COPDSpirometry.pptVIP

Payment rules vary by state and by Medicare intermediary regarding medical necessity, frequency per year etc. * * In general , spirometry is financially beneficial for most practices. * Spirometer Review Process (SRP) – Revised. Ferguson, 2000 * * Jing, 2009 * * * A patient who does not make a maximal effort will have a spirometry curve and values which falsely look to represent obstruction. Patients are unable to consistently blow sub-maximally however, and therefore three FEV6 measurements within 5% of one another will be accurate * AARC Clinical Practice Guideline,1996 * Blain, 2009 Poels, 2006 Kaminsky, 2005 * Basic spirometry involves only the measurement of forced vital capacity (FVC) and the forced expired volume in the first second (FEV1). The ratio between the two is a self-controlled statistic which tells if obstruction is present. FVC and FEV1 can be measured against predicted values. PEFR is not reproducible enough measurement for accurate diagnosis, but may be used more for following progress with asthma. FEF 25-75% is a measurement of smaller airway function but this measurement is usually not clinically useful. * It is important to enter the accurate values for patient’s bio-demographic variables in order to have an accurate test, otherwise over or under-diagnosis can happen. When the values say 150% of predicted, one should re-enter the variables. There is debate over the different relationship between lung function and age before and after bronchodilation, so there is research to establish different “normal” values for post-bronchodilation spirometry. Johannessen, 2006 Hankinson, 1999 Knudson, 1976 * * GOLD guidelines no longer require “reversibility testing”, but consider it sufficient to have post-spirometry evidence of obstruction (FEV1/FVC 70) (Some machines read this as FEV1% 70) * * This slide shows a sample printout from a spirometry machine. Of note only the FVC, FEV1 and FEV1% are necessary for interpretation. Also,