FEV1 and FVC) are used to calculate the level of your COPD as a percentage of the predicted value for someone of a similar age, height and weight. For example a normal test would be 80% or more predicted value. Very severe COPD could show a predicted value of 30% or less.

Your treatment will depend on the results of your spirometry test and this will be discussed with you by your respiratory team. Results are usually classified in to mild, moderate, severe or very severe depending on the percentage of how well your lungs are working.

When you have your spirometry test

Female patient breathing into a spirometry tube, wearing nose clipsWhen you have your test.

  • You will be given clear instructions from staff about what you have to do before the test and how to perform the test on the day.  Do ask questions if you are not sure.
  • During the spirometry test you have to blow out as hard and as fast as you can (this is really important or results could be inaccurate).
  • You will be asked to do the forced breathing test at least three times to get consistent results.
  • Because you have to force air out quickly, it can make you feel a little light headed at the end of the breath. The staff will look after you and help if you do feel dizzy.
  • The test requires your co operation and effort for the forced breath out. Some people may find it difficult to follow the instructions or to control their breathing during the test. If you are not sure what you have to do ask staff to explain again.
  • Nose clips will be used to stop any air escaping which may lead to false results.

Reasons for postponing a spirometry test

Spirometry testing may be postponed

  • If you have had recent surgery.
  • If you have had a chest infection within the past 6 weeks as this may give unreliable results.
  • If you have had a recent condition called pneumothorax. (This is an abnormal collection of air in the space between lungs and chest wall called the pleura and it interferes with normal breathing).
  • If you have had a recent operation to your eyes or ongoing eye problems. Spirometry tests can increase pressure in the eyes during the test.
  • If you have heart problems which are unstable this may prevent you having the test.
  • If you have been diagnosed with an Aneurysm – in the brain or abdomen. (An Aneurysm is weakness in the wall of a blood vessel causing a bulge) there is an increased risk this may burst due to increased pressure during the spirometry test.
  • If you feel sick or are sick (as this may affect your effort).

What happens at Spirometry? Before your test

Female patient having height taken by a female nurse

Before your spirometry test you may be asked:

  • Not to take your medication, as this may be assessed during test or it may affect the results.
  • Not to take vigorous exercise prior to testing.
  • Not to smoke, stop smoking for a short time before your test.
  • Do not eat a heavy meal before your test.
  • To avoid alcohol before your test.
  • To have your height and weight will be measured. This can help to calculate or predict what would be considered to be normal results for someone of your height and weight.
  • To take your medication with you. Medication and your general health will be checked before proceeding with test.

What is spirometry

Female patient with clinician in hospital room

Spirometry is:

  • A test to show how your lungs are working.
  • One of the first tests which may be carried out to investigate any respiratory symptoms such as shortness of breath, cough or wheeze.
  • The test can show if the narrowing of your airways is reversible or not and this helps with the diagnosis of either asthma or COPD.
  • Used to measure how much air can be quickly blown out of your lungs in 1 second (this is called your FEV1 or Forced Expiratory Volume 1).
  • Used to measure the full amount of air that can be breathed out FVC or Forced Vital Capacity. (There will always be a small amount of air which remains in your lungs to prevent them from collapsing).

The respiratory team roles

These are some of the respiratory team members that you may meet. However, not all teams will have access to the same members, this will depend on where you live.

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Primary care team

GP

  • Medical history.
  • Listen to your lungs.
  • Refer for X-ray.
  • Refer for Simple breathing tests with the Practice Nurse or Healthcare assistant or Clinical Physiology GP Spirometry service if available.
  • Prescribe medication – inhalers as appropriate.
  • Communicate with Respiratory Consultant in the hospital.

Practice nurse

  • General observations.
  • Perform simple peak flow and tests such as spirometry if appropriate.
  • Reversibility study, if appropriate.
  • Inhaler technique if appropriate.

Hospital respiratory care team

Respiratory consultant

  • Medical history.
  • Listen to your lungs.
  • Review of X-ray, possible repeat.
  • Refer for further CT, MRI as appropriate.
  • Review Spirometry, possible repeat.
  • Refer of full breathing tests.
  • Refer for Specialised breathing test

Respiratory specialist nurse

  • General Observations.
  • Perform simple peak flow and/or Spirometry test.
  • Reversibility study, if appropriate.
  • Review and/or prescribe medications
  • Inhaler technique if appropriate.
  • Refer for full breathing tests.

Specialist pharmacist

  • Advice and review current medication.
  • Advice and dispense medication.
  • Advice about inhaler technique.
  • Explain what your medication is for and any side effects.

