PCCP Consensus Statement on Spirometry Testing

Philippine College of Chest Physician (PCCP):
Consensus Statement on the Performance

and Reporting of Spirometry Testing
Executive Summary
Report of the Council on Diagnostics and Therapeutics
Philippine College of Chest Physicians
Primary Investigator: Tim S. Trinidad, MD, FPCCP
Secondary Investigators: Ma. Janeth T. Samson, MD, FPCCP

Celeste Mae L. Campomanes, MD, FPCCP
Marites A. Tan- Ang, MD,FPCCP
Geraldine C. Garcia, MD, FPCCP
Maria Peachy Lara L. Villanueva,MD,FPCCP
Lolita Brigida V. Micu, MD, FPCP
Rachel M. Lee-Chua,MD, FPCP
Maria Piedad R. Natividad, MD, FPCCP
PROPONENTS:
Chair: Ma. Janeth T. Samson, MD, FPCCP
Advisers: Camilo C. Roa, MD,FPCCP

Tomas M. Realiza, MD, FPCCP
Vincent M. Balanag Jr.,MD, FPCCP
Benilda B. Galvez, MD, FPCCP
Jennifer Ann M. Wi, MD, FPCCP
Ricardo C. Zotomayor, MD, FPCCP
Consultative Groups:
All hospitals and individuals who have participated in the meetings and voting forms and
have commented in one way or another.
Chinese General Hospital: Eden D. Chua, MD, FPCCP

Shirley Jane Chua-Panganiban, MD, FPCCP
Lung Center of the Philippines: Luisito F. Idolor, MD, FPCCP

Augusto S. Sablan, Jr. MD, FPCP
Araceli Pascual, RT
Manila Doctors Hospital: Dennis C. Teo, MD, FPCCP

Aileen M. David-Wang, MD, FPCCP
Philippine Heart Center: Rodolfo E. Tamse, MD, FPCCP

Irenee Faustina J. Casio, MD, FPCP
i
St. Lukes Medical Center: Myrna N. Baares,MD, FPCCP
Raphael Ryan R. Zantua, MD, FPCCP
Ma. Janeth T. Samson, MD, FPCCP
University of Perpetual Help Medical Center: Ricardo M. Salonga, MD, FPCCP

Jose Edzel V. Tamayo, MD, FPCCP
Mary Leslee Tabi,RT
Nio Jessielito N. Doydora, MD
University of the Philippines Philippine General Hospital:

Ma. Bella R. Siasoco, MD, FPCCP
Jubert P. Benedicto, MD, FPCCP
University of Sto. Tomas Hospital: Tim S.Trinidad, MD, FPCCP

Apolonio G. Javier, JR., MD, FPCP
FPCCP
Veterans Memorial Medical Center: Eloisa S. De Guia, MD, FPCCP
PCCP- Central and North Luzon Chapter: Ruel G. Rivera, MD, FPCCP
PCCP-Cebu Chapter: Evan N. Mendoza,MD, FPCCP
PCCP-Iloilo Chapter: Malbar G. Ferrer, MD, FPCCP
PCCP-Negros Chapter: Ethel Marie B. Tangarorang-Lacson, MD, FPCCP
PCCP Northern Mindanao Chapter: Eileen G. Aniceto, MD, FPCCP
PCCP-Southern Mindanao Chapter: Romulo T. Uy, MD, FPCCP
PCCP- Southern Tagalog Chapter: Violeta C. Reyes, MD, FPCCP
Key Opinion Leaders

Camilo C. Roa, MD,FPCCP
Joven Q. Tanchuco, MD, FPCCP
Abundio A. Balgos, MD, FPCCP
Jennifer Ann M. Wi, MD, FPCCP
Ricardo C. Zotomayor, MD, FPCCP
Council of Diagnostics and Therapeutics Members
Caburnay, Eloise Arabelle, MD, FPCCP

Campomanes, Celeste Mae L.,MD, FPCCP
Chavez, Christine L., MD, FPCP
Chua-Panganiban, Shirley Jane, MD, FPCCP
Claveria, Angelica, MD, FPCCP
Cristobal- Aquino, Ma. Flordeliza, MD, FPCCP
ii
Dalupang, Julius, MD, FPCCP
Divinagracia, Charissa, MD, FPCCP
Elisterio, Helarose M., MD, FPCCP
Garcia, Geraldine, MD, FPCCP
Germar, Arnold G., MD, FPCCP
Gonzales, Andrew S.A., MD, FPCCP
Lee-Chua, Rachel, MD, FPCP
Llanes-Gracia, Liza, MD, FPCCP
Mapanao, Daisy, MD, FPCCP
Micu, Lolita Brigida, MD,FPCP
Mora, Czarina J., MD, FPCCP
Natividad, Ma. Piedad R., MD, FPCCP
Ogbac, William George, MD,FPCP
Peafiel, Alvin, MD, FPCCP
Reside, Evelyn Victoria E., MD, FPCCP
Reyes, Mary Jane, MD, FPCCP
Santos, Alfredo Romeo Q., MD, FPCCP
Tan, Marites, MD, FPCCP
Tan, Florita, MD, FPCCP
Samson, Lyndon H., MD, FPCCP
Trinidad, Tim S., MD, FPCCP
Valenzuela, Rosauro Vicente H. Jr.,MD, FPCCP
Villanueva, Anna Tessa, MD. FPCCP
Villanueva, Ma. Peachy Lara, MD, FPCCP
Villasanta, Edwin I.,MD,FPCCP
Zantua, Raphael Ryan R., MD, FPCCP
iii
Message from the PCCP President
Greetings from the Philippine College of Chest Physicians (PCCP) !
Spirometry is a useful tool in the assessment of lung function. National and

international guidelines like the Global Initiative for Chronic Obstructive Lung
Disease guidelines, recommend spirometry as the gold standard for accurate
measurement of lung function.
Spirometry has many clinical applications in assessing and managing

respiratory disease such as: detecting the presence of obstructive and restrictive
lung defects, determining the severity of lung disease, evaluation of patients with
unexplained respiratory symptoms, assessment of preoperative pulmonary risk,
disability testing, and screening people at risk in certain occupational environments.
However, despite the known usefulness of spirometry, it has remained underutilized
in clinical practice. No uniform way of reporting the interpretation of spirometry
results is also available in our country.
This spirometry manual was prepared by the PCCP Council on Diagnostics

and Therapeutics with the aim of providing standards on the performance and
reporting/interpretation of spirometry testing. It is meant to be a working reference
for chest specialists, internists, general practitioners, primary care physicians,
medical trainees and paramedical personnel.
On behalf of the PCCP Executive Board of Directors, I commend the Council

on Diagnostics and Therapeutics under the leadership of Dr. Ma. Janeth T. Samson,
for their hard work and dedication in preparing this manual.
I hope that all users of this manual will benefit greatly from it and promote the
use of spirometry more extensively.
BENILDA B. GALVEZ, MD, FPCCP

President (2012-2013)
Philippines College of Chest Physicians
iv
Message from the Council Chair
Greetings! The Council of Diagnostics and Therapeutics of the Philippine

College of Chest Physicians aims to promote awareness of the use of spirometry in
the diagnosis of pulmonary diseases as well as to measure lung wellness. The
under utilization of this diagnostic tool may be because of its unavailability in the
rural areas as well as the lack of understanding of the spirometry report among non-
pulmonologist. This lack of understanding may stem from differences in the
interpretation of the values in the report or in the manner of reporting these
interpretations. It is our objective that by promoting uniformity in the conduct and
reporting of simple spirometry we will be able to create more understanding of the
report eventually increasing its use to improve the quality of patient care.
This project would not have been possible if not for the cooperation and
support of executive board, resource persons from training institutions, chapters and
key opinion leaders. Likewise, special thanks to the members of the council who
painstakingly contributed their efforts and support , spearheaded by Dr. Tim
Trinidad, in making this manuscript a reality.

Council Chair
PCCP Council of Diagnostics and Therapeutics
v
Table of Contents
Introduction -------------------------------------------------------------------------------- 1
Methodology ------------------------------------------------------------------------------- 1
Statements
Performance of the Test ------------------------------------------------------------- 2
Quality Control ------------------------------------------------------------------------- 3
Parameters Measured --------------------------------------------------------------- 3
Test Result Selection ---------------------------------------------------------------- 3
Parts of the Report ------------------------------------------------------------------- 3
General Data -------------------------------------------------------------------------- 4
Technicians Comment -------------------------------------------------------------- 4
Semantics in Interpretation --------------------------------------------------------- 5
Interpretation Algorithm -------------------------------------------------------------- 5
Use of other Parameters Not in Algorithm -------------------------------------- 5
Grading of Severity ------------------------------------------------------------------- 7
Lower Limit of Normality ------------------------------------------------------------ 7
Response to Bronchodilator -------------------------------------------------------- 8
Statement on Need for Additional Test ------------------------------------------ 9
Reference Equations ----------------------------------------------------------------- 9
Comments on the Quality of the Test -------------------------------------------- 10
Graphical Representation ----------------------------------------------------------- 11
Results in Tabular Graph ------------------------------------------------------------ 11
Interpreters Comments -------------------------------------------------------------- 12
Final Interpretation -------------------------------------------------------------------- 13
References ---------------------------------------------------------------------------------- 13
Appendix ------------------------------------------------------------------------------------- 14
vi
Philippine College of Chest Physician (PCCP):
Consensus Statement on the Performance and
Reporting of Spirometry Testing
Introduction
Spirometry testing is an underutilized ancillary procedure. There are numerous

reasons for this observation. Perhaps one of the reasons is the non-uniformity and
complexity of the reports generated. It is for reason the Philippine College of Chest
Physician (PCCP) Council of Diagnostics and Therapeutics (DATS) came out with this
consensus document. It is envisioned that with these recommendations, PCCP Pulmonary
Fellowship Training Institutions (PFTI) will be able to come up with a recommended generic
spirometry report that is of good quality and simple enough for both the pulmonary and non-
pulmonary specialist (general practitioner) to use. (Kindly see appendix A).
Methodology & Results
Generation of the List of Statements for Voting
From September till December of 2011, the PCCP PFTI pulmonary function lab
directors or resource persons were requested to answer a survey questionnaire on
performance and reporting of spirometry testing in their respective institutions. They were
likewise requested to submit a sample of their reports that shows the following results:
normal, obstructive, possible restrictive and possible combined defect. The composition of
the PCCP-PFTI and their corresponding pulmonary function lab director/resource persons
can be seen in appendix B.
On January 9, 2012 and February 20, 2012, the collected survey forms were tallied
and analyzed by DATS. Specifically, DATS evaluated the uniformity of the performance and
reporting of spirometry testing. From the results and statements of American Thoracic
Society and European Respiratory Society Task Force on Standardization of Lung Function
Testing (ATS-ERS-TFLFT), DATS came out with a list of proposed recommendations for the
different PCCP-PFTI in the performance and reporting of spirometry testing.
The initial list of statements was presented and deliberated upon by the
representatives of PCCP-PFTI on March 2, 2012. A revised list was presented to the
members of the PCCP during its annual convention on March 14 & 16, 2012. The
statements were further modified based on the suggestions during the annual convention.
Method Used in Voting and Grading of Consensus Statements
On April 2, 2012, DATS deliberated on the penultimate statements. Thereafter the

penultimate document was distributed to the different 11 PCCP PFTI, 4 PCCP Chapters and
3 key opinion leaders for voting. The form used for voting and the list of those who voted
can be seen in appendix K & L respectively.
After the votes were tallied (this can be seen in appendix M), the statements were
classified according to the following level of consensus:
1
Perfect consensus is defined as 100% of the voters agreeing with the statement and
none of the voters chose option D.
Very good consensus is defined as 80 to 99% of the voters agreeing with the
statement and there are less than 20% of the voters who chose option D.
Good consensus is defined as either
80 to 99% of the voters agreeing with the statement with more than 20% of
the voters choosing option D
60 to 79% of the voters agreeing with the statement with less than 20% of the
voters choosing option D
Some consensus is defined as 51 to 59% of the voters agreeing with the statement
No consensus is defined as less than 50% of voters agreeing with the statement
The computation of the parameters needed for the level of consensus classification can
be seen in appendix N.
Based on the level of consensus, the statements were modified based on the modal
auxiliary verbs: must, should and may. Statements classified as having either a perfect or a
very good consensus used the modal auxiliary verb must. Must is used in the context that
personnel involved in spirometry testing has a responsibility or an obligation to follow the
statement. Statements classified as having a good consensus used the modal auxiliary verb
should. Should is used in the context that personnel involved in spirometry testing are
advised to follow the statement.
There are 22, 25 & 4 statements with perfect, very good and good consensus
respectively. None of the statements were classified as some or no consensus.
Spirometry Testing Consensus Statements
Performance of the Test

Statements:
(S1-1) Spirometry testing using the closed circuit technique must be performed based on
the standards set by the ATS-ERS-TFLFT1. Part of the procedure includes the
answering of the PCCP DATS Spirometry Testing Information Sheet. Kindly see
appendix I & J (very good consensus).
(S1-2) A referring physician must either request any of the following types of spirometry
testing (perfect consensus):
Simple spirometry
Spirometry with post bronchodilator study
Simple spirometry study with possible post bronchodilator study if initial result is
abnormal.
(S1-3) In a situation where in the referring physician requested only a simple spirometry
and it showed abnormal results, the technician in coordination with the doctor
(interpreter of the results) must try to seek permission from the referring physician to
proceed in performing a post bronchodilator study while the patient is still in the test site
(very good consensus) or may suggest Postbronchodilator study in the results.
2
Quality Control
Statements:
(S2-1) Daily instrument calibration must be done (very good consensus).
(S2-2) The interpreter (lab medical director or pulmonary consultant on deck) must
give a feedback to the technician with regards to the quality of the test (perfect
consensus).
(S2-3) A log book must be maintained. It must contain the following (very good
consensus):
1. Daily calibration results
2. Anomalous events or problems encountered with the system
3.Feedback of the interpreter to the technician
Parameters Measured
Statements:
(S3-1) The following must be measured and reported: FEV1/ FVC, FVC and FEV1
(perfect consensus).
(S3-2) If the spirometry machine is capable, the following should be measured and
reported (in order of decreasing importance) (very good consensus):
A. PEFR
B. FEF 25-75
C. FEF 75
D. MIF50/ MEF50
E. FEV1/FV6
F. MVV
G. MIF 50
H. MEF 50
I. FEV6
J. FEF 25
K. FEF 50
Test Result Selection

Statement:
(S4-1) Test result selection must be based on the recommendations set by the ATS-
ERS-TFLFT1 (perfect consensus).
1. Report the highest FVC and FEV1 obtained.
2. The spirogram with the highest sum of FEV1 & FVC is chosen as the best trial.
3. The other parameters reported are obtained from the best trial.
Parts of the Report

