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Spirometry is a physiological test used to establish baseline lung function by measuring how an individual inhales or exhales volumes of air as a function of time. Spirometry is important as a screening test of general respiratory health.
Spirometry (section: physical state) is measured in Lifelines participants aged 8 years and older during:
Besides the raw data, information on the validity of the spirometry and GLI reference values have been developed.
Spirometry was performed following ATS guidelines using a Welch Allyn Version 1.6.0.489, PC-based SpiroPerfect with CardioPerfect Workstation software. The Welch Allyn SpiroPerfect device (spiroperfect_manual.pdf) consists of a pressure tubing (6.6 ft/2.0m), nose clip, disposable flow transducer and calibration syringe.
As of June 2021, MADA-83 bacteria filters are implemented in our Welch Allyn spirometry devices to prevent the spread of Covid-19. The measurement settings did not change.
===== Protocol =====
* Calibrate the device
* Inform the participant about the aim and procedure of the measurement
* Mention that the measurement will be repeated several times in order to obtain a reliable measurement
* Check contraindications
* Check if participants has constrictions given by a physician/specialist
* Give instructions to participant:
* Turn the chair
* Sit straight with legs next to each other
* Do not lean forward while exhaling in the tube
* Place the nose clip with patch
* Take the tube in your mouth, hold with your teeth and place the lips around the tube
* Exhale 10 times with maximum effort. After each test you receive new instructions about the blowing technique
* In- and exhale technique:
* Inhale as deep as possible (quick is not necessary)
* Exhale as hard and powerful as possible
* Continue expiratory effort to a maximum, until unable to continue
* On my sign (PA) you inhale as fast en deep as possible
* Initialize before each test, whereby the tube observes no airflow. It is important that the participants do not move the tube.
===== Quality Checks =====
Calibration of the device was performed at login and again after 4 hours, as follows:
* Humidity, barometric pressure and termperature are registered
* A pressure tube is placed on the spirometer, and the calibration syringe is connected
* The calibration syringe is pulled out before starting with calibration > click OK
* After 3 seconds, the syringe is pushed in and pulled out once, following the pace of the blue bar
* Result of the calibration are checked,
* deviation is less than 3% of 3 liter? OK
* deviation is more than 3% of 3 liter? Try again
Spirometry systems should be evaluated using a computer-driven mechanical syringe or its equivalent, in order to test the range of exhalations that are likely to be encountered in the test population. Computer-controlled mechanical syringes (i.e. pump systems) used for validation should be accurate within ±50 mL, which is 0.5% of their full range up to 10L.
===== Contraindications =====
Spirometry should not be performed on participants who need to avoid increased pressure situations, for example due to the following:
* Recent eye surgery (< 6 wks)
* Recent thorax-/abdominal surgery (< 6wks)
* Recent operation on umbilical hernia/ incisional hernia (< 6 wks)
* Presence of umbilical hernia/incisional hernia and hernia
* Pneumothorax (< 6 wks)
* Spontaneous pneumothorax (more than twice)
* Rib fracture
* Recent lung embolism (2 - 6 wks)
* Recent infarct ( 2 - 6 wks)
* Recent heart catheterisation (< 2 wks)
* Aneurism
* Avoidance of (heavy) exertion as per instructions from doctor/ specialist
* Tuberculosis
* Recent airway infection (<3 wks)
===== Measurements (overview) =====
Important aspects of spirometry are:
* FVC (Forced vital capacity): the determination of the vital capacity from a maximally forced expiratory effort
* FEV1 (Forced expiratory volume): a generic term indicating the volume of air exhaled under forced conditions in the first t seconds of an FVC manoeuvre from a position of full inspiration
* PEF (Peak expiratory flow): The highest forced expiratory flow measured with a peak flow meter
* FEF (Forced expiratory flow): related to some portion of the FVC curve; modifiers refer to amount of FVC already exhaled
* FIVC (Forced inspiratory vital capacity). The maximum volume of air (in liters) that can be inspired during forced inspiration starting from full expiration.
