====== Pulmonary Function Test ====== [[https://en.wikipedia.org/wiki/Spirometry|Spirometry]] is a physiological test used to establish baseline lung function by measuring how an individual inhales or exhales volumes of air as a function of time. Spirometry is important as a screening test of general respiratory health. Spirometry ([[sections|section]]: [[physical state]]) is measured in [[start|Lifelines]] participants aged 8 years and older during: * [[1A Visit 1]] (in ~123.000 participants, including ~10.000 [[children]]) * [[2A Visit 1]] (in ~32.000 adult participants that also underwent the test at baseline) * [[3A Visit 1]] (in ~40.000 participants of 13 years and older) * [[4A Visit 1]] (currently ongoing, in participants of 8 years and older) Besides the raw data, information on the [[spirometry_validation|validity of the spirometry and GLI reference values]] have been developed. ===== Device ===== Spirometry was performed following ATS guidelines using a Welch Allyn Version 1.6.0.489, PC-based SpiroPerfect with CardioPerfect Workstation software. The Welch Allyn SpiroPerfect device ({{ :spiroperfect_manual.pdf |}}) consists of a pressure tubing (6.6 ft/2.0m), nose clip, disposable flow transducer and calibration syringe.\\ As of June 2021, MADA-83 bacteria filters are implemented in our Welch Allyn spirometry devices to prevent the spread of Covid-19. The measurement settings did not change.\\ ===== Protocol ===== * Calibrate the device * Inform the participant about the aim and procedure of the measurement * Mention that the measurement will be repeated several times in order to obtain a reliable measurement * Check contraindications * Check if participants has constrictions given by a physician/specialist * Give instructions to participant: * Turn the chair * Sit straight with legs next to each other * Do not lean forward while exhaling in the tube * Place the nose clip with patch * Take the tube in your mouth, hold with your teeth and place the lips around the tube * Exhale 10 times with maximum effort. After each test you receive new instructions about the blowing technique * In- and exhale technique: * Inhale as deep as possible (quick is not necessary) * Exhale as hard and powerful as possible * Continue expiratory effort to a maximum, until unable to continue * On my sign (PA) you inhale as fast en deep as possible * Initialize before each test, whereby the tube observes no airflow. It is important that the participants do not move the tube. ===== Quality Checks ===== Calibration of the device was performed at login and again after 4 hours, as follows: * Humidity, barometric pressure and termperature are registered * A pressure tube is placed on the spirometer, and the calibration syringe is connected * The calibration syringe is pulled out before starting with calibration > click OK * After 3 seconds, the syringe is pushed in and pulled out once, following the pace of the blue bar * Result of the calibration are checked, * deviation is less than 3% of 3 liter? OK * deviation is more than 3% of 3 liter? Try again {{:spiro_flowchart.jpg?400|}} Spirometry systems should be evaluated using a computer-driven mechanical syringe or its equivalent, in order to test the range of exhalations that are likely to be encountered in the test population. Computer-controlled mechanical syringes (i.e. pump systems) used for validation should be accurate within ±50 mL, which is 0.5% of their full range up to 10L. ===== Contraindications ===== Spirometry should not be performed on participants who need to avoid increased pressure situations, for example due to the following: * Recent eye surgery (< 6 wks) * Recent thorax-/abdominal surgery (< 6wks) * Recent operation on umbilical hernia/ incisional hernia (< 6 wks) * Presence of umbilical hernia/incisional hernia and hernia * Pneumothorax (< 6 wks) * Spontaneous pneumothorax (more than twice) * Rib fracture * Recent lung embolism (2 - 6 wks) * Recent infarct ( 2 - 6 wks) * Recent heart catheterisation (< 2 wks) * Aneurism * Avoidance of (heavy) exertion as per instructions from doctor/ specialist * Tuberculosis * Recent airway infection (<3 wks) ===== Measurements (overview) ===== Important aspects of spirometry are: * FVC (Forced vital capacity): the determination of the vital capacity from a maximally forced expiratory effort * FEV1 (Forced expiratory volume): a generic term indicating the volume of air exhaled under forced conditions in the first t seconds of an FVC manoeuvre from a position of full inspiration * PEF (Peak