Statements:
(S5-1) In the spirometry report, there must be 3 sections for the interpretation of the
results (perfect consensus):
A. Technicians Comments
3
B. Interpreters comments
C. Final Interpretation
(S5-2) Clinical correlation should not be incorporated in the final interpretation (good
consensus).
General Data
Statement:
(S6-1) The spirometry report must contain a section on general data which contains the
following information (very good consensus):
A. Name of patient
B. Age of patient
C. Gender of patient
D. Measured height
E. Measured weight
F. Race of patient
G. Date of procedure
H. Time of procedure
I. Room temperature at time of testing
J. Room atmospheric pressure at time of testing
K. Name of referring physician
L. Name of the laboratory
M. Phone number of laboratory
Components of the Report
Technicians Comment
Statements:
(S7-1) The report must contain a section for the technicians comments. It should state
the indication for doing the test and the information about previous spirometry testing
(very good consensus).
(S7-2) The technicians comments must state if the test done satisfies the ATS-ERS-
TFLFT1 reproducibility criteria. If not, it must state which of the criteria was not satisfied
(S7-3) The technicians comments must state if conditions that may alter the results are
present or not (perfect consensus).
(S7-4) The technicians comments must state if the patient is on respiratory drug and if
so, when was the last intake (perfect consensus).
(S7-5) The technicians comments must state the patients smoking history particularly
the pack years and the last time the patient smoked cigarettes (perfect consensus).
4
For example:
Technicians Comments:
A spirometry test was done to confirm the diagnosis of COPD.
Patient has no history of previous spirometry testing.
The patient is a previous smoker who has a 20-pack year of smoking history.
His last intake of cigarette smoke was 10 years ago.
There were no conditions present in the check list which may alter the results
of this study.
The patient took his Indacaterol 16 hours prior to test
The test done satisfied the reproducibility criteria set by the ATS-ERS.
Semantics in Interpretation
Statement:
(S8-1) In the interpretation of the results, the report must use the phrase ventilatory
defect (not lung defect or ventilatory pattern) (very good consensus).
Interpretation Algorithm
Statement:
(S9-1) Spirometry results must be interpreted based on the ATS-ERS-TFLFT2
suggested algorithm.
Fig. 1 Interpretative strategies for lung function tests: R. Pellegrino, G. Viegi, V. Brusasco, et
al. Eur Respi Respi J 2005; 26: 948-968.
Use of other Parameters Not in the ATS-ERS-TFLFT Interpretation Algorithm

Statements:
(S10-1) The best trial flow volume (pre and post-bronchodilator if done) must be part of
the spirometry report (perfect consensus).
(S10-2) In cases of possible upper airway obstruction interpretation, all of the trial flow
volume loops must be reported. If the spirometry software is not capable, reproducibility
5
of the flow volume loop must be mentioned in the interpreters comments (very good
consensus).
Example:
Interpreters Comments:
1. The spirometry test is of good quality based on standards set by the ATS-
ERS.
2. The FEV1/FVC is normal (using the 5th percentile of the predicted as the
lower limit of normality).
3. The FVC is normal (using the 5th percentile of the predicted as the lower
limit of normality).
4. Flow volume shows a plateau shape of the expiratory limb which is
reproducible in 3 acceptable trials. The MIF50/MEF50 is greater than one.
These are suggestive of a variable intra thoracic upper airway obstruction.
5. There is no significant response to bronchodilator.
6. The normality of the parameters is based on the Morris Polgar equation
Final Interpretation:
Probable variable intra-thoracic upper airway obstruction
Please correlate results with patients clinical data.
(S10-3) Slowing down of the terminal portion of spirogram must be described as

exaggerated concavity in the distal portion of the expiratory limb of the flow volume
loop. Use of the term scooping is discouraged (perfect consensus).
(S10-4) In cases where in the interpretation uses any of the following: flow volume
loops configuration, FEF25-75 and other spirometry parameters, it must be stated that
these parameters are suggestive but not definitive. Use of the term compatible is
discouraged (very good consensus).
Example:
ERS.
4. There is (exaggerated) concavity of the flow volume loop. The FEF 25-75
and FEF 75 are low (using 65% of the predicted as the lower limit of
normality). These are suggestive of obstructive (small airways disease)
ventilatory defect.
5. The severity of the probable obstructive ventilatory defect is mild, based
on the post bronchodilator FEV1 % predicted of 80.
Probable mild obstructive ventilatory defect
6
Grading of Severity
Statements:
(S11-1) Grading of severity must be based on the criteria set by ATS-ERS-TFLFT2
(S11-2) FEV1% predicted (post bronchodilator value if available) must be used both for
obstructive and restrictive ventilatory defect (perfect consensus).
Table 1: Grading of Severity of Ventilatory Defect

Degree of Severity FEV1 % Predicted (post bronchodilator if available)
Mild 70 & above
Moderate 60-69
Moderately Severe 50-59
Severe 35-49
Very Severe <35
Lower Limit of Normality

Statements:
(S12-1) In the spirometry report, all parameters must have corresponding (perfect
consensus):
Actual value (in BTPS)
Predicted value
% Predicted
(S12-2) If the spirometer software is capable (optional), the value corresponding to the
95% CI of the predicted value must be written in the report (very good consensus).
(S12-3) If the spirometer software is capable (optional), values < 5th percentile of the
predicted should be flagged down (either a change of color or marked). If the
spirometer software is not capable, the technician or interpreter should derive this
value by manual computation or uses an online calculator at
http://www.dynamicmt.com/dataform3.html (good consensus).
(S12-4) The cut-off value for the FEV1/FVC ratio should be <5th percentile of predicted
value. If not available, it should be stated in the interpreters comments what cut off
value was used for the lower limit of normality (good consensus).
(S12-5) Cut off value for the lower limit of normality must be stated in the interpreters
comments (very good consensus).
7
Example 1:
ERS.
2. Based on a low FEV1/FVC (using the 5th percentile of the predicted as the
lower limit of normality), there is an obstructive ventilatory defect.
3. The FVC is normal (using the 5th percentile of the predicted as the lower limit
of normality).
4. The severity of the obstructive ventilatory defect is moderately severe, based
on the post bronchodilator FEV1 % predicted of 50.
Moderately severe obstructive ventilatory defect with no significant response
to Bronchodilator
Example 2:
ERS.
2. The FEV1/FVC is normal (using a fixed cut-off value of 0.70 as the lower
3. The FVC is low (using the 80% of the predicted as the lower limit of
normality) which is probably due to a restrictive ventilatory defect or
obstructive ventilatory defect (with residual volume hyperinflation).
4. The severity of the restrictive ventilatory defect is mild, based on the post
bronchodilator FEV1 % predicted of 70.
Probable mild restrictive ventilatory defect with no significant response to
bronchodilator.
We suggest requesting for a lung volume study to confirm presence of a
restrictive ventilatory defect and rule out obstructive ventilatory defect.
Response to Bronchodilator
Statements:
(S13-1) Performance of a post-bronchodilator study must be done based on the
recommendations of ATS-ERS-TFLFT2 (perfect consensus).
Procedure for Performance of Post-bronchodilator Study

1. Assess lung function at baseline
2. Administer salbutamol in four separate doses of 100 mg through a spacer
3. Re-assess lung function after 15 minutes. If you want to assess the
potential benefits of a different bronchodilator, use the same dose and the
8
same route as used in clinical practice. The wait time may be increased
for some bronchodilators
(S13-2) Interpretation of response to bronchodilator must be based on the criteria set

by the ATS-ERS-TFLFT2 (perfect consensus).
Criteria for Significant Response to Bronchodilator:

An increase in FEV1 or FVC > 12% of control and > 200 mL.
(S13-3) FEF 25-75 must not be used in the interpretation of the post bronchodilator
response (perfect consensus).
(S13-4) To standardize the semantics, response to bronchodilator must be labeled as

significant or no significant response to bronchodilator. The use of other terms such
as poor or good response to bronchodilator are discouraged (perfect consensus).
Statement on Need for Additional Test

Statement:
(S14-1) Interpretation must include suggestion/s on need for an additional test
if warranted (very good consensus).
Reference Equations
Statements:
(S15-1) In the section on Interpreters Comments the report must state what
reference equation was used in the interpretation of the results. Statement on the need
to correlate clinically should be written in the section on Final Interpretation (very
good consensus).
Example:
ERS.
4. The severity of the obstructive ventilatory defect is moderately severe,
based on the post bronchodilator FEV1 % predicted of 50.
Final Interpretation
Moderately severe obstructive ventilatory defect with no significant response
to bronchodilator
(S15-2) A research study must be conducted by the Council of Diagnostics &

Therapeutics to determine which reference equation is best fitted for the local Filipino
population (very good consensus).
9
Comments on the Quality of the Test
Statements:
(S16-1) In the reports section on Interpreters Comments, it must be stated if the test
satisfies the reproducibility criteria set by the ATS-ERS-TFLFT1 or not (very good
consensus).
(S16-2) If the test does not satisfy one of the acceptability or reproducibility criteria, it
must state the consequences of this deficiency in the parameters (very good
consensus).
Example1.
ERS.
Example 2:
1. Despite several attempts, the end of test criteria was not met. This may
underestimate the true FVC of the patient. The FEV1 is however
reproducible and therefore the patients FEV1/FVC may overestimate the
patients real FEV1/FVC
3. The FVC is low (using the 5th percentile of the predicted as the lower limit
of normality). This may be due to poor effort of the patient, obstructive
ventilatory (with residual volume hyperinflation) or a concomitant
restrictive ventilatory defect.
Moderately severe obstructive ventilatory defect with no significant
response to bronchodilator
10
Components of the Report: Graphical Representation
Statements:
(S17-1) The spirometry report must contain at least, the pre (and post-bronchodilator if
done) best trial flow volume loop/s (perfect consensus).
(S17-2) The spirometry report must contain the flow volume loops of all trials if an
interpretation of central airway obstruction (CAO) or upper airway obstruction (UAO) is
made. If the spirometry software is not capable, the reproducibility of the flow volume
loop must be stated in the section on Interpreters Comments (very good consensus).
Example:
ERS.
3. The FVC is normal (using the 5th percentile of the predicted as the lower limit
of normality).
4. Flow volume shows a plateau shape of the expiratory limb which is
reproducible in 3 acceptable trials. The MIF50/MEF50 is greater than one.
These are suggestive of a variable intra thoracic upper airway obstruction.
Probable variable intra-thoracic upper airway obstruction
Components of the Report: Results in Tabular Graph

Statements:
(S18-1) The spirometry report must contain the measured parameters tabular
graph (very good consensus).
(S18-2) The first 3 rows of the tabular graph must be allotted for the most reliable
spirometry parameter (MRSP) in the following order: {This order will facilitate the
interpretation of the results based on the proposed algorithm of ATS-ERS-TFLFT2}
FEV1/FVC
FVC
FEV1
(S18-3) The succeeding rows maybe be allotted for the other parameters in the
following order of priority (very good consensus):
A. PEFR
B. FEF 25-75
11
C. FEF 75
D. MIF50/ MEF50
E. FEV1/FV6
F. MVV
G. MIF 50
H. MEF 50
I. FEV6
J. FEF 25
K. FEF 50
(S18-4) In the tabular graph, each parameter must have its corresponding (perfect
consensus):
A. Actual Values (pre & post if done)
B. Predicted
C. 95% Confidence Interval Limit (if the spirometry software is capable)
D. % Predicted (pre & post if done)
E. % Change from baseline of post-bronchodilator measurement (if the
spirometry software is capable)
(S18-5) In the tabular graph (if the spirometry software is capable), each parameter
below the 5th percentile should be flagged down (good consensus).
Components of the Report: Interpreters Comments

Statements:
(S19-1) The report must contain a section for the interpreters comments (IC) of the
results (perfect consensus).
(S19-2) The IC section must state if the test satisfied the ATS-ERS-TFLFT1
reproducibility criteria. If the test did not satisfy the criteria, the interpreter must
state the consequences of this deficiency (very good consensus).
(S19-3) The IC section must also contain the basis for the interpretation.
Specifically it must apply, the ATS-ERS-TFLFT2 (very good consensus):
A. Interpretation algorithm
B. Criteria for Severity
C. Response to Bronchodilator
Example:
1. The spirometry test is of good quality based on standards
set by the ATS-ERS.
2. Based on a low FEV1/FVC (using the 5th percentile of the
predicted as the lower limit of normality), there is an
obstructive ventilatory defect.
3. The FVC is normal (using the 5th percentile of the predicted
as the lower limit of normality).
4. The severity of the obstructive ventilatory defect is
moderately severe, based on the post bronchodilator FEV1
% predicted of 50.
12
6. The normality of the parameters is based on the Morris
Polgar equation
Components of the Report: Final Interpretation

Statements:
(S20-1) The spirometry report must contain a section for the final interpretation (FI) of
the results (perfect consensus).
(S20-2) The FI must contain the following information (very good consensus):
Presence or absence of Obstructive Ventilatory Defect and severity if present

Presence or absence of probable Restrictive Ventilatory Defect and severity if
present
Significant or No Significant Response to Bronchodilator if done
Suggestion for specific additional test if indicated
A generic sentence Please correlate results with patients clinical data.
Printed Name and Signature of the Interpreter/s
Example
Probable mild restrictive ventilatory defect with no significant response to
bronchodilator.
We suggest requesting for a lung volume study to confirm presence of a
restrictive ventilatory defect and rule out obstructive ventilatory defect.
NB: Full document and Executive Summary of the PCCP: Consensus Statement of
Spirometry Testing can be down loaded at the PCCP website
http://www.philchest.org/
References:
1. American Thoracic Society/ European Respiratory Society. Stardization of
Spirometry: M.R. Miller, J. Hankinson, V. Brusasco, F. et al. Eur Respi Resepi J
2005; 26: 319-338.
2. American Thoracic Society/ European Respiratory Society. Interpretative

strategies for lung function tests: R. Pellegrino, G. Viegi, V. Brusasco, et al. Eur
Respi Respi J 2005; 26: 948-968.
13
Appendices
14
APPENDIX A
Name: Juan Cruz Time of procedure: 10:00 AM

Age: 55 Room temperature: 30
Gender: Male Room atmospheric: 760
Height (inch): 64 Referring physician: Dr. Pedro Andres
Weight (lbs): 135 Name of the laboratory: PCCP PFT Lab
Race: Asian Phone number of laboratory: 723-30-80
Date: 11/20/09
Technicians Comments:
1. A spirometry test was done to confirm the diagnosis of COPD.
2. Patient has no history to previous spirometry testing.
3. The patient is a previous smoker who has a 20-pack year of smoking history. His
last intake of cigarette smoke was 10 years ago.
4. There were no conditions present in the check list which may alter the results of
this study.
5. The patient took his Indacaterol, 16 hours prior to test.
6. The test done satisfied the reproducibility criteria set by the ATS-ERS.
SGD Charlie Go, RT
1. The spirometry test is of good quality based on standards set by the ATS-ERS.
2. Based on a low FEV1/FVC (using the 5th percentile of the predicted as the lower
limit of normality), there is an obstructive ventilatory defect.
3. The FVC is normal (using the 5th percentile of the predicted as the lower limit of
normality).
4. The severity of the obstructive ventilatory defect is moderately severe, based on
the post bronchodilator FEV1 % predicted of 50.
5. There is no significant response bronchodilator response.
o Moderately severe obstructive ventilatory defect with no significant
o Please correlate results with patients clinical data.
Diego Tigas, MD
APPENDIX B
Institution Resource Person

Chinese General Hospital Eden D. Chua, MD, FPCCP
Shirley C. Panganiban Chua, MD, FPCCP
Lung Center of the Philippines Luisito F. Idolor, MD, FPCCP
Augusto S. Sablan, Jr. MD, FPCP
Araceli Pascual, RT
Manila Doctors Hospital Dennis Teo, MD, FPCCP
Aileen M. David-Wang, MD, FPCCP
Philippine Heart Center Rodolfo E. Tamse, MD, FPCCP
Irenee Faustina J. Casio, MD, FPCP
St. Lukes Medical Center Myrna N. Baares,MD, FPCCP
Raphael Ryan R. Zantua, MD, FPCCP
UP- Philippine General Hospital Ma. Bella R. Siasoco, MD, FPCCP
Jubert P. Benedicto, MD, FPCCP
University of Santo Tomas Hospital Tim S.Trinidad, MD, FPCCP
Apolonio G. Javier, JR., MD, FPCP
FPCCP
University of Perpetual-H. D. Ricardo M. Salonga, MD, FPCCP
Jose Edzel V. Tamayo, MD, FPCCP
Medical Center
Mary Leslee Tabi,RT
Nio Jessielito N. Doydora, MD
Veterans Memorial Medical Center Eloisa S. De Guia, MD, FPCCP
APPENDIX C -1-
PCCP Council on Diagnostics

Descriptive Survey Form for Use and Reporting of Spirometry
Name of Institution: ______________________________

