RESPTREC: Respiratory Educator and Training Program

Spirometry Course

The Spirometry course will teach individuals how to conduct quality spirometry including: basic lung anatomy and mechanics, spirometry equipment, spirometry indications and contraindications, spirometry test procedures, criteria for acceptability and repeatability, bronchodilator responsiveness testing, spirometry office procedures, and basic spirometry interpretation.

Canadian and international consensus guidelines for the management of asthma and COPD call for routine use of spirometry for the diagnosis and appropriate management of these diseases. In order to meet the need for more access to quality spirometry, RESPTREC® course launched a Spirometry course in 2009, and in response to an expressed need, the online course in 2021. The goal of this course is to ensure those conducting spirometry continue to have the knowledge, skills, and behaviors needed to conduct quality spirometry in order to improve diagnosis and management of chronic respiratory diseases.

Curriculum includes:

  • Basic Lung Anatomy and Mechanics
  • Spirometry Equipment
  • Spirometry Indications and Contraindications
  • Spirometry Test Procedures
  • Criteria for Acceptability and Repeatability
  • Bronchodilator Responsiveness Testing
  • Spirometry Office Procedures
  • Basic Spirometry Interpretation

CHAPTER: Basic lung anatomy and mechanics

  1. Identify the major components of the airway.
  2. Describe the effect of airway inflammation on airflow during exhalation.
  3. Define the following terms:
    1. Tidal volume
    2. Inspiratory capacity
    3. Vital capacity
    4. Functional residual capacity
    5. Residual volume
    6. Total lung capacity
  4. Define the following spirometric measurements.
    1. FEV1
    2. FVC
    3. PEF
    4. FEV1/FVC
    5. FEF 25%-75%
  5. Identify each of the following measurements in relation to:
    1. The flow volume loop:
      1. PEF
      2. FVC
    2. The volume time graph:
      1. FEV1
      2. FET
      3. FEF25%-75%
  6. List the factors that will influence predicted normal spirometry values.
  7. Describe how age, height, gender and ethnicity influence the predicted spirometer values between adults and children.

CHAPTER: Spirometry Equipment

  1. List the ATS/ERS standards for spirometry equipment.
  2. Define BTPS.
  3. Explain the conversion to BTPS.
  4. Describe how a spirometer works.
  5. Define test accuracy.
  6. Define test precision.
  7. Describe how to perform daily spirometer calibration checks.
  8. Describe the use of biologic controls.
  9. Describe infection control in spirometry.
  10. Describe the basic principles of equipment
    1. maintenance; and
    2. safety.

CHAPTER: Spirometry Indications and Contraindications

  1. List the indications for spirometry.
  2. List the contraindications for spirometry.

CHAPTER: Spirometry Test Procedure

  1. List the instructions that should be given to the patient before testing regarding:
    1. activities; and
    2. medications.
  2. Identify the patient information that should be recorded including:
    1. race, gender, height, and age;
    2. accurate height and weight measurements;
    3. all medications the patient is currently taking;
    4. smoking history; and
    5. time of test.
  3. Describe the proper method for measuring height:
    1. standing; and
    2. using arm span measurement.
  4. Describe proper patient positioning.
  5. Describe the recommended testing procedure.
  6. Demonstrate coaching instructions to achieve optimal results considering:
    1. age-appropriate words; and
    2. individual characteristics.

CHAPTER: Criteria for Acceptability and Repeatability

  1. List the within-manoeuvre criteria for acceptability, according to the ATS/ERS standards, for each of the following:
    1. start of test;
    2. during test (additional criteria);
    3. end of forced expiration (EOFE); and
    4. maximal full inspiration.
  2. Explain the back-extrapolation technique.
  3. List the criteria for repeatability, according to the ATS/ERS standards.
  4. Differentiate among the following:
    1. useable tests; and
    2. unusable tests.
  5. Describe the grading system for spirometry, according to the ATS/ERS standards.
  6. Identify when testing session is complete.
  7. Describe the situations when it is acceptable to terminate the test.
  8. Describe what is meant by ‘alert values’.
  9. Describe the importance of including both the inspiratory and expiratory  components of the flow volume loop.
  10. List appropriate technician comments to be included in final report in relation to:
    1. patient effort;
    2. usable, unusable and acceptable tests; and
    3. repeatability.
  11. List the components that should be included on a standardised spirometry report.

CHAPTER: Bronchodilator Responsiveness Testing

  1. List the indications for bronchodilator responsiveness testing.
  2. Describe the bronchodilator responsiveness testing procedure.
  3. List the recommendations for bronchodilator dose and wait time.
  4. Demonstrate proper bronchodilator delivery device technique.
  5. List the criteria for significant responsiveness.

CHAPTER: Spirometry Office Procedures

  1. List the important information that should be included on the requisition.
  2. Describe the requirements regarding patient consent.
  3. List items to be included in the spirometry procedure manual.

CHAPTER: Basic Spirometry Interpretation

  1. Define the term lower limit of normal.
  2. Distinguish between normal, obstructive and restrictive patterns.
  3. Identify how to select the best reportable value and curves including:
    1. criteria for choosing the appropriate FEV1; and
    2. FVC.
  4. Describe when it is necessary to override the computer.
  5. Describe appropriate communication with patients regarding spirometry results.

Participants must meet the following entrance criteria:

  • be employed in a setting where spirometry is routinely performed and have access to spirometry equipment
  • be working with or under the supervision of a physician or nurse practitioner who is able to interpret the spirometry results
  • have some knowledge of medical terminology and procedures
  • have access to a spirometer and 3L calibration syringe

If there is a question regarding met criteria, acceptance to the program will be made on an individual basis and at the discretion of the RESPTREC® Management committee.

The original spirometry course learning objectives and curriculum outline were established by a national expert committee with representation of key groups: Canadian Thoracic Society (CTS), Canadian Respiratory Health Professionals (CRHP), Family Physicians Airways Group of Canada (FPAGC), the Lung Association and various disciplines, in addition to expertise in: guidelines development, technical skills, teaching, and conducting spirometry.

Spirometry Course Expert Committee

  • Allan Coates MC CM Eng (Elect)
  • Robert Cowie MB ChB FCP(SA) MD MSc MFOM
  • Brian Graham PhD
  • Jan Neumann BPT CRE
  • Alan Kaplan MD CCFP(EM) (Chair FPAGC)
  • Marion Laroque RRT RCPT(P) CRE
  • Dilshad Moosa BSc RRT CRE
  • Donna Rennie PhD (Epidemiology) RN CAE
  • Jeremy Road MD FRCPC
  • Laura Seed RCPT(P)
  • Pat Steele RN RCPT(P) CRE
  • Amin Thawer RRT CRE

External Reviewers

  • John Hankinson PhD
  • Paul Enright MD

Administrative Assistance

  • Lori Nagy (Business and Education Manager, The Lung Assoiciation of Saskatchewan)
  • Janet Sutherland (Executive Director, Canadian Thoracic Society)

Original Faculty Training

  • Dr. Bob Crapo

RESPTREC® gratefully acknowledges The Saskatchewan Health Research Foundation - Research Connections Grant for providing financial support for the development of the Online Spirometry course.

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All Rights Reserved.

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Saskatoon, SK  S7J 3L3

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