expiratory flow): The highest forced expiratory flow measured with a peak flow meter * FEF (Forced expiratory flow): related to some portion of the FVC curve; modifiers refer to amount of FVC already exhaled * FIVC (Forced inspiratory vital capacity). The maximum volume of air (in liters) that can be inspired during forced inspiration starting from full expiration. {{:spiro_graph.png?400|}} ===== Papers using Lifelines Spirometry data ===== * de Lichtenfels, AJFCA et al. (2018) Long-term air pollution exposure, genome-wide DNA methylation and lung function in the lifelines cohort study. Environmental Health Perspectives 126(2): 027004 * de Jong, K. et al. (2017) Genes and pathways underlying susceptibility to impaired lung function in the context of environmental tobacco smoke exposure. Respiratory Research 18(1): 142 * Soler Artigas, M et al. (2011) Genome-wide association and large-scale follow up identifies 16 new loci influencing lung function. Nature Genetics 43(11): 1082-1090 * Hobbs, BD et al. (2017) Genetic loci associated with chronic obstructive pulmonary disease overlap with loci for lung function and pulmonary fibrosis. Nature genetics 49(3): 426-432 * de Jong, K et al. (2013) GST-omega genes interact with environmental tobacco smoke on adult level of lung function. Respiratory Research 14(1): 83 * Hancock, DB et al. (2012) Genome-Wide Joint Meta-Analysis of SNP and SNP-by-Smoking Interaction Identifies Novel Loci for Pulmonary Function. PLOS Genetics 8(12): e1003098 * van der Plaat, DA et al. (2017) Genome-wide association study on the FEV1/FVC ratio in never-smokers identifies HHIP and FAM13A. Journal of Allergy and Clinical Immunology 139(2): 533-540 * de Jong, K et al. (2014) NOS1: A Susceptibility Gene for Reduced Level of FEV1 in the Setting of Pesticide Exposure. American Journal of Respiratory and Critical Care Medicine 190(10): 1188-1190 * de Jong. K et al. (2015) Genome-wide interaction study of gene-by-occupational exposure and effects on FEV1 levels. Journal of Allergy and Clinical Immunology 136(6) 1664-1672 ===== Variables ===== ^ Label English ^ Label Dutch ^ Code ^ Variable ^ Assessment ^ Age | **[[IO]]** | | do you have asthma? | heeft u astma? | spirometry_astma_all_q_1 | astma | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | do you have copd? | heeft u codp? | spirometry_copd_all_q_1 | copd | [[2A Visit 1|2A]] | 18+ | | | do you smoke, or did you smoke in the past month? | rookt u nu, of heeft u de afgelopen maand nog gerookt? | spirometry_smoking_all_q_1 | spirosmk3 | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | spirometry performed | longfunctie onderzocht | spirometry_performed_all_m_1/2 | longond_1 | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | if not, reason: / spirometry performed | indien nee, reden: / longfunctie onderzocht | spirometry_performed_all_m_2_a | spiroreden | [[2A Visit 1|2A]] | 18+ | | | number of attempts selected by research nurse for lung function assessment | aantal door doktersassistent geselecteerde pogingen voor de longfunctiemeting | spirometry_attempts_all_m_1 | number_of_attempts | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | | | spirometry device code | code van spirometrie apparaat | spirometry_devicecode_all_m_1 | spdevice | [[2A Visit 1|2A]] | 18+ | X | | time at the start of spirometry measurement | tijdstip start van de longfunctiemeting | spirometry_starttime_all_m_1 | started_at_spiro | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | time at the end of spirometry measurement | tijdstip einde van de longfunctiemeting | spirometry_endtime_all_m_1 | ended_at_spiro | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | fef25 of maxfvcfev1 (in liter/sec) | fef25 van maxfvcfev1 (liter/sec) | spirometry_fef25_all_m_1 | fef25 | [[1A Visit 1|1A]] [[2A Visit 1|2A]] [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 8+/18+/13+/8+ | | | fef25 of selected individual spirometry effort (1-8) (in liter/sec) | fef25 van geselecteerde spirometrie effort (1-8) (liter/sec) | spirometry_fef25_all_m_1_01-08 | 1_fef25 - 8_fef25 | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | fef25_75 of maxfvcfev1 (in liter/sec) | fef25_75 van maxfvcfev1 (liter/sec) | spirometry_fef2575_all_m_1 | fef25_75 | [[1A Visit 1|1A]] [[2A Visit 1|2A]] [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 8+/18+/13+/8+ | | | fef25_75 of selected individual spirometry effort (1-8) (in liter/sec) | fef25_75 van geselecteerde spirometrie effort (1-8) (liter/sec) | spirometry_fef2575_all_m_1_01-08 | 1_fef25_75 - 8_fef25_75 | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | fef50 of maxfvcfev1 (in liter/sec) | fef50 van maxfvcfev1 (liter/sec) | spirometry_fef50_all_m_1 | fef50 | [[1A Visit 1|1A]] [[2A Visit 1|2A]] [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 8+/18+/13+/8+ | | | fef50 of selected individual spirometry effort (1-8) (in liter/sec) | fef50 van geselecteerde spirometrie effort (1-8) (liter/sec) | spirometry_fef50_all_m_1_01-08 | 1_fef50 - 8_fef50 | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | fef75 of maxfvcfev1 (in liter/sec) | fef75 van maxfvcfev1 (liter/sec) | spirometry_fef75_all_m_1 | fef75 | [[1A Visit 1|1A]] [[2A Visit 1|2A]] [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 8+/18+/13+/8+ | | | fef75 of selected individual spirometry effort (1-8) (in liter/sec) | fef75 van geselecteerde spirometrie effort (1-8) (liter/sec) | spirometry_fef75_all_m_1_01-08 | 1_fef75 - 8_fef75 | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | fev1 (highest value in liter) | fev1(hoogste waarde in liters) | spirometry_fev1_all_m_1 | fev1 | [[1A Visit 1|1A]] [[2A Visit 1|2A]] [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 8+/18+/13+/8+ | | | fev1 of selected individual spirometry effort (1-8) (in liters) | fev1 van geselecteerde spirometrie effort (1-8) (liters) | spirometry_fev1_all_m_1_01-08 | 1_fev1 - 8_fev1 | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | fvc (highest value in liter) | fvc (hoogste waarde in liters) | spirometry_fvc_all_m_1 | fvc | [[1A Visit 1|1A]] [[2A Visit 1|2A]] [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 8+/18+/13+/8+ | | | fvc of selected individual spirometry effort (1-8) (in liters) | fvc van geselecteerde spirometrie effort (1-8) (liters) | spirometry_fvc_all_m_1_01-08 | 1_fvc - 8_fvc | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | fvc + fev1 (highest value in liter) | fvc + fev1 (hoogste waarde) | spirometry_maxfvcfev1_all_m_1 | maxfvcfev1 | [[1A Visit 1|1A]] [[2A Visit 1|2A]] [[4A Visit 1|4A]] | 8+/18+/8+ | | | pef of maxfvcfev1 (in liter/sec) | pef van maxfvcfev1 (in liter/sec) | spirometry_pef_all_m_1 | pef | [[1A Visit 1|1A]] [[2A Visit 1|2A]] [[4A Visit 1|4A]] | 8+/18+ | | | pef of selected individual spirometry effort (1-8) (in liter/sec) | pef van geselecteerde spirometrie effort (1-8) (liter/sec) | spirometry_pef_all_m_1_01-08 | 1_pef 8_pef | [[4A Visit 1|4A]] | 8+ | X | | fet of maxfvcfev1 (in seconds) | fet van maxfvcfev1 (in secondes) | spirometry_fet_all_m_1 | fet | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | fet of selected individual spirometry effort (1-8) (in seconds) | fet van geselecteerde spirometrie effort (1-8) (secondes) | spirometry_fet_all_m_1_01-08 | 1_fet - 8_fet | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | index number of selected individual spirometry effort (1-8) | indexgetal van geselecteerde spirometrie effort (1-8) | spirometry_effindex_all_m_1_01-08 | 1_effindex - 8_effindex | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | lung function assessment completed | beoordeling longfunctie afgerond | spirometry_reviewed_all_e_1 | check_final | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | lfc assistant - assessment performed | lfc assistent - beoordeling afgevinkt | spirometry_reviewed_all_e_1_a | check_as | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | pulmonologist - assessment performed | longarts - beoordeling afgevinkt | spirometry_reviewed_all_e_1_b | check_spec | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | lfc assistant - technical assessment | lfc assistent - technische beoordeling | spirometry_technicalquality_all_e_1_a | review_as | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | pulmonologist - technical assessment | longarts - technische beoordeling | spirometry_technicalquality_all_e_1_b | review_spec | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | lung function assessment of sufficient quality | longfunctiemeting van voldoende kwaliteit | spirometry_qualitycontrol_all_qc_1 | qc_jv | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | | | research nurse - technical review | doktersassistent - technische beoordeling | spirometry_technicalquality_all_e_2 | technische_kwaliteit | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | | | lfc technician - technical review | longfunctieanalist - technische beoordeling | spirometry_technicalquality_all_e_2_a | spiro_functieanalist_spiro_conclusion | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | | | research nurse - lung