Equipment used (type and model): ________________________________
Please encircle your appropriate response. (NA means not at all times).
DO YOU INCLUDE THE FOLLOWING DETAILS IN YOUR REPORT?
I. Patient preparation
A. Patient Details
1) Name of patient YES NO NA
2) Patient Identifier (e.g. Date of birth, personal PIN) YES NO NA
3) Gender of patient YES NO NA
4) Age of patient YES NO NA
5) Measured (not stated) Height YES NO NA
6) Estimated Height of a patient with limb deformity YES NO NA
7) Measured (not stated) weight YES NO NA
8) Race of patient YES NO NA
9) Name of Referring physician YES NO NA
10) Vital signs of patient (BP, CR, RR) prior to test YES NO NA
B. Patient Considerations
1) Symptoms of the patient YES NO NA
2) Smoking history
- Duration of smoking (# of pack years) YES NO NA
- Smoking status (Current or former) YES NO NA
- # of years stopped YES NO NA
3) Medicines taken by patient
- Short acting B agonist (SABA) salmeterol, albuterol, etc YES NO NA
- Inhaled long acting B agonist (LABA) (Salmeterol, formoterol) YES NO NA
- Oral bronchodilator (Salbutamol, formoterol, theophyllines YES NO NA

- Inhaled steroids (Flumetasone, budesonide) YES NO NA
- Oral corticosteroids (prednisone, methylprednisolone, dexamethasone) YES NO NA
- Antileukotrienes (Zafirllukast, montilukast) YES NO NA
- Acute IgE antagonist (omalizumab) YES NO NA
4) Time the above medications were last taken YES NO NA
5) History of following particular symptoms YES NO NA
- Chest or abdominal pain of any cause YES NO NA
- Oral or facial pain exacerbated by mouthpiece YES NO NA
- Stress maintenance YES NO NA
- Dementia or confusional status YES NO NA
6) Position of the patient while performing the test YES NO NA
7) Use of restrictive clothing during test YES NO NA
8) History of doing particular activities immediately prior to test YES NO NA
- Smoking within 1 hour YES NO NA
- Alcohol intake within 4 hours YES NO NA
APPENDIX C -2-
- Performing vigorous exercise within 30 minutes YES NO NA

- Eating large meals within 2 hours YES NO NA
II. Methods
A. Procedure
Do you perform the following for recording Forced Vital Capacity:
1) Check the spirometer calibration YES NO NA
2) Explain the test YES NO NA
3) Prepare the subject YES NO NA
a. Ask about: Smoking history YES NO NA
Recent illness YES NO NA
Medication use YES NO NA
Reason for test YES NO NA
b. Measure weight and height without shoes YES NO NA
4) Instruct and demonstrate the test to the subject, to include YES NO NA
a. Correct posture with head slightly elevated YES NO NA
b. Inhale rapidly and maximally YES NO NA
c. Position of the mouthpiece YES NO NA
d. Exhale with maximal force YES NO NA
5) Maneuvers proper (closed-circuit method) YES NO NA
a. Have subject assume the correct posture YES NO NA
b. Attack nose clip, place mouthpiece in month and close lips around the YES NO NA
mouthpiece
c. Inhale completely and rapidly with a pause of <1 sec at TLC YES NO NA
d. Exhale maximally for <6 sec until no more air can be expelled while YES NO NA
maintaining an upright posture
e. Repeat instructions as necessary YES NO NA
f. Coach vigorously YES NO NA
g. Repeat for a minimum of 3 trials. No more than eight trials YES NO NA
h. Check for acceptability YES NO NA
i. Check for reproducibility YES NO NA
6) Perform maneuver (open circuit method) YES NO NA
a. Have subject assume the correct posture YES NO NA
b. Attack nose clip YES NO NA
c. Inhale completely and rapidly with a pause of <1 sect at >LC YES NO NA
d. Place mouthpiece in mouth and close lips around mouthpiece YES NO NA
e. Repeat instructions as necessary YES NO NA
f. Coach vigorously YES NO NA
g. Repeat for a minimum of 3 trials. No more than eight trials YES NO NA
h. Check for acceptability YES NO NA
i. Check for reproducibility YES NO NA
Do you check for the following? YES NO NA
* Acceptability Criteria YES NO NA
a. Spirograms are free from artifacts YES NO NA

st
Cough during 1 sec of exhalation YES NO NA
Glottis closure YES NO NA
Early termination YES NO NA
Submaximal effort YES NO NA
Leaks YES NO NA
Obstructed mouthpiece YES NO NA
b. Test results have good starts YES NO NA
Extrapolated volume <5% of FVC or 0.15 L, whichever is greater YES NO NA
c. Test shows satisfactory exhalation YES NO NA
Duration of 6s (3s for children) or a plateau in the volume-time YES NO NA
curve or if the subject cannot continue to exhale
Reproducibility Criteria YES NO NA
a. After 3 acceptable spirograms have been obtained, do you apply the YES NO NA
following?
The 2 largest values of FVC must be within 0.150 L of each other YES NO NA
The 2 largest values of FEV1 must be within 0.150 L of each other YES NO NA
b. If both criteria are meet, conclude test series YES NO NA
c. If both criteria are not met, continue testing until .. YES NO NA
Both criteria are met OR YES NO NA
A total of eight test have been performed YES NO NA
Subject can no longer continue YES NO NA
d. Save, as a minimum, 3 satisfactory maneuver YES NO NA
APPENDIX C -3-
Test Result Selection YES NO NA

Do you select YES NO NA
The largest FVC, and largest FEV1 of the same curve YES NO NA
The average of FVC and FEV1 even if the dont come from the same YES NO NA
curve
The maneuver with the largest sum of FVC and FEV1 YES NO NA
Aside from FEV1, FVC and FEV1/FVC YES NO NA
Do you routinely determine the following YES NO NA
a. FEV6 YES NO NA
b. FEV1 / FEV6 YES NO NA
c. FEV1 / VC YES NO NA
d. FEF 25-75% YES NO NA
e. PEF YES NO NA
f. Maximal expiratory flow-volume loop YES NO NA
g. MVV YES NO NA
III. Interpretation and Reporting

Are the following data included in you report? YES NO NA
1) Graphical representation of the best trial flow volume loop YES NO NA

2) Graphical representation of all trials flow volume loop YES NO NA
3) Graphical representation of best trials flow volume loop YES NO NA
4) Graphical representation of all trials flow volume loop YES NO NA
5) Super imposed (overlay) graphical representation of pre and YES NO NA
post bronchodilator best trial
6) Graphical representation of MVV maneuver of best trial YES NO NA
7) Reference equation used in predicted values (ex. Roa, Crapo, YES NO NA
Knudson, etc)
8) Predicted, actual and % predicted of FEV1/FVC YES NO NA
9) Predicted, actual and % predicted of FEV1 YES NO NA
10) Predicted, actual and % predicted of FVC YES NO NA
11) Predicted, actual and % predicted of FEV6 YES NO NA
12) Predicted, actual and % predicted of FEF25 YES NO NA
15) Predicted, actual and % predicted of FEF25-75 YES NO NA
16) Predicted, actual and % predicted of MIF 50 YES NO NA
17) Predicted, actual and % predicted of MEF 50 YES NO NA
18) Predicted, actual and % predicted of MIF 50/ MEF 50
19) MVV (error code) YES NO NA
20) Tabulation of serial PTT (if with previous spirometry) YES NO NA
21) Technologist comments YES NO NA
22) Name of results interpreter YES NO NA
In the interpretation of results are the comments on the following included

Quality of the test YES NO NA
Ventilatory pattern of flow volume loop YES NO NA
Parameters which are abnormal YES NO NA
Type of ventilatory defect (objective, restrictive or mixed) YES NO NA
Severity of ventilatory defect YES NO NA
Response to bronchodilators YES NO NA
Need for additional test (LV, DLCO, post bronchodilator test serial testing) YES NO NA
Clinical correlation with patients signs and symptoms YES NO NA
Need to correlate with clinical data YES NO NA
Please tick the appropriate box and fill up the blank if needed
1) Is the format of results released to patient different from what is interpreted YES NO NA
by the physician?
2) What reference equation is your laboratory test result interpreter using for YES NO NA
classifying the normality or abnormality of the measured parameters? If
using a foreign equation, kindly state the correction factor that your
laboratory is using?
APPENDIX C -4-
[ ] We are using _____________________________________________ with a

correction factor of ___________________________
3) Was the decision of your laboratory interpreter in choosing your reference YES NO NA
equation based on a local study that you had done in your institution?
4) Does your laboratory results interpreter use only one reference equation for YES NO NA
all the measured parameters? If no, kindly explain.
[ ] if no, we use the following reference equations __________________
_______________________________________________________________
_______________________________________________________________
___________________________________________________
5) When does your laboratory results interpreter classify the FEV1/FVC, YES NO NA
FEV1/FEV6 as abnormal?
[ ] < 0.7
[ ] < 80% of the predicted
[ ] < percentile of the normal range
6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory test results YES NO NA
interpreter use the other parameters routinely (example FEF 25-75, MIF
50, MEF 50, MIF 50/MEF 50. FEV1/PEF and FEV1/FEV6
[ ] If yes. Which parameters? __________________________________
__________________________________________________________
7) Are the criteria that your laboratory results interpreter uses for a positive YES NO NA
(significant/good) response to a bronchodilator as follows: an increase in
FEV1 or FVC 12% and 200 ml increase from baseline value?
[ ] If not, kindly state the criteria your laboratory uses. ____________
_______________________________________________________________
_______________________________________________________________
___________________________________________________
8) Does your laboratory test result interpreter, routinely comments on the YES NO NA
MVV?
9) The criteria for the classification of ventilatory dysfunction suggested by the YES NO NA
ATS/ERS are tabulated below. Does your laboratory test interpreter follow
this classification?
FEV1 % Predicted
Mild > 70
Moderate 60 69
Moderately severe 50 59
Severe 35 49
Very severe < 39
IV. Quality Control

A. Laboratory Details
1) Name of laboratory YES NO NA
2) Address of laboratory YES NO NA
3) Phone number of laboratory YES NO NA
4) Name of technician who conducted the test YES NO NA
5) Date of procedure YES NO NA
6) Time of procedure YES NO NA
7) Room temperature at time of testing YES NO NA
8) Room atmospheric pressure at time of testing YES NO NA
9) Indication for procedure YES NO NA
10) Possible order for undertaking lung function tests YES NO NA
B. Personal Qualifications YES NO NA
1) Who interprets the result YES NO NA
a) Pulmonary fellow YES NO NA
b) Pulmonary function laboratory director YES NO NA
c) Pulmonary consultant on deck YES NO NA
d) Patients attending pulmonary consultant YES NO NA
PFT techniques and Procedures YES NO NA
APPENDIX C -5-
2) Do you have a manual of procedure which contain

the following:
- Calibration procedure YES NO NA
- Test performance procedures YES NO NA
- Calculations YES NO NA
- Criteria YES NO NA
- Reference values source YES NO NA
- Action to be taken when panic values are YES NO NA
observed
3) Do you have a record which documents the
following?
- Schedule of instrument calibration YES NO NA
( daily, weekly, monthly, quarterly, others )
- Problems encountered with the system YES NO NA
- Correction action required YES NO NA
- Systems hardware and software upgrades YES NO NA
- Record of anomalous events involving either YES NO NA
patients / subjects or technicians and result of
subsequent evaluation and responses to event
- Record of continuing education of personnel YES NO NA
- Record of results of evaluation and feedback YES NO NA
provided by medical director
- Schedule and procedures for routine YES NO NA
maintenance of all equipment in the facility
- Record of contact phonee numbers of YES NO NA
appropriate maintenance personnel for each
equipment used in the facility
4) Is there a protocol and frequency for calibration? YES NO NA
5) Is there a protocol for testing standard subjects YES NO NA
monthly to supplement spirometry, LV and diffusing
capacity?
6) Is there a schedule for specific quality control YES NO NA
procedures for each procedure done?
7) Are tolerance limits deprived for quality control YES NO NA
checks for each procedure?
8) Is there a plan for corrective action when tolerance YES NO NA
limits are exceeded?
9) Are standard subjects tested monthly? YES NO NA
10) Is there evidence of review by medical director or YES NO NA
head of pulmonary laboratory?
11) Are manuals available for:
- Equipments YES NO NA
- Policies YES NO NA
- Procedures YES NO NA
- Safety YES NO NA
12) Are these manuals readily accessible? YES NO NA
V. Hygiene and Infection Control YES NO NA

Do you perform the following precautions when performing spirometry? YES NO NA
1) Strict hand washing in between patients YES NO NA
2) Wearing gloves when handling body fluids YES NO NA
3) Require suspected potential active infection patients tested on an YES NO NA
isolation room or negative pressure room
4) Prepare testing rooms with filtration or UV decontamination device YES NO NA
5) Require patients with suspected infection airborne disease to wear YES NO NA
barrier protection
6) Require technicians to wear barrier protection YES NO NA
7) Flushing of air in a volume displacement spirometer at least 5x in YES NO NA
between subjects
APPENDIX C -6-
8) Require potentially infected patients with airborne disease be tested at YES NO NA