===== Papers using Lifelines Spirometry data =====
* de Lichtenfels, AJFCA et al. (2018) Long-term air pollution exposure, genome-wide DNA methylation and lung function in the lifelines cohort study. Environmental Health Perspectives 126(2): 027004
* de Jong, K. et al. (2017) Genes and pathways underlying susceptibility to impaired lung function in the context of environmental tobacco smoke exposure. Respiratory Research 18(1): 142
* Soler Artigas, M et al. (2011) Genome-wide association and large-scale follow up identifies 16 new loci influencing lung function. Nature Genetics 43(11): 1082-1090
* Hobbs, BD et al. (2017) Genetic loci associated with chronic obstructive pulmonary disease overlap with loci for lung function and pulmonary fibrosis. Nature genetics 49(3): 426-432
* de Jong, K et al. (2013) GST-omega genes interact with environmental tobacco smoke on adult level of lung function. Respiratory Research 14(1): 83
* Hancock, DB et al. (2012) Genome-Wide Joint Meta-Analysis of SNP and SNP-by-Smoking Interaction Identifies Novel Loci for Pulmonary Function. PLOS Genetics 8(12): e1003098
* van der Plaat, DA et al. (2017) Genome-wide association study on the FEV1/FVC ratio in never-smokers identifies HHIP and FAM13A. Journal of Allergy and Clinical Immunology 139(2): 533-540
* de Jong, K et al. (2014) NOS1: A Susceptibility Gene for Reduced Level of FEV1 in the Setting of Pesticide Exposure. American Journal of Respiratory and Critical Care Medicine 190(10): 1188-1190
* de Jong. K et al. (2015) Genome-wide interaction study of gene-by-occupational exposure and effects on FEV1 levels. Journal of Allergy and Clinical Immunology 136(6) 1664-1672
===== Variables =====
^ Definition English ^ Definition Dutch ^ Code ^ Variable ^ Assessment ^ Age ^
| lfc assistant - there is a flow-volume curve with an abnormal gradient, namely | lfc assistent - er is sprake van een flow-volume curve met een abnormaal verloop nl | spirometry_abnormalcurve_all_e_1_a | revafw3_as | 1A 2A | 8+/18+ |
| pulmonologist - there is a flow-volume curve with an abnormal gradient, namely | longarts - er is sprake van een flow-volume curve met een abnormaal verloop nl | spirometry_abnormalcurve_all_e_1_b | revafw3_spec | 1A 2A | 8+/18+ |
| lfc assistant - assessment | lfc assistent beoordeling | spirometry_conclusion_all_e_1_a | revafw_as | 1A 2A | 8+/18+ |
| pulmonologist - assessment | longarts - beoordeling | spirometry_conclusion_all_e_1_b | revafw_spec | 1A 2A | 8+/18+ |
| do you have asthma? | heeft u astma? | spirometry_astma_all_q_1 | astma | 1A 2A | 8+/18+ |
| do you have copd? | heeft u codp? | spirometry_copd_all_q_1 | copd | 2A | 8+/18+ |
| fef25 of maxfvcfev1 (in liter/sec) | fef25 van maxfvcfev1 (liter/sec) | spirometry_fef25_all_m_1 | fef25 | 1A 2A | 8+/18+ |
| fef25_75 of maxfvcfev1 (in liter/sec) | fef25_75 van maxfvcfev1 (liter/sec) | spirometry_fef2575_all_m_1 | fef25_75 | 1A 2A | 8+/18+ |
| fef50 of maxfvcfev1 (in liter/sec) | fef50 van maxfvcfev1 (liter/sec) | spirometry_fef50_all_m_1 | fef50 | 1A 2A | 8+/18+ |
| fef75 of maxfvcfev1 (in liter/sec) | fef75 van maxfvcfev1 (liter/sec) | spirometry_fef75_all_m_1 | fef75 | 1A 2A | 8+/18+ |
