Get Valid Spirometry Results EVERY Time Sharp peak

6 Flat (plateau) 12
before 15 seconds long

VOLUME (L) (BTPS)

FLOW (L/S) (BTPS)

A Valid Test has: 5

4
10

8
3 or More Good Curves 3
Smooth curve
6
Smooth descent
to baseline

and Repeatable FVC and FEV1* 2 4

1 2 Vertical
0
Steep climb rise Green = Good Curve
0
0 1 2 3 4 5 6 Red = Error
0 1 2 3 4 5 6 7 8 9 10 11 12 13
TIME (sec) VOLUME (L) (BTPS)

HOW TO CORRECT TEST ERRORS

Poor Initial Blast Hesitation; Slow Start; Large Extrapolated Volume Cough in First Second
Coach: Blast air out HARDER Delete Curve; Coach: Blast FASTER Delete Curve; Correction: Try a drink of water
6 12 6 12 6 12
Peak shifted Curve dips

VOLUME (L) (BTPS)

VOLUME (L) (BTPS)

VOLUME (L) (BTPS)

5 10 5 10 5 10

FLOW (L/S) (BTPS)

FLOW (L/S) (BTPS)
FLOW (L/S) (BTPS)

4 8 4 8
to right 4 8
3 6 Rounded or 3 6 3 6
2 4 flat peak 2 4 2 Curve dips 4
1 Slow climb 2 1 Slow take off 2 1 2
0 0 0 0 0 0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 1 2 3 4 5 6 0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 1 2 3 4 5 6 0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 1 2 3 4 5 6
TIME (sec) VOLUME (L) (BTPS) TIME (sec) VOLUME (L) (BTPS) TIME (sec) VOLUME (L) (BTPS)

Incomplete Inhalation No Plateau Before 15 Seconds Inconsistent Effort

Coach: Take a DEEPER breath Coach: Keep blowing until told to stop Coach: One continuous blast and keep blowing
6 12
Ga p 12 6 Difficult 6 12
VOLUME (L) (BTPS)

VOLUME (L) (BTPS)

FLOW (L/S) (BTPS)

VOLUME (L) (BTPS)
FLOW (L/S) (BTPS)

10
5 10 5
to see
5 10 Curve
FLOW (L/S) (BTPS)

4 8 4 8 4 8 flattens out
3 3 Does not flatten 6
on this 3
6 6
Curves have same shape curve
2 4 2 for 1 second 4 2 4
1
but are different sizes Gap 1 1 Curve tilts
2 2 2
0 0 0
0 0 0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 1 2 3 4 5 6 0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 1 2 3 4 5 6 0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 1 2 3 4 5 6
TIME (sec) VOLUME (L) (BTPS) TIME (sec) VOLUME (L) (BTPS) TIME (sec) VOLUME (L) (BTPS)

Partially Blocked Mouthpiece Glottis Closure or Breath Holding Leak

Coach: Position mouthpiece between teeth and Coach: Initial BIG BLAST then RELAX and keep blowing Correction: Check equipment and connections
on top of tongue; secure dentures
6 12 6 12 Drops straight 6
Curve
Smaller peak
VOLUME (L) (BTPS)

moves
VOLUME (L) (BTPS)

VOLUME (L) (BTPS)

5 5 10 down 5
FLOW (L/S) (BTPS)

10
FLOW (L/S) (BTPS)

4 8 and curve 4 8 4 backwards

3 6 wobbles 3 6 3

2
Curve wobbles 2 Abruptly flattens Curve drops down
4 4 2

1 2 1 2 1

0 0 0 0 0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 1 2 3 4 5 6 0 1 2 3 4 5 6 7 8 9 10 11 12 13 0 1 2 3 4 5 6 0 1 2 3 4 5 6
VOLUME (L) (BTPS) 0 1 2 3 4 5 6 7 8 9 10 11 12 13
TIME (sec) VOLUME (L) (BTPS) TIME (sec) VOLUME (L) (BTPS)
TIME (sec)

Negative Zero Flow Error Positive Zero Flow Error Extra Breaths
Correction: No airflow through sensor when spirometer zeroing Correction: No airflow through sensor when spirometer zeroing Correction: DELETE CURVE; Use nose clips and lips tightly sealed
Hold sensor upright during test Hold sensor upright during test

14
8
Flat line Extra breaths
Curve ends 12
Difficult Continues to climb – 6 12
VOLUME (L) (BTPS)

FLOW (L/S) (BTPS)

VOLUME (L) (BTPS)

7
VOLUME (L) (BTPS)

FLOW (L/S) (BTPS)

early
FLOW (L/S) (BTPS)

10
6
NEVER flattens extends 5 10
Extra
5 8 to see 4 8
4 to right 1 or more extra breaths breaths
3
6
on this 3 6

2
4 2 look like miniature 4
1 OR Curve drops down 2
curve 1 additional curves 2

0 0 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
TIME (sec)
1 2 3 4 5 6 7 8 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
VOLUME (L) (BTPS) TIME (sec) VOLUME (L) (BTPS) TIME (sec) VOLUME (L) (BTPS)

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For a monthly update on news at NIOSH, subscribe to NIOSH eNews by visiting www.cdc.gov/niosh/eNews. For more information about NIOSH-Approved Spirometry Training go to http://www.cdc.gov/niosh/topics/spirometry/training.html
S ERVICES
AN US
A
UM

U.S. Department of Health and Human Services

H
&
T OF HEALTH

Centers for Disease Control and Prevention

DHHS (NIOSH) Publication No. 2011-135
EN

National Institute for Occupational Safety and Health

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