end of day or week
9) Require use of disposable mouthpiece of disinfection of tubing or any YES NO NA
parts that come into direct contact with subjects
10) Do you use an open circuit technique? (open circuit means no YES NO NA
rebreathing through mouthpiece of through breathing tube)
If answer is YES:
a) Do you change the mouthpiece between patients? YES NO NA
b) Do you change the breathing tube between patients? YES NO NA
11) Do you use the closed circuit technique (closed circuit means subject YES NO NA
rebreaths into the mouthpiece or through breathing tube and
spirometer)? If answer is YES
a) Do you dispose of or disinfect the mouthpiece between patients? YES NO NA
b) Do you dispose of or disinfect the breathing tube between patients? YES NO NA
12) Do you use a flow sensing system in which no breathing tube is YES NO NA
interposed between subject and device?
a) Is the flow sensing element and interior tubing disinfected between YES NO NA
patients?
b) Is inspiration from the device avoided? YES NO NA
13) Do you use in-line bacterial filters? If answer is yes YES NO NA
a) Do you calibrate machine with the filters? YES NO NA
b) Do you discard the filter after use on a single subject? YES NO NA
c) Do you still do regular cleaning and disinfection despite the filters? YES NO NA
YES NO NA
Comments:
_____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____
Completed by: Noted by:
______________________________ ______________________________
Name and Position Head of the Pulmonary
Laboratory
Appendix D Tally of Responses to the Survey Questions
1 PCCP Council on Diagnostics: Descriptive Survey Form for Use and Reporting of Spirometry
2 SLMC CGH UST UP-PGH LCP PHC VMMC UPHDMC MDH
3 Equipment Vmax Jaeger- Vmax Spectra Viasys Vmax Microloop Vmax
Spectra Master 22 Spectra
Screen
4 Do you include the following details in your report (Are
information about the following noted?)
5 Patient Preparation
6 Patient Details
7 1) Name of patient YES YES YES YES YES YES YES YES YES
8 2) Patient identifier YES YES YES YES YES YES YES YES
9 3) Gender of patient YES YES YES YES YES YES YES YES YES
10 4) Age of patient YES YES YES YES YES YES YES YES YES
11 5) Measured height YES YES YES YES YES YES YES YES YES
12 6) Estimated Height of a patient with limb deformity YES YES YES YES YES NO YES YES YES
13 7) Measured weight YES YES YES YES YES YES YES YES YES
14 8) Race of patient YES YES YES YES YES YES YES YES YES
15 9) Name of referring physician YES YES YES YES YES YES YES YES YES
16 10) Vitas signs of patient (BP, CR, RR) prior to test NO NO NO NO NA NO YES YES YES
17 Patient Considerations
18 1) Symptoms of the patient YES YES YES YES YES YES YES YES YES
19 2) Smoking history
20 Duration of smoking (# of pack years) YES YES YES YES YES NO YES YES YES
21 Smoking status (current or former) YES YES YES YES YES YES YES YES YES
22 # of years stopped YES YES YES NO YES NO YES YES YES
23 3) Medicines taken by patient
24 Short acting B agonist YES YES YES YES YES NA YES YES NO
25 Inhaled long acting B agonist YES YES YES YES NA YES YES NO
26 Oral bronchodilator YES YES YES YES YES NA YES YES NO
27 Inhaled steroids YES YES NO YES YES NA YES YES NO
28 Oral corticosteroids YES NO NO YES YES NA YES YES NO
29 Antileukotrienes YES NO NO YES YES NA YES YES NO
30 Anti-IgE antagonist NA NO NO NO YES NA YES YES NO
31 4) Time the above medications were last taken YES YES YES YES NO YES YES YES NO
32 5) History of the following particular symptoms
33 Chest or abdominal pain of any cause NA NO YES YES NO YES YES YES YES
34 Oral or facial pain exacerbated by mouthpiece YES NO NO NO NO NO YES YES YES
35 Stress incontinence NA NO NO NO NO NO YES YES YES
36 Dementia or confusional status YES NO NO NO NO NO YES YES YES
37 6) Position of the patient while performing the test YES YES NO YES NO NO YES YES NO
38 7) Use of restrictive clothing during the test YES NO YES NO NO NO YES YES NO
39 8) History of doing particular activities immediately prior to test
40 Smoking within 1 hour YES NO YES NO NO NO YES YES YES
41 Alcohol intake within 4 hours YES NO YES NO NO NO YES YES YES
42 Performing vigourous exercise within 30 mins YES NO YES YES NO NO YES YES YES
43 Eating large meals within 2 hours YES NO YES NO NO NO YES YES YES
44 Methods
45 Procedure
46 Do you perform the following for recording FVC
47 1) Check the spirometer calibration YES YES YES YES YES YES YES YES YES
48 2) Explain the test YES YES YES YES YES YES YES YES YES
49 3) Prepare the subject
50 Ask about: Smoking history YES YES YES YES YES YES YES YES YES
51 Recent illness YES YES YES YES YES YES YES YES YES
52 Medication use YES YES YES YES YES YES YES YES YES
53 Reason for test YES YES YES YES YES YES YES YES YES
54 Measure weight and height without shoes YES YES YES YES YES YES YES YES YES
55 4) Instruct and demonstrate the test to the subject, to include
56 Correct posture YES YES YES YES YES YES YES YES
57 Inhale rapidly and maximally YES YES YES YES YES YES YES YES YES
58 Position of the mouthpiece YES YES YES YES YES YES YES YES YES
59 Exhale with maximal force YES YES YES YES YES YES YES YES YES
60 5) Maneuvers proper (closed-circuit method)
61 Have subject assume the correct posture YES YES YES YES YES YES YES YES YES
62 Attach nose clip, place mouthpiece in mouth and close lips YES YES YES YES YES YES YES YES YES
around the mouthpiece
63 Inhale completely and rapidly with a pause of <1sec at TLC YES YES YES YES YES YES YES YES YES
64 Exhale maximally for <6secs until no more air can be expelled YES YES YES YES YES YES YES YES YES
while maintaining an upright posture
65 Repeat instructions as necessary YES YES YES YES YES YES YES YES YES
66 Coach vigorously YES YES YES YES YES YES YES YES YES
67 Repeat for a minimum of 3 trials. No more than 8 trials YES YES YES YES YES YES YES YES YES
68 Check for acceptability YES YES YES YES YES YES YES YES YES
69 Check for reproducibility YES YES YES YES YES YES YES YES YES
70 6) Perform maneuver (open circuit method)
71 Have subject assume the correct posture YES YES YES YES NA NO YES YES YES
72 Attach nose clip YES YES YES YES NA NO YES YES YES
73 Inhale completely and rapidly with a pause of <1sec at TLC YES YES YES YES NA NO YES YES YES
74 Place mouthpiece in mouth and close lips around mouthpiece YES YES YES YES NA NO YES YES YES
75 Repeat instructions as necessary YES YES YES YES NA NO YES YES YES
76 Coach vigorously YES YES YES YES NA NO YES YES YES
77 Repeat for a minimum of 3 trials. No more than 8 trials YES YES YES YES NA NO YES YES YES
78 Check for acceptability YES YES YES YES NA NO YES YES YES
79 Check for reproducibility YES YES YES YES NA NO YES YES YES
80 Do you check the following
81 Acceptability Criteria
82 a) Spirograms are free from artifacts
83 Cough during 1st second of exhalation YES YES YES YES YES YES YES YES YES
84 Glottis closure YES YES YES YES YES YES YES YES YES
85 Early termination YES YES YES YES YES YES YES YES YES
86 Submaximal effort YES YES YES YES YES YES YES YES YES
87 Leaks YES YES YES YES YES YES YES YES YES
88 Obstructive mouthpiece YES YES YES YES YES YES YES YES YES
89 b) Test results have good starts
90 Extrapolated volume <5% of FVC or 0.15L, whichever is greater YES YES YES YES YES NA YES YES YES
91 c) Test shows satisfactory exhalation YES YES YES YES YES YES YES YES YES
92 Duration of >= 6 secs or a plateau in the volume-time curve or if YES YES YES YES NA YES YES YES YES
the subject cannot continue to exhale
93 Reproducibility Criteria
94 a) After 3 acceptable spirograms have been obtained, do you apply
the following?
95 The 2 largest values of FVC must be within 0.150L of each other YES YES YES YES YES YES YES YES YES
96 The 2 largest values of FEV1 must be within 0.150L of each YES YES YES YES YES YES YES YES YES
other
97 b) If both criteria are met, conclude test series YES YES YES YES YES YES YES YES YES
98 c) If both criteria are not met, continue testing until
99 Both criteria are met OR YES YES YES YES YES YES YES YES YES
100 A total of eight tests have been performed YES YES YES YES YES NA NO YES YES
101 Subject can no longer continue YES YES YES YES * YES NO YES YES
102 d) Save, as a minimum, 3 satisfactory maneuvers YES YES YES YES YES YES YES YES
103 Test Result Selection
104 Do you select (SELECT ONE ONLY)
105 The largest FVC and the largest FEV1 of the same curve YES YES NO YES YES YES NO YES YES
106 The average of FVC and FEV1 even if they don't come from the YES YES NO YES YES NO YES YES
same curve
107 The maneuver with the largest sum of FVC and FEV1 YES YES YES YES NA NO NO YES
108 Aside from FEV1, FVC and FEV1/FVC, do you routinely determine
the following
109 Aside from FEV1, FVC and FEV1/FVC, do you routinely determine
the following
110 a) FEV6 YES NO NO NO NO YES NO YES NO
111 b) FEV1/FEV6 NO NO NO NO NO NO NO YES NO
112 e) PEF YES YES YES YES YES YES YES YES YES
113 g) MVV YES YES YES YES YES YES YES YES YES
114 Are the following data included in your report?
117 1) Graphical representation of the best trial flow volume loop YES YES YES YES YES YES YES YES YES
118 2) Graphical representation of all trials flow volume loop YES NO YES YES NO NO YES NO YES
119 3) Graphical representation of best trials flow volume loop (SAME
AS #1)
120 3) Superimposed (overlay) graphical representation of pre and post YES YES YES YES YES YES YES YES YES
bronchodilator best trial
121 4) Graphical representation of MVV maneuver of best trial YES YES YES YES YES NO YES NO YES
122 5) Reference equation used in predicted values (ex. Roa, Crapo, YES YES YES NO YES YES YES
Knudson, etc)
123 6) Predicted, actual and % predicted of FEV1/FVC YES YES YES YES YES YES YES YES YES
124 7) Predicted, actual and % predicted of FEV1 YES YES YES YES YES YES YES YES YES
125 8) Predicted, actual and % predicted of FVC YES YES YES YES YES YES YES YES YES
126 11) Predicted, actual and % predicted of FEF50 YES YES YES YES NO YES YES YES
127 12) Predicted, actual and % predicted of FEF75 YES YES YES YES YES NO YES YES YES
128 13) Predicted, actual and % predicted of FEF25-75 YES YES YES YES YES YES YES YES YES
129 14) Predicted, actual and % predicted of MIF50 YES YES NO YES NO NO NO NA NO
130 15) Predicted, actual and % predicted of MEF50 YES YES NO NO NO NO NO NA NO
131 16) Predicted, actual and % predicted of MIF50/MEF50 NO NO NA
132 17) MVV (error code) YES YES YES YES YES NO NO NA YES
133 18) Tabulation of serial PTT (if with previous spirometry) NO NO NO NO YES NO NO NA NO
134 In the interpretation of results are the comments on the following
included
135 Quality of test YES YES YES YES NO YES YES YES
136 Ventilatory pattern of flow volume loop YES YES YES YES YES NO YES YES YES
137 Parameters which are abnormal YES YES YES YES YES YES YES YES YES
138 Type of ventilatory defect (obstructive, restrictive or mixed) YES YES YES YES YES YES YES YES YES
139 Severity of ventilatory defect YES YES YES YES YES YES YES YES YES
140 Resonse to bronchodilators YES YES YES YES YES YES YES YES YES
141 Need for additional test (LV, DLCO, postbronchodilator test YES YES YES YES YES YES YES YES YES
serial testing)
142 Clinical correlation with patients signs and symptoms YES YES NO YES NA NO YES YES YES
143 Need to correlate with clinical data YES YES YES YES NA YES YES YES YES
144 Please tick the appropriate box and fill up the blank if needed
145 1) Is the format of results released to patient different from what is NO NO NO NO NO NO NO NO NO
interpreted by the physician?
146 2) What reference equation is your laboratory test result interpreter Morris Morris Morris ECCS Morris ATS, NHANES, ATS Morris
using for classifying the normality or abnormality of the measured Polgar Polgar Polgar Polgar GOLD 0.88 OF Polgar
parameters? If using a foreign equation, kindly state the correction ABS
factor that your laboratory is using? VALUE
147 3) Was the decision of your laboratory interpreter in choosing your NO NA NO YES NO NO NO NO NO
reference equation based on a local study that you had done in
your institution?
148 4) Does your laboratory results interpreter use only one reference YES YES YES YES YES YES YES YES YES
equation for all the measured parameters? If no, kindly explain.
149 5) When does your laboratory results interpreter classify the

