Spirometry

Spirometry is a diagnostic pulmonary function test. Relatively easy to perform, for both the patient and the clinician, Spirometry testing is noninvasive. The spirometry tests measure lung volumes. There are many reasons spirometry testing is done. Most common would be to assess lung function in disease process, but studies are also done in exercise testing for lung capacity and expenditure of oxygen. Speech Language Pathologists are also concerned with Spirometry testing. The lungs are the power house of speech; therefore in assessing speech disorders, it is necessary to understand lung volumes and their role in speech production.
Physicians such as lung specialists, or Pulmonologists, perform lung function studies to assess and diagnose a variety of patient conditions. The most common is COPD, or Chronic Obstructive Pulmonary Disease. According to the National Heart Lung and Blood Institute page, on the NIH website, COPD is 3rd leading cause of death. COPD should be considered with any adult that exhibits shortness of breath. Other disease processes that Spirometry is useful for: to diagnose and manage asthma, assess impairment in occupational asthma, to differentiate between obstructive and restrictive airway disease, pre-operation assessment for anesthesia administration. Also, spirometry testing is useful to follow lung disease history, and assess response to lung treatments.
Pulmonary testing and equipment has seen much technological advancement through centuries, since the first known test of this kind was performed around 200 A.D., by a Greek physician, Claudius Galen. He used an animal bladder to perform his experiments. Today Spirometry equipment is accurate computerized technology, can be portable, while specialized tests like Plethysmograph, is done inside a closed chamber. The computer software reads the results, records the information on a graph. The apparatus consists of a mouthpiece that the patient will breathe into, connected to a hose that is attached to the computer. Inside the mouthpiece and hose there are sensors that allow the flow of air inhaled and exhaled to be measured. The mouthpiece is disposable for infection control purposes. A nose piece must be utilized; to clamp off the nares and insure that all air inspired or expired is coming through the mouth.
Basic spirometry allows the air volume that enters and exits the lungs, along with the rate and force of the exchange to be measured. Normal lung volumes for gender have been established and the test results are compared to these baselines. Before the procedure, basic information about the patient will be assessed, such as height, weight, medical history, and a careful respiratory history, along with respiratory medications. Assessment of medications is important, as some medications will need to be withheld prior to the testing. In other tests, such as the Post Bronchodilator Test, a medication is going to be administered to achieve the results needed. The test is always performed with the patient sitting down, with safety in mind, as the inspiration and forced expiration can cause a patient to faint. Education on test procedure, and why test is being performed is important for the patient prior to testing, because Spirometry relies on patient compliance for complete and accurate results. Also, complete education can prevent typical errors, such as not exhaling to max capacity, taking an extra breathe, or air leak around lips. Spirometry testing is limited to those patients that can understand and follow the instructions, young children that cannot follow the directions, and patients with altered consciousness are unable to perform this type of test.
A Speech Language Pathologist will be concerned with client respiratory status in performing assessments for speech and voice disorders. It is important to know when a referral for pulmonary function testing would be necessary, in order to allow the client the most positive outcome with speech and voice therapy. Vital to speech, is the power of the lungs, inspiration and expiration are necessary for the vocal folds to vibrate and produce sound. A clients inability to adequately fill the lungs and will result in poor expiratory quality, affecting the sound produced. A breathy voice or low pitch could be due to lung dysfunction or disease process. Breathing technique can be taught to improve sound quality. Overall health improvement found through diagnosis and treatment of lung disorders can assist the client in voice production.
Incentive Spirometry is related to Spirometry testing, loosely. Incentive Spirometry is a breathing exercise tool that can assist the client in gaining more breathing power to improve speech. A simple apparatus, the Incentive Spirometer is a clear plastic device, with an attached hose and mouth piece. The cylindrical body of the Incentive Spirometer is marked with gradient volumes, and a baffle inside moves when air is drawn out, indicating the volume inspired. The process is simple: the mouthpiece is fitted inside the lips, the patient takes a breath in and holds it for several seconds, and then gently releases the breath. This process is repeated several times, generally ever hour or two for the prescribed time period. This exercise can be recommended by the Speech Language Pathologist to assist the patient in building breath quality for speech.

Works Cited
Booker, R. (2007). Retrieved from NursingTimes.net: http://www.nursingtimes.net/best-practice-carrying-out-accurate-spirometry-testing-part-2/524380.article
COPD Learn more, Breathe better. (n.d.). Retrieved from National Heart Lung and Blood Institute: http://www.nhlbi.nih.gov/health/public/lung/copd/health-care-professionals/index.htm
Kiraly, A. (Winter 2005 Volume 4 Issue 1). Retrieved from http://www2.uic.edu/orgs/jphas/journal/vol4/issue1/features_ak.shtml
Spirometry. (n.d.). Retrieved from Wikipedia: http://en.wikipedia.org/wiki/Spirometry

Cited: Booker, R. (2007). Retrieved from NursingTimes.net: http://www.nursingtimes.net/best-practice-carrying-out-accurate-spirometry-testing-part-2/524380.article COPD Learn more, Breathe better. (n.d.). Retrieved from National Heart Lung and Blood Institute: http://www.nhlbi.nih.gov/health/public/lung/copd/health-care-professionals/index.htm Kiraly, A. (Winter 2005 Volume 4 Issue 1). Retrieved from http://www2.uic.edu/orgs/jphas/journal/vol4/issue1/features_ak.shtml Spirometry. (n.d.). Retrieved from Wikipedia: http://en.wikipedia.org/wiki/Spirometry