Are all lung patients still not being tested with Spirometry at hospitals?
November 3rd, 2009 | by admin |Just came across article in internet from October 2006, which details how up till then one-third of COPD and CHF (congestive heart failure) patients were not given the Spirometry test upon admission to hospital to check for breathing problems. The study done had found substantial differences in the primary tests done. But that determining treatment based on the severity of the two illnesses was dependent on the Spirometry test. Simply put, it was much more effective.
The test is said to be very simple and it is used to measure lung capacity and how far air can be expelled from the lung.
Curiously someone in my family had this test done by nurses after a long period of intubation. But we don’t recall seeing it done ever before during multiple hospitalizations. Is this supposed to be done only at beginning of original hospitalization, or can it be repeated?
Also, if this is so helpful in determining lung capacity, etc, why isn’ itt done from the very beginning?
When I was diagnosed with asthma, my doctor did spirometry on me in his office. That was to see if I had asthma. My symptoms were not particularly bad at the time. When I returned to his office about a month later, I had been coughing my guts up all the previous day and night. No spirometry was needed that time.
When a patient has obvious symptoms, why would you waste time doing a test that confirms what you already know? If something needs to be done right now, I guarantee you that any health care professional who should keep their license will not be fussing around with a portable spirometer when their patient is dying.
After a patient is extubated, it helps to know how well their lungs are functioning to determine what the course of treatment should be. I have extubated many patients and not performed bedside spirometry on any of them. It was not necessary.
Spirometry is a very useful and simple diagnostic tool. When there is a need to use it, it should be used. I think that every child should be screened for lung disease in Kindergarten and Grade 9. This would help to identify and get appropriate treatment for kids with asthma. It can be done clinically whenever an indication for it exists. If the patient is too sick to safely perform the breathing maneuvers, then it will not be performed.
Spirometry could be done on every patient daily. The reason it is not done, I think, is mostly because it is not indicated and therefore not needed. Patient safety is more important than precise evaluation of a disease when urgent care is needed.
3 Responses to “Are all lung patients still not being tested with Spirometry at hospitals?”
By jssrn on Nov 3, 2009 | Reply
Incentive spirometry is usually done post operatively or, as in your case, after periods of intubation in hospitalized and relatively immobile patients to promote deep breathing and prevent pneumonia. I have not ever heard of it being done on admission, but I have never worked in ER where most patients are admitted from. I don’t think it would be much help as a diagnostic tool as it is pretty much a given that COPD patients and CHF patients have decreased lung capacity (which is why they have frequent rehospitalizations), but it is definitely something that should be done during hospitalization to help prevent pneumonia. Usually, the nurse or respiratory therapist will teach the patient to use it 5-10 times/breaths every 1-2 hours while awake..
For people who are able to get up and walk around, turn themselves regularly, etc. IS may not be needed. It is the person who is not moving around much who is more at risk.
You can always ask for a spirometer-it is often part of standard admission orders or would be easy to get a physicians order for. Just taking deep breaths and blowing them out does the same thing, though and costs nothing.
References :
nurse
By Faerie loue on Nov 3, 2009 | Reply
Oximeters on the forefinger tell the tale of the persons oxygen saturation level and a stethoscope to the chest hear air movement. Without the normal expected rates and sounds the person will be admitted and treated and the Doctor in charge will recommend a pulmonary follow up after discharge. This is when "levels of air flow"will be charted and the level of care adjusted for the particular patient.
They don’t need to know FEV flow when a person is obviously in respiratory distress, they take action then later worry about actual flow amount, if your bleeding to death you need to stop the hemorrhage not measure it.
References :
By James S on Nov 3, 2009 | Reply
When I was diagnosed with asthma, my doctor did spirometry on me in his office. That was to see if I had asthma. My symptoms were not particularly bad at the time. When I returned to his office about a month later, I had been coughing my guts up all the previous day and night. No spirometry was needed that time.
When a patient has obvious symptoms, why would you waste time doing a test that confirms what you already know? If something needs to be done right now, I guarantee you that any health care professional who should keep their license will not be fussing around with a portable spirometer when their patient is dying.
After a patient is extubated, it helps to know how well their lungs are functioning to determine what the course of treatment should be. I have extubated many patients and not performed bedside spirometry on any of them. It was not necessary.
Spirometry is a very useful and simple diagnostic tool. When there is a need to use it, it should be used. I think that every child should be screened for lung disease in Kindergarten and Grade 9. This would help to identify and get appropriate treatment for kids with asthma. It can be done clinically whenever an indication for it exists. If the patient is too sick to safely perform the breathing maneuvers, then it will not be performed.
Spirometry could be done on every patient daily. The reason it is not done, I think, is mostly because it is not indicated and therefore not needed. Patient safety is more important than precise evaluation of a disease when urgent care is needed.
References :
I’m a Respiratory Therapist (RRT) with asthma.