FEV1/FVC, FEV1/FEV6 as abnormal?
150 <0.7 YES YES YES (0.75) YES YES YES YES YES YES
151 <80% of predicted YES YES
152 < percentile of the normal range YES
153 6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory YES YES NO FEF25- FEF 25- FEF25- FEF 25- NO NO
test results interpreter use the "other parameters" routinely? 75, PEF, 75 75, 75
FEF25, FEF75-
FEF50, 85, FEF
FEF75 200-1200
154 7) Is the criteria that your laboratory results interpreter uses for a YES YES YES YES YES YES YES YES YES
positive response to a bronchodilator as follows: an increase in
FEV1 or FVC >= 12% and 200 ml increase from baseline value
155 8) Does your laboratory test result interpreter routinely comment on YES YES NO NO NA NO NO NA YES
the MVV?
156 8) Does your laboratory test result interpreter routinely comment on YES YES NO NO NA NO NO NA YES
the MVV?
157 9) Is the criteria for the classification of ventilatory dysfunction YES YES YES YES YES YES YES YES YES
suggested by the ATS/ERS followed by your laboratory test
interpreter?
158 Quality Control
159 Laboratory Details
160 1) Name of laboratory YES YES YES YES YES YES YES YES YES
161 2) Address of laboratory YES YES YES YES YES YES YES YES YES
162 3) Phone number of laboratory YES YES YES YES YES NO YES YES NO
163 4) Name of techinican who conducted the test YES YES YES YES YES YES YES YES YES
164 5) Date of procedure YES YES YES YES YES YES YES YES YES
165 6) Time of procedure YES YES YES YES YES NO YES YES YES
166 7) Room temperature at time of testing YES YES YES YES NO NO YES YES YES
167 8) Room atmospheric pressure at time of testing YES YES YES YES NO NO NA NO YES
168 10) Possible sequence for undertaking lung function tests YES YES YES YES NO YES YES NO
169 1) Who interprets the result
170 Pulmonary fellow YES YES YES YES YES YES YES YES YES
171 Pulmonary function laboratory director NA NO YES NO NO YES NA YES
172 Pulmonary consultant on deck YES YES YES YES YES YES YES YES YES
173 Patient's attending pulmonary consultant YES YES YES YES NO YES YES NO
174 PFT Techniques and Procedures
175 2) Do you have a manual of procedure which contain the following
176 Calibration procedure YES YES YES YES YES YES YES YES YES
177 Test performance procedures YES YES YES YES YES YES YES YES YES
178 Calculations YES YES YES YES YES YES YES YES YES
179 Criteria YES YES YES YES YES YES YES YES YES
180 Reference values source YES YES YES YES YES YES YES YES YES
181 Action to be taken when "panic" values are observed YES YES YES YES YES YES YES YES
182 3) Do you have a record which documents the following
183 Schedule of instrument calibration YES YES YES YES YES YES NO YES YES
184 Problems encountered with the system YES YES YES YES YES YES NO YES YES
185 Correction action required YES YES YES YES YES YES YES YES YES
186 Systems hardware and software upgrades YES YES YES NO NO YES YES
187 Record of anomalous events involving either patients/subjects or YES YES NO YES NO YES NO YES YES
technicians and result of subsequent evaluation and responses to
event
188 Record of continuing eduction of personnel NO NO NO YES YES YES YES YES YES
189 Record of results of evaluation and feedback provided by NO YES NO YES YES NO NO NA YES
medical director
190 Schedule and procedures for routine maintenance of all YES YES NO YES YES NO YES YES YES
equipment in the facility
191 Record of contact phone numbers of appropriate maintenance YES YES YES YES YES YES YES YES YES
of all equipment in the facility
192 4) Is there a protocol and frequency for calibration? YES YES YES YES YES YES YES NA YES
193 5) Is there a protocol for testing standard subjects monthly to YES YES NO YES YES NA YES NA YES
supplement spirometry, LV and diffusing capacity?
194 6) Is there a schedule for specific quality control procedures for YES YES NO YES YES NO YES NA YES
each procedure done?
195 7) Are tolerance limits derived for quality control checks for each YES YES NO YES YES YES NO NA YES
procedure?
196 8) Is there a plan for corrective action when tolerance limits are YES YES NO YES YES YES NO NA YES
exceeded?
197 9) Are standard subjects tested monthly? YES NO YES YES NA NO YES NO YES
198 10) Is there evidence of review by medical director or head of NO YES NO YES YES NO YES NO YES
pulmonary laboratory?
199 11) Are manuals available for
200 Equipments YES YES YES YES YES YES YES YES
201 Policies YES YES YES YES YES YES YES YES YES
202 Procedures YES YES YES YES YES YES YES YES YES
203 Safety YES YES YES YES YES YES YES YES YES
204 12) Are these manuals readily accessible? YES YES YES YES YES YES YES YES YES
205 Hygine and Infection Control
206 Do you perform the following precautions when performing
spirometry?
207 1) Strict handwashing in between patients YES YES YES YES YES YES YES YES YES
208 2) Wearing gloves by the technician when handling body fluids and YES YES YES YES YES YES YES YES YES
equipment
209 3) Require suspected potential active infection patients tested on an YES NO NO YES NA NO NA YES YES
isolation room or negative pressure room
210 4) Prepare testing rooms with filtration or UV decontamination NO NO NO NO NO NO NA YES
device
211 5) Require patients with suspected infectious airborne disease to YES NO NO YES YES YES NA NA YES
wear barrier protection
212 6) Require technicians to wear barrier protection YES NO YES YES YES YES YES YES YES
213 7) Flushing of air in a volume displacement spirometer at least 5x in YES NO NO NO YES YES NO NA YES
between subjects
214 8) Require potentially infected patients with airborne disease to be YES NO YES YES YES NA NA NA YES
tested at the end of the day or week
215 9) Require use of disposable mouthpiece of disinfection of tubing or YES YES YES YES YES YES YES YES YES
any parts that come into direct contact with subjects
216 10) Do you use an open circuit technique? If yes, YES YES NO NO NO YES
217 Do you change the mouthpiece between patients? YES YES YES YES YES YES YES
218 Do you change the breathing tube between patients? NO NO YES NO NO NA YES
219 11) Do you use the closed circuit technique? If yes, YES YES YES YES YES NA
220 Do you dispose of or disinfect the mouthpiece between YES YES YES YES YES YES YES YES
patients?
221 Do you dispose of or disinfect the breathing tube between NO NO NO NO YES NO YES YES
patients?
222 12) Do you use a flow sensing system in which no breathing tube is YES NO YES YES NO YES YES
interposed between subject and device?
223 Is the flow sensing element and interior tubing disinfected NO YES NO YES YES NO YES YES YES
between patients?
224 Is inspiration from the device avoided? YES YES NO NO YES NO YES YES YES
225 13) Do you use in-line bacterial filters? If yes, YES YES YES YES YES YES YES YES YES
226 Do you calibrate machine with the filters? NO NO NO YES YES NO YES YES YES
227 Do you discard the filter after use on a single patient? YES YES YES NO YES YES YES YES YES
228 Do you still do regular cleaning and disinfection despite the YES YES YES YES YES YES NA YES YES
filters?
Appendix E Tally of Responses to the Survey Questions Rearranged
1 Parameter SLMC CGH UST UP-PGH LCP PHC VMMC UPHDMC MDH
4 2) Explain the test YES YES YES YES YES YES YES YES YES
5 3) Prepare the subject
6 Ask about: Smoking history YES YES YES YES YES YES YES YES YES
7 Recent illness YES YES YES YES YES YES YES YES YES
8 Medication use YES YES YES YES YES YES YES YES YES
9 Reason for test YES YES YES YES YES YES YES YES YES
10 Measure weight and height without shoes YES YES YES YES YES YES YES YES YES
11 4) Instruct and demonstrate the test to the subject, to include
12 Correct posture YES YES YES YES YES YES YES YES
13 Inhale rapidly and maximally YES YES YES YES YES YES YES YES YES
14 Position of the mouthpiece YES YES YES YES YES YES YES YES YES
15 Exhale with maximal force YES YES YES YES YES YES YES YES YES
16 5) Maneuvers proper (closed-circuit method)
17 Have subject assume the correct posture YES YES YES YES YES YES YES YES YES
18 Attach nose clip, place mouthpiece in mouth and close lips around YES YES YES YES YES YES YES YES YES
the mouthpiece
19 Inhale completely and rapidly with a pause of <1sec at TLC YES YES YES YES YES YES YES YES YES
20 Exhale maximally for <6secs until no more air can be expelled while YES YES YES YES YES YES YES YES YES
maintaining an upright posture
21 Repeat instructions as necessary YES YES YES YES YES YES YES YES YES
22 Coach vigorously YES YES YES YES YES YES YES YES YES
23 Repeat for a minimum of 3 trials. No more than 8 trials YES YES YES YES YES YES YES YES YES
24 Check for acceptability YES YES YES YES YES YES YES YES YES
25 Check for reproducibility YES YES YES YES YES YES YES YES YES
26 6) Perform maneuver (open circuit method)
27 Have subject assume the correct posture YES YES YES YES NA NO YES YES YES
28 Attach nose clip YES YES YES YES NA NO YES YES YES
29 Inhale completely and rapidly with a pause of <1sec at TLC YES YES YES YES NA NO YES YES YES
30 Place mouthpiece in mouth and close lips around mouthpiece YES YES YES YES NA NO YES YES YES
31 Repeat instructions as necessary YES YES YES YES NA NO YES YES YES
32 Coach vigorously YES YES YES YES NA NO YES YES YES
33 Repeat for a minimum of 3 trials. No more than 8 trials YES YES YES YES NA NO YES YES YES
34 Check for acceptability YES YES YES YES NA NO YES YES YES
35 Check for reproducibility YES YES YES YES NA NO YES YES YES
36 Do you check the following
37 Acceptability Criteria
38 a) Spirograms are free from artifacts
39 Cough during 1st second of exhalation YES YES YES YES YES YES YES YES YES
40 Glottis closure YES YES YES YES YES YES YES YES YES
41 Early termination YES YES YES YES YES YES YES YES YES
42 Submaximal effort YES YES YES YES YES YES YES YES YES
43 Leaks YES YES YES YES YES YES YES YES YES
44 Obstructive mouthpiece YES YES YES YES YES YES YES YES YES
45 b) Test results have good starts
46 Extrapolated volume <5% of FVC or 0.15L, whichever is greater YES YES YES YES YES NA YES YES YES
47 c) Test shows satisfactory exhalation YES YES YES YES YES YES YES YES YES
48 Duration of >= 6 secs or a plateau in the volume-time curve or if the YES YES YES YES NA YES YES YES YES
subject cannot continue to exhale
49 Reproducibility Criteria
50 a) After 3 acceptable spirograms have been obtained, do you apply the
following?
51 The 2 largest values of FVC must be within 0.150L of each other YES YES YES YES YES YES YES YES YES
52 The 2 largest values of FEV1 must be within 0.150L of each other YES YES YES YES YES YES YES YES YES
53 b) If both criteria are met, conclude test series YES YES YES YES YES YES YES YES YES
54 c) If both criteria are not met, continue testing until
55 Both criteria are met OR YES YES YES YES YES YES YES YES YES
56 A total of eight tests have been performed YES YES YES YES YES NA NO YES YES
57 Subject can no longer continue YES YES YES YES * YES NO YES YES
58 d) Save, as a minimum, 3 satisfactory maneuvers YES YES YES YES YES YES YES YES
59
60 1) Who interprets the result
61 Pulmonary fellow YES YES YES YES YES YES YES YES YES
62 Pulmonary consultant on deck YES YES YES YES YES YES YES YES YES
63 Pulmonary function laboratory director NA NO YES NO NO YES NA YES
66 3) Do you have a record which documents the following
67 Schedule of instrument calibration YES YES YES YES YES YES NO YES YES
68 Problems encountered with the system YES YES YES YES YES YES NO YES YES
69 Record of anomalous events involving either patients/subjects or YES YES NO YES NO YES NO YES YES
technicians and result of subsequent evaluation and responses to event
70 Record of results of evaluation and feedback provided by medical NO YES NO YES YES NO NO NA YES
director
71
73 6) Predicted, actual and % predicted of FEV1/FVC YES YES YES YES YES YES YES YES YES
74 8) Predicted, actual and % predicted of FVC YES YES YES YES YES YES YES YES YES
75 7) Predicted, actual and % predicted of FEV1 YES YES YES YES YES YES YES YES YES
76 13) Predicted, actual and % predicted of FEF25-75 YES YES YES YES YES YES YES YES YES
77 Aside from FEV1, FVC and FEV1/FVC, do you routinely determine the
following
78 e) PEF YES YES YES YES YES YES YES YES YES
79 g) MVV YES YES YES YES YES YES YES YES YES
80
82 11) Predicted, actual and % predicted of FEF50 YES YES YES YES NO YES YES YES
83 12) Predicted, actual and % predicted of FEF75 YES YES YES YES YES NO YES YES YES
84
85 Aside from FEV1, FVC and FEV1/FVC, do you routinely determine the
following
86 14) Predicted, actual and % predicted of MIF50 YES YES NO YES NO NO NO NA NO
87 15) Predicted, actual and % predicted of MEF50 YES YES NO NO NO NO NO NA NO
88 16) Predicted, actual and % predicted of MIF50/MEF50 NO NO NA
89 a) FEV6 YES NO NO NO NO YES NO YES NO
90 b) FEV1/FEV6 NO NO NO NO NO NO NO YES NO
91
92 6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory test YES YES NO FEF25- FEF 25- FEF25- FEF 25- NO NO
results interpreter use the "other parameters" routinely? 75, PEF, 75 75, 75
FEF25, FEF75-
FEF50, 85, FEF
FEF75 200-1200
93
94 Test Result Selection
95 Do you select (SELECT ONE ONLY)
96 The largest FVC and the largest FEV1 of the same curve YES YES NO YES YES YES NO YES YES
97 The average of FVC and FEV1 even if they don't come from the YES YES NO YES YES NO YES YES
same curve
98 The maneuver with the largest sum of FVC and FEV1 YES YES YES YES NA NO NO YES
99
100 6) Aside from the FEV1, FVC and FEV1/FVC, does your laboratory test YES YES NO FEF25- FEF 25- FEF25- FEF 25- NO NO
results interpreter use the "other parameters" routinely? 75, PEF, 75 75, 75
FEF25, FEF75-
FEF50, 85, FEF
FEF75 200-1200
101
included
103 Ventilatory pattern of flow volume loop YES YES YES YES YES NO YES YES YES
104
106 1) Graphical representation of the best trial flow volume loop YES YES YES YES YES YES YES YES YES
107 2) Graphical representation of all trials flow volume loop YES NO YES YES NO NO YES NO YES
108
included
110 9) Is the criteria for the classification of ventilatory dysfunction YES YES YES YES YES YES YES YES YES
suggested by the ATS/ERS followed by your laboratory test interpreter?
111
112 5) When does your laboratory results interpreter classify the
FEV1/FVC, FEV1/FEV6 as abnormal?
113 <0.7 YES YES YES (0.75) YES YES YES YES YES YES
114 <80% of predicted YES YES
115 < percentile of the normal range YES
116
117 7) Is the criteria that your laboratory results interpreter uses for a YES YES YES YES YES YES YES YES YES
positive response to a bronchodilator as follows: an increase in FEV1 or
FVC >= 12% and 200 ml increase from baseline value
118
included
120 Need for additional test (LV, DLCO, postbronchodilator test serial YES YES YES YES YES YES YES YES YES
testing)
121
122 2) What reference equation is your laboratory test result interpreter Morris Morris Morris ECCS Morris ATS, NHANES, ATS Morris
using for classifying the normality or abnormality of the measured Polgar Polgar Polgar Polgar GOLD 0.88 OF Polgar
parameters? If using a foreign equation, kindly state the correction ABS
factor that your laboratory is using? VALUE
123 3) Was the decision of your laboratory interpreter in choosing your NO NA NO YES NO NO NO NO NO
reference equation based on a local study that you had done in your
institution?
124
included
126 Quality of test YES YES YES YES NO YES YES YES
127
128 Do you include the following details in your report (Are information
about the following noted?)
129 Patient Details
130 1) Name of patient YES YES YES YES YES YES YES YES YES
131 2) Patient identifier YES YES YES YES YES YES YES YES
132 3) Gender of patient YES YES YES YES YES YES YES YES YES
133 4) Age of patient YES YES YES YES YES YES YES YES YES
134 5) Measured height YES YES YES YES YES YES YES YES YES
135 6) Estimated Height of a patient with limb deformity YES YES YES YES YES NO YES YES YES
136 7) Measured weight YES YES YES YES YES YES YES YES YES
137 8) Race of patient YES YES YES YES YES YES YES YES YES
138 9) Name of referring physician YES YES YES YES YES YES YES YES YES
139 10) Vitas signs of patient (BP, CR, RR) prior to test NO NO NO NO NA NO YES YES YES
140 Patient Considerations
141 1) Symptoms of the patient YES YES YES YES YES YES YES YES YES
142 2) Smoking history
143 Duration of smoking (# of pack years) YES YES YES YES YES NO YES YES YES
144 Smoking status (current or former) YES YES YES YES YES YES YES YES YES
145 # of years stopped YES YES YES NO YES NO YES YES YES
146 3) Medicines taken by patient
147 Short acting B agonist YES YES YES YES YES NA YES YES NO
148 Inhaled long acting B agonist YES YES YES YES NA YES YES NO
149 Oral bronchodilator YES YES YES YES YES NA YES YES NO
150 Inhaled steroids YES YES NO YES YES NA YES YES NO
151 Oral corticosteroids YES NO NO YES YES NA YES YES NO
152 Antileukotrienes YES NO NO YES YES NA YES YES NO
153 Anti-IgE antagonist NA NO NO NO YES NA YES YES NO
154 4) Time the above medications were last taken YES YES YES YES NO YES YES YES NO
155 5) History of the following particular symptoms
156 Chest or abdominal pain of any cause NA NO YES YES NO YES YES YES YES
157 Oral or facial pain exacerbated by mouthpiece YES NO NO NO NO NO YES YES YES
158 Stress incontinence NA NO NO NO NO NO YES YES YES
159 Dementia or confusional status YES NO NO NO NO NO YES YES YES
160 6) Position of the patient while performing the test YES YES NO YES NO NO YES YES NO
161 7) Use of restrictive clothing during the test YES NO YES NO NO NO YES YES NO
162 8) History of doing particular activities immediately prior to test
163 Smoking within 1 hour YES NO YES NO NO NO YES YES YES
164 Alcohol intake within 4 hours YES NO YES NO NO NO YES YES YES
165 Performing vigourous exercise within 30 mins YES NO YES YES NO NO YES YES YES
166 Eating large meals within 2 hours YES NO YES NO NO NO YES YES YES
Appendix F: Sample PFT reports from PCCP PFTI
APPENDIX G
Terms Used by PCCP-PFTI in the Interpretation of Spirometry Results
1 Chinese General Hospital

Normal
Comments:
Patient performed the test maximally on standing position.
Nebulization of 5 cc distilled water was given for modified
bronchoprovocation test
Interpretation
Normal spirometry study
Bronchoprovocation showed no reduction in post FEV1 values
Probable Restrictive Ventilatory Defect
Comments
1 neb of ventolin was given for post bronchodilator test
Interpretation
Normal FEV1/FVC and FEV1.
Decreased FVC.
There is probable restriction. Suggest lung volume studies if clinically
indicated.
There is no significant response to bronchodilator.
Please correlate clinically.
Obstructive with probable Restrictive Ventilatory Defect
Comments
1 neb of ventolin was given for post bronchodilator test
Interpretation
There is moderate obstructive lung defect with significant response to
bronchodilator.
FVC is reduced probably due to obstructive defect and/ or restrictive lung
defect. Suggest lung volume studies if clinically indicated.
2 Lung Center of the Philippines

Normal
Comments and Interpretation
Normal spirometry
Obstructive Ventilatory Defect
Spirometry shows a severe obstructive ventilatory pattern with significant
Spirometry shows a mild restrictive ventilatory pattern.
Spirometry shows severe obstructive ventilatory pattern with significant
bronchodilator response with moderate restrictive ventilatory pattern.
Suggest post bronchodilator and lung volume studies.
3 Manila Doctors Medical Center
Normal
Comments:
FVC and FV1 are normal; FEV1/ FVC ratio is normal
There is no acute bronchodilator response
Able to do 6 seconds test. MVV is normal.
Interpretation:
PFT suggest normal ventilatory pattern
There is no significant bronchodilator response
APPENDIX G