Clinical physiologist

  • Assess full lung function.
  • Assess effectiveness of inhaled treatment.
  • Assess hypersensitivity using challenge tests.
  • Report findings to Respiratory Consultant.

Respiratory physiotherapist

  • Advice on lung disease and exercise.
  • Specialist advice and treatment for abnormal breathing patterns such as hyperventilation. How to relax and retrain your breathing.
  • Helping with breathlessness management.

Occupational therapist

  • Assessment and discharge planning from hospital
  • Assessment of personal activities of daily living, transfers, mobility and practice of these skills for a safe discharge
  • Provision of equipment
  • Conserving energy to manage daily activities
  • Planning and pacing activities, and fatigue management in order to manage daily activities in the most efficient way

Dietician

People with breathing problems may have increased difficulties eating and drinking and thus lose weight, putting them at an increased risk of malnutrition. A dietician’s role is to:

  • Maintain or improve body weight
  • Reduce muscle wasting
  • Meet daily recommended requirements of all nutrients
  • Offer nutritional support: Nutritional high energy and protein drinks/puddings may be provided
  • follow up after discharge to review

Psychologist

  • Minimize distress and disability associated with respiratory disease through psychological interventions
  • Pulmonary rehabilitation groups
  • Support patients’ adaptation to respiratory disease

Frequently asked questions

Diagnosis and tests

Q: Sometimes doctors tell me I have asthma sometimes COPD - why is this?

COPD is an umbrella term that is used to describe a mix of lung conditions. This includes chronic bronchitis and emphysema. Most people will have a mix of conditions. It might be that your doctor suspects that you have a greater degree of chronic asthma which can have similar symptoms but the cause is different.

Q: What are the similarities/differences between Asthma and COPD?

Both diseases cause narrowing of the breathing tubes (airways) which can cause breathlessness and wheeze. However, some of the airway narrowing in asthma may be reversible (though not always). The airway narrowing in COPD cannot be reversed. In both cases, taking your inhalers correctly can improve your symptoms.

Q: Why do I have to keep doing breathing tests?

These tests will check if your COPD is being well controlled or not. Your treatment can be adjusted depending on the results of the tests.

Q: Can I have normal spirometry and COPD?

Yes, some people with pure emphysema and no airways disease may have changes which can only be seen in more detailed lung function tests. For more information please see our sections on Peak flow and Spirometry.

Smoking

Q: Why have I got COPD? I have never been a smoker.

There are different causes of COPD. It may be that you have chronic asthma, a genetic deficiency or were exposed to an environmental irritant as a child or when at work. You can have COPD if you are exposed to passive smoke or second hand smoke from another person.

Q. Why should I stop smoking?

Quitting smoking is the one most important thing you can do to improve your COPD or prevent further lung damage. It also helps improve your general health and reduces the risk of developing other serious health problems.You can get lots of help and support to do this. See our section on help to stop smoking.

Q: I only smoke cannabis - am I still at risk?

Yes. There is evidence that COPD is linked to cannabis use especially when mixed with tobacco. You are less likely to use a filter and the smoke you inhale is hotter than that of tobacco. Some types of cannabis are much stronger than others. Some research suggests an increased risk of fungal and respiratory infections. Doctors are starting to see younger people with emphysema if they have been long term cannabis users.

Inhalers

Q: What’s the best inhaler?

Your doctor or respiratory specialist will advise you on the best inhaler for you. This may depend on your symptoms, if you can use one type of inhaler more easily than another or the best way to get as much of the medicine in to your lungs. Some inhalers are for prevention of symptoms. Some are for relief of symptoms and some contain different types of medicine. Which ever inhaler you use you should have your inhaler method checked by your healthcare professional to make sure you are using your inhaler correctly to get the most benefit from it. For more information see our section on A practical guide to inhalers

Q: Why are my inhalers different to my neighbour?

Your doctor has prescribed for you not for anyone else. You may not have the same condition, cause or symptoms. Never use someone else’s inhaler. If you are concerned that your inhaler is not working as well as it should, see your GP, practice nurse or pharmacist.

Q: How quickly does my inhaler work?

There are three main types of inhaler Short acting relievers, long acting relievers and preventers. Short acting relievers work quickly to relieve symptoms. Long acting relievers are usually taken twice a day and may take 30 minutes to work but the effects can last up to 12 hours. Preventers have a combination of inhaled reliever and steroids which help to reduce inflammation. They do not work instantly but are taken regularly over a period of time for best effect. You should have a review of how you take your inhaler at least once a year to make sure you are using the most effective method or inhaler technique. Your GP, respiratory nurse or a pharmacist can help with this.

Q: How do I clean my inhaler?

This will depend on the type of inhaler you use. The manufacturer should give instructions with you inhaler. You can ask at your pharmacy or see our section on A practical guide to inhalers for a step by step guide.