| fev1 (highest value in liter) | fev1(hoogste waarde in liters) | spirometry_fev1_all_m_1 | fev1 | 1A 2A | 8+/18+ |
| fvc (highest value in liter) | fvc (hoogste waarde in liters) | spirometry_fvc_all_m_1 | fvc | 1A 2A | 8+/18+ |
| fvc + fev1 (highest value in liter) | fvc + fev1 (hoogste waarde) | spirometry_maxfvcfev1_all_m_1 | maxfvcfev1 | 1A 2A | 8+/18+ |
| lfc assistant - there are abnormalities to airway obstruction, fev1/fvc <70% | lfc assistent - er zijn afwijkingen voor luchtwegobstructie, fev1/fvc < 70% | spirometry_obstruction_all_e_1_a | revafw1_as | 1A | 8+/18+ |
| pulmonologist - there are abnormalities to airway obstruction, fev1/fvc <70% | longarts - er zijn afwijkingen voor luchtwegobstructie, fev1/fvc < 70% | spirometry_obstruction_all_e_1_b | revafw1_spec | 1A | 8+/18+ |
| lfc assistant - there are abnormalities to airway obstruction, fev1/fvc <75% | lfc assistent - er zijn afwijkingen voor luchtwegobstructie, fev1/fvc < 75% | spirometry_obstruction_all_e_2_a | revafw1_kp_as | 1A 2A | 8+/18+ |
| pulmonologist - there are abnormalities to airway obstruction, fev1/fvc <75% | longarts - er zijn afwijkingen voor luchtwegobstructie, fev1/fvc < 75% | spirometry_obstruction_all_e_2_b | revafw1_kp_spec | 1A 2A | 8+/18+ |
| pef of maxfvcfev1 (in liter/sec) | pef van maxfvcfev1 (in liter/sec) | spirometry_pef_all_m_1 | pef | 1A 2A | 8+/18+ |
| spirometry performed | longfunctie onderzocht | spirometry_performed_all_m_1/2 | longond_1 | 1A 2A | 8+/18+ |
| if not, reason: / spirometry performed | indien nee, reden: / longfunctie onderzocht | spirometry_performed_all_m_2_a | spiroreden | 2A | 8+/18+ |
| lfc assistant - there is a reduced vc that is <80% predicted | lfc assistent - er is sprake van een verlaagde vc die < 80% predicted | spirometry_reducedvc_all_e_1_a | revafw2_as | 1A 2A | 8+/18+ |
| pulmonologist - there is a reduced vc that is <80% predicted | longarts - er is sprake van een verlaagde vc die < 80% predicted | spirometry_reducedvc_all_e_1_b | revafw2_spec | 1A 2A | 8+/18+ |
| lfc assistant - remark | lfc assistant - opmerking | spirometry_remarks_all_e_1_a | remark_as | 1A 2A | 8+/18+ |
| pulmonologist - remark | longarts - opmerking | spirometry_remarks_all_e_1_b | remark_spec | 1A 2A | 8+/18+ |
| lung function assessment completed | beoordeling longfunctie afgerond | spirometry_reviewed_all_e_1 | check_final | 1A 2A | 8+/18+ |
| lfc assistant - assessment performed | lfc assistent - beoordeling afgevinkt | spirometry_reviewed_all_e_1_a | check_as | 1A 2A | 8+/18+ |
| pulmonologist - assessment performed | longarts - beoordeling afgevinkt | spirometry_reviewed_all_e_1_b | check_spec | 1A 2A | 8+/18+ |
| do you smoke, or did you smoke in the past month? | rookt u nu, of heeft u de afgelopen maand nog gerookt? | spirometry_smoking_all_q_1 | spirosmk3 | 1A 2A | 8+/18+ |
| lfc assistant - technical assessment | lfc assistent - technische beoordeling | spirometry_technicalquality_all_e_1_a | review_as | 1A 2A | 8+/18+ |
| pulmonologist - technical assessment | longarts - technische beoordeling | spirometry_technicalquality_all_e_1_b | review_spec | 1A 2A | 8+/18+ |