Comments
FVC, FEV1 and FEV1/FVC ratio are decreased. Normal MVV
No airway resistance exam done. DLCO is decreased
There is significant bronchodilator response.
Interpretation
PFT showed severe obstructive ventilatory pattern with significant
bronchodilator response.
There is mild diffusion limitation to CO.
Suggest lung volume study if clinically indicated.
Comments
Spirometry shows low FEB1 and FVC while FEV1/FVC ratio, MVV and
flow rates are within normal range.
There is no significant acute bronchodilator response noted.
Lung volume shows low TLC and RV, DLCO is normal.
Interpretation
PFY is consistent with moderate restrictive ventilatory pattern with normal
DLCO.
4 St. Lukes Medical Center Quezon City
Normal
Comments & Interpretation
Normal Spirometric Study
There is a mild obstructive lung defect
Suggest post-bronchodilator study if clinically indicated.
There is no obstructive lung defect.
Post-bronchodilator study showed a 22% improvement in the FEF25-75
Please correlate clinically
There is moderate obstructive lung defect with significant response to
bronchodilator.
FVC is reduced probably due to underlying obstructive lung defect and or
concomitant restrictive defect. Suggest lung volume study if clinically
indicated.
5 University of Philippines- Philippine General Hospital
Normal
Comments and Findings
The FEV1/FVC, FEV1, FVC, FEF 25-75 values are within normal limits.
There is no scooping of the expiratory curve.
There is no acute bronchodilator response
Interpretation & Recommendation
Normal Spirometry Findings
The FEV1/FVC, FEF 25-75, FEV1, FVC values are low.
There is scooping of the expiratory curve
There is an acute bronchodilator response
Spirometric findings are consistent with a severe obstructive ventilatory
defect with acute bronchodilator response.
In view of the smoking history of the patient, he maybe labeled at risk for
COPD.
APPENDIX G

The FEV1/FVC is normal
FEV1& FVC values are low.
There is no significant acute bronchodilator effect.
There is no scooping in the expiratory curve.
Spirometric findings are consistent with a moderate restriction in the
volume expansion of the lungs.
Suggest total lung volume studies with DLCO and or clinical correlation for
further evaluation especially if a restrictive lung disease secondary to ILD
is considered.
6 Philippine Heart Center
Normal
Normal spirometry study
Obstructive Ventilatory Defect (To be submitted)
FEV1/FVC ratio is normal. FEV1 and FVC are reduced indicative of mild
restriction of the volume excursion of the lung.
FEV1/FVC ratio, FEV1 and FVC are low indicative of severe obstructive
lung defect.
Post-bronchodilator study showed no significant reversibility.
FVC is reduced probably due to underlying obstructive defect and/ or
concomitant restrictive lung defect. Suggest lung volume studies if clinical
indicated.
7 University of Perpetual Health Medical Center
Normal
Interpretation
Normal Spirometry
Interpretation
Severe obstructive ventilatory pattern with significant post bronchodilator
response.
Interpretation
Restrictive Ventilatory Pattern
Please Correlate Clinically
Suggest Body Phlethysmography
Interpretation
Combined restrictive and obstructive ventilatory pattern due to low FVC
and FEF25-75 in the background of inadequate of expiratory maneuver
Suggest body phlethysmography.
8 Veterans Memorial Medical Center
Normal
FEV1/FVC is normal. FEV1 is normal. FVC is normal.
FEV1 has no significant improvement after bronchodilator administration.
FVC has no significant improvement after bronchodilator administration.
Normal Spirometric Studies
APPENDIX G

FEV1/FVC is low. FEV1 is low and there is an exaggerated concavity in
the distal portion of the expiratory limb.
FVC is low. FEV1 has significant improvement after bronchodilator
administration. FVC has no significant improvement after post
bronchodilator studies. These findings are suggestive of Moderately
Obstructive Ventilatory Defect. Post bronchodilator study showed a
significant degree of reversibility.
FEV/FVC is normal. FEV1 is normal. FVC is low. FEV1 has no significant
improvement after bronchodilator administration. FVC has no significant
improvement after bronchodilator administration.
These findings are suggestive of a restrictive ventilatory impairment
For lung volume studies if clinically indicated
9 University of Santo Tomas Hospital
Normal
Interpretation
Based on FEV1/FVC, FEV1, FVC there is no ventilatory defect
The predicted values are based on Morris and Polgar. Kindly correlate
clinically.
Interpretation
Based on a low FEV1/FVC and FEV1, there is a severe obstructive
ventilatory defect.
Based on a 51% change in FEV1, there is a good response to
bronchodilator
The predicted values are based on Morris and Polgar. Kindly correlate
clinically.
Interpretations
Based on the FEV1/FVC ratio there is no obstructive ventilatory defect.
The FVC is low which maybe due to a restrictive ventilatory defect. For
verification, we suggest lung volume studies.
The predicted values are based on Morris Polgar. Kindly correlate with
clinical data.
Based on the low FEV1/FVC and FEV1, there is a moderately severe
obstructive ventilatory defect. Based on the 12% (120ml) change in FEV1,
there is a poor response to bronchodilator. The FVC is low which maybe
due to a concomitant restrictive ventilatory defect or RV hyperinflation. To
verify the cause of the low FVC we suggest a lung volume study. The
predicted values are based on Morris Polgar. Kindly correlate with clinical
data.
APPENDIX H
Definition of Terms/ Abbreviations
Definition of Terms
Closed Circuit Method Spirometry Testing: method of conducting spirometry

wherein the volume is measured indirectly by a device which either measure
a pressure drop across a fixed resistance or flow via means of a propeller.
Most Reliable Spirometry Parameters (MRSP): refers to the spirometry
parameters used in the American Thoracic Society European Respiratory
Society Task Force on Lung Function Testing suggested algorithm for the
interpretation of lung function testing. These parameters are FEV1/FVC,
FEV1 and FVC.
Open Circuit Method Spirometry Testing: method of conducting spirometry
wherein the volume is measured by a wedge bellows, bell, water seal or
rolling seal cylinder/ piston.
Other Spirometry Parameters (OSP): refers the spirometry parameters not
used in the American Thoracic Society European Respiratory Society Task
Force on Lung Function Testing suggested algorithm for the interpretation of
lung function testing. These parameters are FEV1/FVC, FEV1 and FVC.
Simple spirometry: a type spirometry testing wherein only a pre-
bronchodilator study is done.
Spirometry with post-bronchodilator study: a type of spirometry testing
wherein a pre-bronchodilator and post bronchodilator study is done.
Abbreviations
ATS-ERS-TFLFT: American Thoracic Society Task Force on Lung Function

Testing
CAO: Central airway obstruction
DATS: Philippine College of Chest Physician Council on Diagnostics and
Therapeutic
FEV1: Forced expiratory volume in one second
FEF 25-75: Mean forced expiratory flow between 25% and 75% of FVC
FEF50: Instantaneous expiratory flow when 50% of the FVC has been
expired
FEF75: Instantaneous expiratory flow when 75% of the FVC has been
expired
FVC: Forced vital capacity
FVC6: Forced expiratory volume in 6 seconds
MIF50: Maximum inspiratory flow at 50% of the FVC
MEF50: Maximum expiratory flow at 50% of the FVC
MRSP: Most reliable spirometry parameters
MVV: Maximum voluntary ventilation
OSP: Other spirometry parameters
PCCP PFTI: Philippine College of Chest Physicians Pulmonary Fellowship
Training Institution
PEF: Peak expiratory flow
PEFR: Peak expiratory flow rate
UAO: Upper airway obstruction
Appendix I
Procedural Steps for Spirometry testing

(using closed circuit method)
o Calibrate the spirometer and record

o Explain the test
o Secure a written consent
o Answer the PCCP Spirometry Testing Information Sheet (Appendix J)
o Measure weight and height without shoes
o Wash hands
o Instruct and demonstrate the test to the subject, this includes
Proper posture
Rapid and complete inhalation
Proper use of mouthpiece
Rapid and maximally forceful expiration
o Perform maneuver
Assist the to assume the correct posture
Attach the nose clip
Place the mouthpiece and ask patient to close lips around the
mouthpiece
Ask the patient to inhale completely and rapidly with a pause of 0.1 s at
TLC
Instruct the patient to exhale maximally until no more air can be expelled
while maintaining an upright posture
Repeat instructions as necessary, coaching vigorously
Repeat the test until any of the following
The reproducibility criteria is met (see below)
The patient cannot continue
A maximum of 8 maneuvers is obtained
Save at least the best 3 spirograms
o Completes the answering of the PCCP Spirometry Testing information sheet
o Spirogram Reproducibility Criteria
There is at least 3 acceptable spirogram
The two largest values of FVC are within 0.150 L of each other
The two largest values of FEV1 are within 0.150 L of each other
o Spirogram Acceptability Criteria
o It is free from artifacts
Cough during the first second of exhalation
Glottis closure that influences the measurement
Early termination or cut-off
Effort that is not maximal throughout
Leak
Obstructed mouthpiece
o It shows a good start
Extrapolated volume 0.5% of FVC or 0.15 L, whichever is greater
o It shows satisfactory exhalation
Duration of 6 seconds
A plateau in the volumetime curve
APPENDIX J
PCCP Council of Diagnostic & Therapeutic Spirometry Testing Information Sheet
1. Name: __________________________________Age: _________

2. Gender: _________ Height: ____________ Weight: ______________
3. Race of patient: ___________________
4. Date of procedure: _________________Time of procedure: ___________
5. Room temperature: __________Atmospheric pressure: _________
6. Name of referring physician: __________________________
7. Smoking History: Status (Never, Current or Previous): __________________
Pack years: __________________ Last Intake: __________________
8. Working Diagnosis/ Reason for Testing: ____________________
9. Date of Previous Spirometry Testing: _________________
10. Conditions that may influence the results (Place a check if present or x if absent)
Chest or abdominal pain of any Use of restrictive clothing during

cause the test
Oral or facial pain exacerbated Alcohol/ Caffeinated drink intake
by mouthpiece within 4 hours prior to testing
Stress incontinence Vigorous exercise within 30 mins
Dementia or confusional status prior to testing
Non standing position of the Eating large meals within 2
patient while performing the test hours prior to testing
11. Intake of the following respiratory drugs prior to testing

Medicine Trade Name Dosage Last Intake (Hours prior to testing)
Salbutamol
Terbutaline
Formoterol
Indacaterol
Salmeterol
Ipratropium Bromide
Tioptropium
Methylxanthines
Formoterol/
Budesonide
Salmeterol/
Fluticasone
Oral Steroid
Roflumilast
Please use the back page for additional listing of medicines if needed
12. Were the ATS/ERS reproducible criteria satisfied? _________________________

_____________________________________________________________________
Appendix K: Forms Used for Voting of the Statements/ Recommendations - 1 -
Name of Institution/ Chapter/ Key Opinion Leader: ____________________________

Name of Person Answering in behalf of Institution/ Chapter: ____________________
For each of the 51 recommendations, kindly write the letter corresponding to your answer/
vote. The choices are
A. We disagree with the recommendation.
B. We agree with recommendation and are, in fact, already instituting this.
C. We agree with the recommendation, and we will institute measures to implement
this.
D. We agree with the recommendation but will have a hard time implementing this in the
near future.
_____ 1 (R1-1) Spirometry testing using the closed circuit technique should be
performed based on the standards set by the ATS-ERS-TFLFT (1). Part of the
procedure includes the answering of the PCCP DATS Spirometry Testing
Information Sheet. Kindly see appendix I & J.
_____ 2 (R1-2) A referring physician can either request any of the following types of
spirometry testing: simple spirometry, spirometry with post bronchodilator study
and simple spirometry study with possible post bronchodilator study if initial
result is abnormal
_____ 3 (R1-3) In a situation wherein the referring physician requested only a simple
spirometry and it showed abnormal results, the technician in coordination with
doctor (interpreter of the results) should try to ask permission from the
referring physician to proceed in performing a post bronchodilator study while
the patient is still in the test site.
_____ 4 (R2-1) Daily instrument calibration should be done.
_____ 5 (R2-2) The interpreter (lab medical director or pulmonary consultant on deck)
should give a feedback to the technician with regards the quality of the test.
_____ 6 (R2-3) A log book should be maintained. It should contain the following: daily
calibration results, anomalous events or problems encountered with the system
and feedback of the interpreter to the technician.
_____ 7 (R3-1) The following should be measured and reported FEV1/ FVC, FVC and
FEV1.
_____ 8 (R3-2) If the spirometry machine is capable, the following should be measured
and reported (in order of decreasing importance): PEFR, FEF 25-75, FEF 75,
MIF50/ MEF50, FEV1/FV6, MVV, MIF 50, MEF 50, FEV6, FEF 25 and FEF 50
_____ 9 (R4-1) Test result selection should be based on the recommendations set by
the ATS-ERS-TFLFT (1).
_____ 10 (R5-1) In the spirometry report, there should be 3 sections for the interpretation
of the results: technicians comments, interpreters comments and final
interpretation.
_____ 11 (R5-2) There is no need to give a clinical correlation.
this.
near future.
_____ 12 (R6-1) The spirometry report should contain a section on general data which
contains the following information: name of patient, age of patient, gender of
patient, measured height, measured weight, race of patient, date of procedure,
time of procedure, room temperature at time of testing, room atmospheric
pressure at time of testing, name of referring physician, name of the laboratory
and phone number of laboratory
_____ 13 (R7-1) The report should contain a section for technician comments.
_____ 14 (R7-2) The technician comments should state if the test done satisfies the
ATS-ERS-TFLFT (1) reproducibility criteria. If not, it should state which of the
criteria was not satisfied.
_____ 15 (R7-3) The technician comments should state if conditions that may alter the
results are present or not.
_____ 16 (R7-4) Technician comments should state if the patient is on respiratory drug
and if so when was the last intake.
_____ 17 (R7-5) Technician comments should state the patients smoking history
particular the pack years and the last time when the patient smoked cigarettes.
_____ 18 (R8-1) In the interpretation of the results, the report should use the phrase
ventilatory defect (not lung defect or ventilatory pattern).
_____ 19 (R9-1) Spirometry results should be interpreted based on the ATS-ERS-TFLFT
suggested algorithm.
_____ 20 (R10-1) The best trial flow volume (pre and post-bronchodilator if done) should
be part of the spirometry report.
_____ 21 (R10-2) In cases of possible upper airway obstruction interpretation, all trials
flow volume loop should be reported. If the spirometry software is not capable,
reproducibility of the flow volume loop should be mentioned in the interpreters
comments.
_____ 22 (R10-3) Slowing down of the terminal portion of spirogram should be described
as exaggerated concavity in the distal portion of the expiratory limb of the flow
volume loop. Use of the term scooping is discouraged.
_____ 23 (R10-4) In cases wherein the interpretation uses any of the following: flow
volume loops configuration, FEF25-75 and other spirometry parameters, it
should be stated that these parameters are suggestive but not definitive. Use
of the term compatible is discouraged.
this.
near future.
_____ 24 (R11-1) Grading of severity should be based on the criteria set by ATS-ERS-
TFLFT (2).
_____ 25 (R11-2) FEV1% predicted (post bronchodilator value if available) is used both
for obstructive and restrictive ventilatory defect.
_____ 26 (R12-1) In the spirometry report, all parameters should have corresponding
actual value (in BTPS), predicted value and % predicted.
_____ 27 (R12-2) If the spirometer software is capable (optional), the value
corresponding to the 95% CI of the predicted value should be written in the
report.
_____ 28 (R12-3) If the spirometer software is capable (optional), values < 5th percentile
of the predicted should be flagged down (either a change of color or marked).
If the spirometer software is not capable, it is encouraged that the technician or
interpreter derived this value by manual computation or use an online
calculator at http://www.dynamicmt.com/dataform3.html.
_____ 29 (R12-4) The cut-off value for the FEV1/FVC ratio should be <5th percentile of
predicted value. If not available, it should stated in the interpreters comments
what cut off value was used for the lower limit of normality.
_____ 30 (R12-5) Cut off value for the lower limit of normality should be stated in the
interpreters comments.
_____ 31 (R13-1) Performance of a post-bronchodilator study should be done based on
the recommendations of ATS-ERS-TFLFT (2).
_____ 32 (R13-2) Interpretation of response to bronchodilator should be based on the
criteria set by the ATS-ERS-TFLFT (2).
_____ 33 (R13-3) FEF 25-75 should not be used in the interpretation of the post
_____ 34 (R13-4) To standardize the semantics, response to bronchodilator will either be
labeled as significant or no significant response to bronchodilator {as used by
the ATS-ERS-TFLFT (2)}. Uses of other terms such as poor or good response
to bronchodilator are discouraged.
_____ 35 (R14-1) Interpretation should include suggestion/s on need for additional test if
warranted.
_____ 36 (R15-1) In the section on Interpreters Comments the report should state what
reference equation was used in the interpretation of the results. Statement on
the need to correlate clinically should be written in the final interpretation.
this.
near future.
_____ 37 (R15-2) A research study will be conducted by the Council of Diagnostics &
Therapeutics to determine which reference equation is best fitted for the local
Filipino population.
_____ 38 (R16-1) In the reports section on Interpreters Comments, it should be stated
if the test satisfies the reproducibility criteria set by the ATS-ERS-TFLFT (1) or
not.
_____ 39 (R16-2) It the test does not satisfy one of the acceptability or reproducibility
criteria, it should state the consequences of this deficiency in the parameters.
_____ 40 (R17-1) The spirometry report should contain at least, the pre (and post-
bronchodilator if done) best trial flow volume loop/s
_____ 41 (R17-2) The spirometry report should contain all trials flow volume loops if an
interpretation of CAO or UAO made. If the spirometry software is not capable,
the reproducibility of the flow volume loop should be stated in the section on
Interpreters Comments.
_____ 42 (R18-1) The spirometry report should contain the measured parameters tabular
graph.
_____ 43 (R18-2) The first 3 rows of should be allotted for the MRSP in the following
order: FEV1/FVC, FVC and FEV1.
_____ 44 (R18-3) The succeeding rows maybe be allotted for the other parameters in
the following order of priority: PEFR, FEF 25-75, FEF 75, MIF50/ MEF50,
FEV1/FV6, MVV, MIF 50, MEF 50, FEV6, FEF 25 and FEF 50
_____ 45 (R18-4) In the tabular graph, each parameter should have its corresponding
actual values (pre & post if done), predicted, 95% confidence interval limit (if
the spirometry software is capable), % predicted (pre & post if done) and %
change from baseline of post-bronchodilator measurement.
_____ 46 (R18-5) In the tabular graph (if the spirometry software is capable), each
parameter below the 5th percentile should be flagged down.
_____ 47 (R19-1) The report should contain a section for the interpreters comments (IC)
of the results.
_____ 48 (R19-2) The IC section should state if the test satisfied the ATS-ERS-TFLFT
(1) reproducibility criteria. If the test did not satisfy the criteria, the interpreter
should state the consequences of this deficiency.
_____ 49 (R19-3) The section should contain the basis for the interpretation. Specifically
it should apply, the ATS-ERS-TFLFT (2) interpretation algorithm, criteria for
severity and response to bronchodilator
this.
near future.
_____ 50 (R20-1) The spirometry report should contain a section for the final
interpretation (FI) of the results.
_____ 51 (R20-2) The FI should contain the following information: presence or absence
of obstructive ventilatory defect and severity if present, presence or absence of
probable restrictive ventilatory defect and severity if present, positive or
negative response to bronchodilator if done, suggestion for specific additional
test if indicated, a generic sentence Please correlate results with patients
clinical data. and printed name plus signature of the interpreter/s
Appendix L
List of Voters
Philippine College of Chest Physicians Accredited Training Institutions
1. Chinese General Hospital and Medical Center (CGH)