Nebulisers and oxygen

Q: Why won’t my doctor give me a nebuliser when it made me feel so much better when I was in hospital?

Once stable most people don’t need nebulised treatment although they are helpful when your breathing is worse than usual. Nebulisers should only be used when prescribed by your doctor or while you are in hospital.  Most people with COPD symptoms can be successfully controlled by medication and inhalers if they are taken correctly. If you do need a nebuliser you will be given details of how to get one. This may vary depending on where you live. You should not buy a nebuliser unless advised to do so by your healthcare professional. Your GP may not prescribe the liquid medication to go into the nebuliser unless the nebuliser has also been prescribed as part of your treatment plan.

Q. How do I clean my nebuliser?

You should follow the instructions from the manufacturer for your nebuliser. It should be cleaned daily or after each use. Use warm water and a mild detergent. Leave all the parts to air dry.

Q: Why don’t I have oxygen when I'm obviously breathless?

Being breathless and needing oxygen are sometimes different. Not everyone who is breathless will need oxygen. Some people with COPD are breathless because their airways are narrowed but they still have normal levels of oxygen in their blood. Anxiety, stress or having to work harder to breathe can make you feel breathless. Correcting these causes can help you to cope better with your breathing and help you to feel more comfortable. For more information see our sections on;

Daily living

Q. What benefits am I eligible for?

Each person is different so you should get help if you are having difficulty with money because of your COPD, for example help with fuel bills in winter or if you have been advised to stop working because of your COPD. The UK benefits system is changing and it is complicated to try to understand. Contact your local authority social work office benefits department, Department of Work and Pensions or Citizen’s Advice. For more information please see: Chest Heart & Stroke Scotland factsheet: Financial support [.pdf]

Q. Can I get a Blue Badge for parking?

There are strict rules for blue badge applications. If you receive High rate mobility component of the Disability Living Allowance or Personal Independence Payment (moving around component) or the mobility supplement of a War pension, you will be entitled to a blue badge. If you can only walk 50 meters or less you may also be eligible. See the link to Scottish Government website for more details and application.

Q. I am caring for someone with COPD. Can I claim Carer allowance?

You may be able to claim if the person you care for has a qualifying benefit themselves. For example attendance allowance. You have to be over 16 years old, not in full time education. If you care for over 35 hours a week and earn less than £100 per week. If you need help to make a claim seek help from your local carer organisation such as Carers UK website.

Q. How do I get some aids and adaptations at my house?

You should contact your local authority and ask for an Occupational Therapy assessment. Your GP or practice nurse may also be able to help you by making a referral or get some small equipment items for you. They would have to make a referral for any adaptations to your home. An adaptation is any change to the structure of your home for example changes to install a stair lift, shower room or a ramp outside your house. There may be a waiting list for assessment and also there may be a financial cost for part of the cost depending on your income. Some local authorities can give you small items of personal equipment by mail order or from their internet websites.

Managing exacerbations

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Pulmonary rehabilitation for COPD patients

An exacerbation or flare up is as a worsening of your symptoms from your usual stable state, which is not within your normal day-to-day variations.  It can start suddenly.

There will be a discussion about how you manage with breathlessness on a day to day basis and how you cope if you have a flare up or an exacerbation such as an infection. Sometimes you may be offered “stand by” or “rescue” medicine to keep at home. You will be given instructions about how and when to take them. They are used to treat an exacerbation as soon as you start to feel unwell. Quick treatment means fewer symptoms, fewer complications and fewer hospital admissions.

Even though COPD cannot be cured there are lots of ways you can improve your symptoms and manage your condition in the long term.

Pulmonary rehabilitation is a programme of exercise and group discussions which has been proven to make a big difference to how people cope with COPD. For more information please see our section on Pulmonary rehab.

Treatments


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Treatments: medications, inhalesrs, nebuliser and oxygen

If you have increasing symptoms of COPD you may be recommended some of the following:

  • Tablets
    You will have your tablets reviewed and you may be prescribed different types or strengths, these may be one or a combination of tablets to:
    • break up sticky secretions in the airways
    • ease your breathing by acting on the muscle in the breathing tubes
    • reduce the feeling of breathlessness
  • Inhalers
    You will be assessed on using your inhaler to make sure you are taking it correctly to get the maximum effect and you may be changed to a new one or have a change in strength of your current one.
  • Nebulised treatments
    Nebulisers are an alternative form of breathing in medication using a special machine and face mask. However few people will need this at home.
  • Oxygen
    You may have a special assessment to see if you would benefit from having oxygen available at home. This is because not all patients who are breathless, benefit from oxygen.