fuction result needs to be reviewed by lfc assistant | doktersassistent - resultaat longfunctie moet worden beoordeeld door longfunctieanalist | spirometry_toreview_all_e_1 | needs_review | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | | | lfc assistant - assessment | lfc assistent beoordeling | spirometry_conclusion_all_e_1_a | revafw_as | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | pulmonologist - assessment | longarts - beoordeling | spirometry_conclusion_all_e_1_b | revafw_spec | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | lfc technician - conclusion of review | longfunctieanalist - conclusie van beoordeling | spirometry_conclusion_all_e_2_a | spiro_functieanalist_spiro_quality_result | [[4A Visit 1|4A]] | 8+ | X | | research nurse - results within normal limits? | doktersassistent - resultaten binnen normale limieten? | spirometry_withinlimits_all_e_1 | binnen_de_normale_limieten | [[4A Visit 1|4A]] | 8+ | | | lfc assistant - there are abnormalities to airway obstruction, fev1/fvc <70% | lfc assistent - er zijn afwijkingen voor luchtwegobstructie, fev1/fvc < 70% | spirometry_obstruction_all_e_1_a | revafw1_as | [[1A Visit 1|1A]] | 8+ | | | pulmonologist - there are abnormalities to airway obstruction, fev1/fvc <70% | longarts - er zijn afwijkingen voor luchtwegobstructie, fev1/fvc < 70% | spirometry_obstruction_all_e_1_b | revafw1_spec | [[1A Visit 1|1A]] | 8+ | | | lfc assistant - there are abnormalities to airway obstruction, fev1/fvc <75% | lfc assistent - er zijn afwijkingen voor luchtwegobstructie, fev1/fvc < 75% | spirometry_obstruction_all_e_2_a | revafw1_kp_as | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | pulmonologist - there are abnormalities to airway obstruction, fev1/fvc <75% | longarts - er zijn afwijkingen voor luchtwegobstructie, fev1/fvc < 75% | spirometry_obstruction_all_e_2_b | revafw1_kp_spec | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | lfc assistant - there is a flow-volume curve with an abnormal gradient, namely | lfc assistent - er is sprake van een flow-volume curve met een abnormaal verloop nl | spirometry_abnormalcurve_all_e_1_a | revafw3_as | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | pulmonologist - there is a flow-volume curve with an abnormal gradient, namely | longarts - er is sprake van een flow-volume curve met een abnormaal verloop nl | spirometry_abnormalcurve_all_e_1_b | revafw3_spec | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | lfc assistant - there is a reduced vc that is <80% predicted | lfc assistent - er is sprake van een verlaagde vc die < 80% predicted | spirometry_reducedvc_all_e_1_a | revafw2_as | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | pulmonologist - there is a reduced vc that is <80% predicted | longarts - er is sprake van een verlaagde vc die < 80% predicted | spirometry_reducedvc_all_e_1_b | revafw2_spec | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | | | additional remarks from research nurse | aanvullende opmerkingen van doktersassistent | spirometry_remarks_all_e_1 | remark_loc | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | X | | lfc assistant - remark | lfc assistant - opmerking | spirometry_remarks_all_e_1_a | remark_as | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | X | | pulmonologist - remark | longarts - opmerking | spirometry_remarks_all_e_1_b | remark_spec | [[1A Visit 1|1A]] [[2A Visit 1|2A]] | 8+/18+ | X | | research nurse - remarks on measurement | doktersassistent - opmerkingen over meting | spirometry_remarks_all_e_2 | tstcomment | [[4A Visit 1|4A]] | 8+ | X | | lfc technician- internal remarks about spirometry | longfunctieanalist - interne opmerkingen over spirometrie | spirometry_remarks_all_e_2_a | spiro_functieanalist_spiro_comments_internal | [[4A Visit 1|4A]] | 8+ | X | | lfc technician - advise to gp based on spirometry review | longfunctieanalist - advies aan huisarts op basis van spirometrie beoordeling | spirometry_gpadvise_all_e_2 | spiro_functieanalist_spiro_feedback_gp_2 | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X | | lfc technician - remarks to gp | longfunctieanalist - opmerkingen aan huisarts | spirometry_gpadvise_all_e_1_a | spiro_functieanalist_spiro_comments_letter | [[4A Visit 1|4A]] | 8+ | X | | lfc technician - feedback to participant based on spirometry review | longfunctieanalist - feedback aan deelnemer op basis van spirometrie beoordeling | spirometry_feedback_all_e_2 | spiro_functieanalist_spiro_feedback_pp_2 | [[3A Visit 1|3A]] [[4A Visit 1|4A]] | 13+/8+ | X |