2. Chong Hua Hospital (CHH)
3. Lung Center of the Philippines (LCP)
4. Makati Medical Center (MMC)
5. Manila Doctors Hospital (MDH)
6. Philippine Heart Center (PHC)
7. St. Lukes Medical Center (SLMC)
8. University of Perpetual Help Dalta Medical Center (UPHM)
9. University of the Philippines - Philippine General Hospital (UP-PGH)
10. University of Santo Tomas Hospital (UST)
11. Veterans Memorial Medical Center (VMMC)
Philippine College of Chest Physicians Chapters
1. Southern Tagalog
2. Northern Mindanao
3. Negros
4. Mindanao
Key Opinion Leaders
1. Dr. Camilo Roa

2. Dr. Jennifer Wi
3. Dr. Ric Zotomayor
Appendix M: Tally of Votes
SLMC CGH VMMC LCP UP-PGH MMC CHH MDH UST PHC UPHM Dr. Roa Dr. Zotomayor Dr. Wi Mindanao S. Tagalog N. Mindanao Negros
(R1-1) Spirometry testing
using the closed circuit
technique should be
performed based on the B B B B B C B C B B B B B B B B D B
standards set by the ATS-
ERS-TFLFT (very good
consensus)
(R1-2) A referring physician

can either request any of
the following types of
spirometry testing: simple
spirometry, spirometry with
post bronchodilator study B B B B C B B B B B B C B B B B C B
and simple spirometry
study with possible post
bronchodilator study if initial
result is abnormal. (perfect
consensus)
(R1-3) In a situation
wherein the referring
physician requested only a
simple spirometry and it
showed abnormal results,
the technician in
coordination with doctor
(interpreter of the results)
C B B B C C B B B C B C B B C A C B
should try to ask
permission from the
referring physician to
proceed in performing a
post bronchodilator study
while the patient is still in
the test site. (very good
consensus)
(R2-1) Daily instrument
calibration should be done. B B C B B B B B B B D B B B A B D B
(very good consensus)
(R2-2) The interpreter (lab
medical director or
pulmonary consultant on
deck) should give a
B B B B B B B B B C B B B B C B B C
feedback to the technician
with regards the quality of
the test. (perfect
consensus)
(R2-3) A log book should

be maintained. It should
contain the following: daily
calibration results,
anomalous events or
B B C B B B B C B C D C B B C B C B
problems encountered with
the system and feedback of
the interpreter to the
technician. (very good
consensus)
(R3-1) The following should

be measured and reported
B B B B B B B B B B B B B B B B B B
FEV1/ FVC, FVC and
FEV1. (perfect consensus)
(R3-2) If the spirometry
machine is capable, the
following should be
measured and reported (in
order of decreasing
importance): PEFR, FEF 25- B O ANSW C C B C B C B C B B B B B B B B
75, FEF 75, MIF50/ MEF50,
FEV1/FV6, MVV, MIF 50,
MEF 50, FEV6, FEF 25 and
FEF 50 (very good
consensus)
(R4-1) Test result selection

should be based on the
recommendations set by B B B B B B B B B C B B B B B B B B
the ATS-ERS-TFLFT (1).
(perfect consensus)
(R5-1) In the spirometry

report, there should be 3
sections for the
interpretation of the results:
C C C B B C C C C C B C B B B B C C
technicians comments,
interpreters comments and
final interpretation. (perfect
consensus)
(R5-2) There is no need to

give a clinical correlation. B B B B A O ANSW B B B A B A B B B A A A
(good consensus)
(R6-1) The spirometry

report should contain a
section on general data
which contains the following
information: name of
patient, age of patient,
gender of patient,
measured height,
measured weight, race of
B B C C C C B B B B C B C C B C C
patient, date of procedure,
time of procedure, room
temperature at time of
testing, room atmospheric
pressure at time of testing,
name of referring physician,
name of the laboratory and
phone number of laboratory
(R7-1) The report should

contain a section for
technicians comments. It
should state the indication
C C D B B B C C C C B C B C B B C C
for doing the test and the
information about previous
spirometry testing. (very
good consensus)
(R7-2) The technician
comments should state if
the test done satisfies the
ATS-ERS-TFLFT (1)
reproducibility criteria. If C B B B C C B C B C B C B C C C C C
not, it should state which of
the criteria was not
satisfied. (perfect
consensus)
(R7-3) The technicians
conditions that may alter C C B B B C B C B C B C B C C C C C
the results are present or
not. (perfect consensus)
(R7-4) Technicians
the patient is on respiratory
C C C B B B B C B C B B B B B B C B
drug and if so when was
the last intake. (perfect
consensus)
(R7-5) Technicians
comments should state the
patients smoking history
particularly the pack years C B C B C B B C B C B C B B C B C C
and the last time when the
patient smoked cigarettes.
(perfect consensus)
(R8-1) In the interpretation

of the results, the report
should use the phrase
ventilatory defect (not lung B C B C B B B C B C B B B C B A B C
defect or ventilatory
pattern). (very good
consensus)
(R9-1) Spirometry results

should be interpreted based
on the ATS-ERS-TFLFT B B B B B B C B C B B B D B B C B
suggested algorithm. (very
good consensus)
(R10-1) The best trial flow
volume (pre and post-
bronchodilator if done)
B B B B B B B B B B B B B B B B C B
should be part of the
spirometry report. (perfect
consensus)
(R10-2) In cases of
possible upper airway
obstruction interpretation,
all of the trials flow volume
loop should be reported. If
the spirometry software is C B C C C B C C C C B B B C B B D C
not capable, reproducibility
of the flow volume loop
should be mentioned in the
(R10-3) Slowing down of

the terminal portion of
spirogram should be
described as exaggerated
concavity in the distal
C B B C C C B C C C B C B C C C C C
portion of the expiratory
limb of the flow volume
loop. Use of the term
scooping is discouraged.
(perfect consensus)
(R10-4) In cases wherein

the interpretation uses any
of the following: flow
volume loops configuration,
FEF25-75 and other
spirometry parameters, it
B B C C C C B C C C B B B D B B C B
should be stated that these
parameters are suggestive
but not definitive. Use of the
term compatible is
discouraged. (very good
consensus)
(R11-1) Grading of severity

should be based on the
criteria set by ATS-ERS-
TFLFT. (perfect consensus)
(R11-2) FEV1% predicted

(post bronchodilator value if
available) is used both for
B B B B B B B B B B B B B B B B B
obstructive and restrictive
ventilatory defect. (perfect
consensus)
(R12-1) In the spirometry

report, all parameters
should have corresponding
actual value (in BTPS), B B B B B B B B B B B B B C C B B B
predicted value and %
predicted. (perfect
consensus)
(R12-2) If the spirometer
software is capable
(optional), the value
corresponding to the 95%
B B B C C C C C B C B C B C C/B B D C
CI of the predicted value
should be written in the
report. (very good
consensus)
(R12-3) If the spirometer

software is capable
(optional), values < 5th
percentile of the predicted
should be flagged down
(either a change of color or
marked). If the spirometer
software is not capable, it is
B B D D D A D D B C D C B C C D D C
encouraged that the
technician or interpreter
derives this value by
manual computation or
uses an online calculator at
http://www.dynamicmt.com/
dataform3.html. (good
consensus)
(R12-4) The cut-off value

for the FEV1/FVC ratio
should be <5th percentile of
predicted value. If not
available, it should be
B C C C D A C D C C B C B C C/B D D C
stated in the interpreters
comments what cut off
value was used for the
lower limit of normality.
(good consensus)
(R12-5) Cut off value for
the lower limit of normality
should be stated in the B C C C D A C C C C B C B C B/C D C C
(R13-1) Performance of a
post-bronchodilator study
should be done based on
B B B B B B B B B C B B B B B B C B
the recommendations of
ATS-ERS-TFLFT (2).
(perfect consensus)
(R13-2) Interpretation of
should be based on the B B B B B B B ANSW B C B B B B B B C B
criteria set by the ATS-ERS-
TFLFT. (perfect consensus)
(R13-3) FEF 25-75 should
not be used in the
interpretation of the post C B B B B C B B B C B B B C B B C C
(perfect consensus)
(R13-4) To standardize the

semantics, response to
bronchodilator will either be
labeled as significant or no
significant response to
bronchodilator {as used by
B B B B B B B B C B B B B C C/B B B B
the ATS-ERS-TFLFT (2)}.
Uses of other terms such
as poor or good response
to bronchodilator are
discouraged. (perfect
consensus)
(R14-1) Interpretation
should include suggestion/s
on need for additional test if B B B B B B B B B B B B B D C/B B B B
warranted. (very good
consensus)
(R15-1) In the section on

Interpreters Comments
the report should state what
reference equation was
used in the interpretation of
C C C C C A B C B C B C B D A/B A C C
the results. Statement on
the need to correlate
clinically should be written
in the final interpretation
(R15-2) A research study

will be conducted by the
Council of Diagnostics &
Therapeutics to determine
which reference equation is
Y/A Y/A Y/A Y/A Y/A N/D Y/A Y/A Y/A Y/A Y/A Y/A Y/A Y/A Y/A Y/A Y/A
best fitted for the local
Filipino population. (For
this item, kindly just state
of your agree or disagree)
(R16-1) In the reports

section on Interpreters
Comments, it should be
stated if the test satisfies
C C C C C C B C B C B B B B A B C C
the reproducibility criteria
set by the ATS-ERS-TFLFT
(1) or not. (very good
consensus)
(R16-2) It the test does not
satisfy one of the
acceptability or
reproducibility criteria, it
should state the C B C C D C B C B C B B B D B B C C
consequences of this
deficiency in the
parameters. (very good
consensus)

report should contain at
least, the pre (and post-
bronchodilator if done) best
trial flow volume loop/s.
(perfect consensus)
report should contain the
flow volume loops of all
trials, if an interpretation of
CAO or UAO made. If the
spirometry software is not
C B C C B C D B B C B B B C A/C C D D
capable, the reproducibility
of the flow volume loop
should be stated in the
section on Interpreters
Comments. (very good
consensus)
report should contain the
measured parameters B B D B B C B B B B B B B B B B D B
tabular graph. (very good
consensus)
(R18-2) The first 3 rows of
the tabular graph should be
allotted for the MRSP in the
B C D C B C B C C C B C B B B C B C
following order: FEV1/FVC,
FVC and FEV1. (very good
consensus)
(R18-3) The succeeding
rows maybe be allotted for
the other parameters in
the following order of
priority: PEFR, FEF 25-75,
B C D C B B B C C C B C B B B C B C
FEF 75, MIF50/ MEF50,
FEV1/FV6, MVV, MIF 50,
MEF 50, FEV6, FEF 25 and
FEF 50. (very good
consensus)
(R18-4) In the tabular
graph, each parameter
should have its
corresponding actual
values (pre & post if done),
predicted, 95% confidence
interval limit (if the
B B B B B B B C B B B B B B B B B B
spirometry software is
capable), % predicted (pre
& post if done) and %
change from baseline of
post-bronchodilator
measurement. (perfect
consensus)
(R18-5) In the tabular graph
(if the spirometry software
is capable), each parameter
B B D C D C C C B B D D B B C B C
below the 5th percentile
should be flagged down.
(good consensus)
(R19-1) The report should
contain a section for the
interpreters comments (IC) B C B C B B B C B B B B B B B B B B
of the results. (perfect
consensus)
(R19-2) The IC section
should state if the test
satisfied the ATS-ERS-
TFLFT (1) reproducibility
criteria. If the test did not
C C C C D C C C B C B B D B C C B B
satisfy the criteria, the
interpreter should state the
consequences of this
deficiency.(very good
consensus)
(R19-3) The IC section

should also contain the
basis for the interpretation.
Specifically it should apply,
the ATS-ERS-TFLFT (2) C C B C B B C C C C B B D B C B B B
interpretation algorithm,
criteria for severity and
response to bronchodilator.

report should contain a
section for the final B B B B B B B B B B B B B B B B B B
interpretation (FI) of the
results. (perfect consensus)
(R20-2) The FI should

contain the following
information: presence or
absence of obstructive
ventilatory defect and
severity if present,
presence or absence of
probable restrictive
ventilatory defect and
severity if present,
significant or no significant B B B B B B B C B C B B B B B B B
if done, suggestion for
specific additional test if
indicated, a generic
sentence Please correlate
results with patients clinical
data. and printed name
plus signature of the
interpreter/s. (very good
consensus)
Appendix N: Computation of the Parameters Needed for the Level of Consensus Classification
A B C D % of those who Agreed % of those who answered D Level of Consensus

(R5-2) There is no need to give a clinical correlation. (good consensus) 6 11 64.7 0.0 G
(R12-3) If the spirometer software is capable (optional), values < 5th
percentile of the predicted should be flagged down (either a change
of color or marked). If the spirometer software is not capable, it is
1 4 5 8 94.4 47.1 G
encouraged that the technician or interpreter derives this value by
manual computation or uses an online calculator at
http://www.dynamicmt.com/dataform3.html. (good consensus)
(R12-4) The cut-off value for the FEV1/FVC ratio should be <5th
percentile of predicted value. If not available, it should be stated in
1 3 10 4 94.4 23.5 G
the interpreters comments what cut off value was used for the lower
limit of normality. (good consensus)
(R18-5) In the tabular graph (if the spirometry software is capable),
each parameter below the 5th percentile should be flagged down. 7 6 4 100.0 23.5 G
(good consensus)
(R1-2) A referring physician can either request any of the following

types of spirometry testing: simple spirometry, spirometry with post 15 3 100.0 0.0 P
bronchodilator study and simple spirometry study with possible post
bronchodilator study if initial result is abnormal. (perfect consensus)
(R2-2) The interpreter (lab medical director or pulmonary consultant
on deck) should give a feedback to the technician with regards the 15 3 100.0 0.0 P
quality of the test. (perfect consensus)
(R3-1) The following should be measured and reported FEV1/ FVC,
18 100.0 0.0 P
FVC and FEV1. (perfect consensus)
(R4-1) Test result selection should be based on the
recommendations set by the ATS-ERS-TFLFT (1). (perfect 17 1 100.0 0.0 P
consensus)
(R5-1) In the spirometry report, there should be 3 sections for the
interpretation of the results: technicians comments, interpreters 7 11 100.0 0.0 P
comments and final interpretation. (perfect consensus)

(R7-2) The technician comments should state if the test done
satisfies the ATS-ERS-TFLFT (1) reproducibility criteria. If not, it
7 11 100.0 0.0 P
should state which of the criteria was not satisfied. (perfect
consensus)
(R7-3) The technicians comments should state if conditions that
7 11 100.0 0.0 P
may alter the results are present or not. (perfect consensus)
(R7-4) Technicians comments should state if the patient is on
respiratory drug and if so when was the last intake. (perfect 12 6 100.0 0.0 P
consensus)
(R7-5) Technicians comments should state the patients smoking
history particularly the pack years and the last time when the patient 9 9 100.0 0.0 P
smoked cigarettes. (perfect consensus)
(R10-1) The best trial flow volume (pre and post-bronchodilator if 17 1 100.0 0.0 P
done) should be part of the spirometry report. (perfect consensus)
(R10-3) Slowing down of the terminal portion of spirogram should be
described as exaggerated concavity in the distal portion of the
5 13 100.0 0.0 P
expiratory limb of the flow volume loop. Use of the term scooping
is discouraged. (perfect consensus)
(R11-1) Grading of severity should be based on the criteria set by
17 1 100.0 0.0 P
ATS-ERS-TFLFT. (perfect consensus)
(R11-2) FEV1% predicted (post bronchodilator value if available) is
used both for obstructive and restrictive ventilatory defect. (perfect 17 100.0 0.0 P
consensus)
(R12-1) In the spirometry report, all parameters should have
corresponding actual value (in BTPS), predicted value and % 16 2 100.0 0.0 P
predicted. (perfect consensus)
(R13-1) Performance of a post-bronchodilator study should be done
based on the recommendations of ATS-ERS-TFLFT (2). (perfect 16 2 100.0 0.0 P
consensus)

(R13-2) Interpretation of response to bronchodilator should be
based on the criteria set by the ATS-ERS-TFLFT. (perfect 15 2 100.0 0.0 P
consensus)
(R13-3) FEF 25-75 should not be used in the interpretation of the
12 6 100.0 0.0 P
post bronchodilator response. (perfect consensus)
(R13-4) To standardize the semantics, response to bronchodilator
will either be labeled as significant or no significant response to
bronchodilator {as used by the ATS-ERS-TFLFT (2)}. Uses of other 15 3 100.0 0.0 P
terms such as poor or good response to bronchodilator are
discouraged. (perfect consensus)
(R17-1) The spirometry report should contain at least, the pre (and
post-bronchodilator if done) best trial flow volume loop/s. (perfect 17 1 100.0 0.0 P
consensus)
(R18-4) In the tabular graph, each parameter should have its
corresponding actual values (pre & post if done), predicted, 95%
confidence interval limit (if the spirometry software is capable), % 17 1 100.0 0.0 P
predicted (pre & post if done) and % change from baseline of post-
bronchodilator measurement. (perfect consensus)
(R19-1) The report should contain a section for the interpreters
15 3 100.0 0.0 P
comments (IC) of the results. (perfect consensus)
(R20-1) The spirometry report should contain a section for the final
18 100.0 0.0 P
interpretation (FI) of the results. (perfect consensus)
(R1-1) Spirometry testing using the closed circuit technique should
be performed based on the standards set by the ATS-ERS-TFLFT 15 2 1 100.0 5.6 VG
(R1-3) In a situation wherein the referring physician requested only a
simple spirometry and it showed abnormal results, the technician in
coordination with doctor (interpreter of the results) should try to ask
1 10 7 94.4 0.0 VG
permission from the referring physician to proceed in performing a
post bronchodilator study while the patient is still in the test site.

(R2-1) Daily instrument calibration should be done. (very good
1 14 1 2 94.4 11.8 VG
consensus)
(R2-3) A log book should be maintained. It should contain the
following: daily calibration results, anomalous events or problems
11 6 1 100.0 5.6 VG
encountered with the system and feedback of the interpreter to the
technician. (very good consensus)
(R3-2) If the spirometry machine is capable, the following should be
measured and reported (in order of decreasing importance): PEFR,
12 5 94.4 0.0 VG
FEF 25-75, FEF 75, MIF50/ MEF50, FEV1/FV6, MVV, MIF 50, MEF
50, FEV6, FEF 25 and FEF 50 (very good consensus)
(R6-1) The spirometry report should contain a section on general

data which contains the following information: name of patient, age
of patient, gender of patient, measured height, measured weight,
8 9 94.4 0.0 VG
race of patient, date of procedure, time of procedure, room
temperature at time of testing, room atmospheric pressure at time of
testing, name of referring physician, name of the laboratory and
phone number of laboratory (very good consensus)
(R7-1) The report should contain a section for technicians
comments. It should state the indication for doing the test and the information 7 10 1 100.0 5.6 VG
about previous spirometry testing. (very good consensus)
(R8-1) In the interpretation of the results, the report should use the
phrase ventilatory defect (not lung defect or ventilatory pattern). 1 11 6 94.4 0.0 VG
(R9-1) Spirometry results should be interpreted based on the ATS-
13 3 1 100.0 5.9 VG
ERS-TFLFT suggested algorithm. (very good consensus)
(R10-2) In cases of possible upper airway obstruction interpretation,
all of the trials flow volume loop should be reported. If the spirometry
software is not capable, reproducibility of the flow volume loop 7 10 1 100.0 5.6 VG
should be mentioned in the interpreters comments. (very good
consensus)

(R10-4) In cases wherein the interpretation uses any of the
following: flow volume loops configuration, FEF25-75 and other
spirometry parameters, it should be stated that these parameters 9 8 1 100.0 5.6 VG
are suggestive but not definitive. Use of the term compatible is
discouraged. (very good consensus)
(R12-2) If the spirometer software is capable (optional), the value
corresponding to the 95% CI of the predicted value should be 7 10 1 100.0 5.6 VG
written in the report. (very good consensus)
(R12-5) Cut off value for the lower limit of normality should be stated
1 4 11 2 94.4 11.1 VG
in the interpreters comments. (very good consensus)
(R14-1) Interpretation should include suggestion/s on need for
16 1 1 100.0 5.6 VG
additional test if warranted. (very good consensus)
(R15-1) In the section on Interpreters Comments the report should

state what reference equation was used in the interpretation of the 2 4 10 1 88.2 6.7 VG
results. Statement on the need to correlate clinically should be
written in the final interpretation (very good consensus).
(R15-2) A research study will be conducted by the Council of

Diagnostics & Therapeutics to determine which reference equation 0.0 0.0 VG
is best fitted for the local Filipino population. (For this item, kindly
just state of your agree or disagree) (very good consensus)
(R16-1) In the reports section on Interpreters Comments, it should
be stated if the test satisfies the reproducibility criteria set by the 1 7 10 94.4 0.0 VG
ATS-ERS-TFLFT (1) or not. (very good consensus)
(R16-2) It the test does not satisfy one of the acceptability or
reproducibility criteria, it should state the consequences of this 8 8 2 100.0 11.1 VG
deficiency in the parameters. (very good consensus)

(R17-2) The spirometry report should contain the flow volume loops
of all trials, if an interpretation of CAO or UAO made. If the
spirometry software is not capable, the reproducibility of the flow 7 7 3 100.0 17.6 VG
volume loop should be stated in the section on Interpreters
Comments. (very good consensus)
(R18-1) The spirometry report should contain the measured
15 1 2 100.0 11.1 VG
parameters tabular graph. (very good consensus)
(R18-2) The first 3 rows of the tabular graph should be allotted for
the MRSP in the following order: FEV1/FVC, FVC and FEV1. (very 8 9 1 100.0 5.6 VG
good consensus)
(R18-3) The succeeding rows maybe be allotted for the other
parameters in the following order of priority: PEFR, FEF 25-75, FEF
9 8 1 100.0 5.6 VG
75, MIF50/ MEF50, FEV1/FV6, MVV, MIF 50, MEF 50, FEV6, FEF
25 and FEF 50. (very good consensus)
(R19-2) The IC section should state if the test satisfied the ATS-
ERS-TFLFT (1) reproducibility criteria. If the test did not satisfy the
6 10 2 100.0 11.1 VG
criteria, the interpreter should state the consequences of this
deficiency.(very good consensus)
(R19-3) The IC section should also contain the basis for the
interpretation. Specifically it should apply, the ATS-ERS-TFLFT (2)
9 8 1 100.0 5.6 VG
interpretation algorithm, criteria for severity and response to
bronchodilator. (very good consensus)
(R20-2) The FI should contain the following information: presence or
absence of obstructive ventilatory defect and severity if present,
presence or absence of probable restrictive ventilatory defect and
severity if present, significant or no significant response to
15 2 1 100.0 5.6 VG
bronchodilator if done, suggestion for specific additional test if
indicated, a generic sentence Please correlate results with patients
clinical data. and printed name plus signature of the interpreter/s.
Appendix O
PCCP-DATS Committee on Spirometry Consensus
Chair: Ma. Janeth T. Samson, MD, FPCCP
Council of Diagnostics and Therapeutics Members
Caburnay, Eloise Arabelle, MD, FPCCP

Campomanes, Celeste Mae L.,MD, FPCCP
Chavez, Christine L., MD, FPCP
Chua-Panganiban, Shirley Jane, MD, FPCCP
Claveria, Angelica, MD, FPCCP
Cristobal- Aquino, Ma. Flordeliza, MD, FPCCP
Dalupang, Julius, MD, FPCCP
Divinagracia, Charissa, MD, FPCCP
Elisterio, Helarose M., MD, FPCCP
Garcia, Geraldine, MD, FPCCP
Germar, Arnold G., MD, FPCCP
Gonzales, Andrew S.A., MD, FPCCP
Lee-Chua, Rachel, MD, FPCP
Llanes-Gracia, Liza, MD, FPCCP
Mapanao, Daisy, MD, FPCCP
Micu, Lolita Brigida, MD,FPCP
Mora, Czarina J., MD, FPCCP
Natividad, Ma. Piedad R., MD, FPCCP
Ogbac, William George, MD,FPCP
Peafiel, Alvin, MD, FPCCP
Reside, Evelyn Victoria E., MD, FPCCP
Reyes, Mary Jane, MD, FPCCP
Santos, Alfredo Romeo Q., MD, FPCCP
Tan, Marites, MD, FPCCP
Tan, Florita, MD, FPCCP
Samson, Lyndon H., MD, FPCCP
Trinidad, Tim S., MD, FPCCP
Valenzuela, Rosauro Vicente H. Jr.,MD, FPCCP
Villanueva, Anna Tessa, MD. FPCCP
Villanueva, Ma. Peachy Lara, MD, FPCCP
Villasanta, Edwin I.,MD,FPCCP
Zantua, Raphael Ryan R., MD, FPCCP

PCCP Consensus Statement on Spirometry Testing

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PCCP Consensus Statement on Spirometry Testing

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Philippine College of Chest Physician (PCCP):

Consensus Statement on the Performance

Primary Investigator: Tim S. Trinidad, MD, FPCCP

Secondary Investigators: Ma. Janeth T. Samson, MD, FPCCP

Advisers: Camilo C. Roa, MD,FPCCP

Chinese General Hospital: Eden D. Chua, MD, FPCCP

Lung Center of the Philippines: Luisito F. Idolor, MD, FPCCP

Manila Doctors Hospital: Dennis C. Teo, MD, FPCCP

Philippine Heart Center: Rodolfo E. Tamse, MD, FPCCP

University of Perpetual Help Medical Center: Ricardo M. Salonga, MD, FPCCP

University of the Philippines Philippine General Hospital:

University of Sto. Tomas Hospital: Tim S.Trinidad, MD, FPCCP

Veterans Memorial Medical Center: Eloisa S. De Guia, MD, FPCCP

PCCP-Cebu Chapter: Evan N. Mendoza,MD, FPCCP

PCCP-Iloilo Chapter: Malbar G. Ferrer, MD, FPCCP

PCCP-Negros Chapter: Ethel Marie B. Tangarorang-Lacson, MD, FPCCP

PCCP Northern Mindanao Chapter: Eileen G. Aniceto, MD, FPCCP

PCCP-Southern Mindanao Chapter: Romulo T. Uy, MD, FPCCP

PCCP- Southern Tagalog Chapter: Violeta C. Reyes, MD, FPCCP

Key Opinion Leaders

Council of Diagnostics and Therapeutics Members

Caburnay, Eloise Arabelle, MD, FPCCP

Greetings from the Philippine College of Chest Physicians (PCCP) !

Spirometry is a useful tool in the assessment of lung function. National and

Spirometry has many clinical applications in assessing and managing

This spirometry manual was prepared by the PCCP Council on Diagnostics

On behalf of the PCCP Executive Board of Directors, I commend the Council

BENILDA B. GALVEZ, MD, FPCCP

Greetings! The Council of Diagnostics and Therapeutics of the Philippine

Ma. Janeth T. Samson, MD, FPCCP

Spirometry testing is an underutilized ancillary procedure. There are numerous

Methodology & Results

Generation of the List of Statements for Voting

Method Used in Voting and Grading of Consensus Statements

On April 2, 2012, DATS deliberated on the penultimate statements. Thereafter the

Spirometry Testing Consensus Statements

Performance of the Test

Test Result Selection

Parts of the Report

Components of the Report

Use of other Parameters Not in the ATS-ERS-TFLFT Interpretation Algorithm

(S10-3) Slowing down of the terminal portion of spirogram must be described as

Table 1: Grading of Severity of Ventilatory Defect

Mild 70 & above

Moderately Severe 50-59

Very Severe <35

Lower Limit of Normality

Procedure for Performance of Post-bronchodilator Study

(S13-2) Interpretation of response to bronchodilator must be based on the criteria set

Criteria for Significant Response to Bronchodilator:

(S13-4) To standardize the semantics, response to bronchodilator must be labeled as

Statement on Need for Additional Test

(S15-2) A research study must be conducted by the Council of Diagnostics &

Components of the Report: Results in Tabular Graph

Components of the Report: Interpreters Comments

Components of the Report: Final Interpretation

Presence or absence of Obstructive Ventilatory Defect and severity if present

2. American Thoracic Society/ European Respiratory Society. Interpretative

Name: Juan Cruz Time of procedure: 10:00 AM

SGD Charlie Go, RT

Institution Resource Person

PCCP Council on Diagnostics

1. Name: __________________________Age: _