kp 1.3.5.6 SPIROMETRI-BLOK-1.3-14

SPIROMETRISPIROMETRISPIROMETRISPIROMETRI

OlehOleh : : AfriwardiAfriwardi

SPIROMETRI

• Peralatan untuk memeriksa fungsi pernafasan

– Volume udara yang masuk ke paru– Volume udara yang masuk ke paru

– Kecepatan udara keluar masuki

• Jenis : sangat berkembang

• Standar :Benedic

Hipoksia Tempat Tinggi

• Penurunan tekanan udara

• Tekanan pasrsial oksigen juga turun• Tekanan pasrsial oksigen juga turun

• Hirup oksigen murni

Manfaat • Diagnostik

– Patofisiologi

– Sumber kelainan sesak : Paru, saluran nafas, Jantung, Thorak, Dllnafas, Jantung, Thorak, Dll

• Prognostik : Klinis penyakit,Kerusakan paru, Gangguan faal paru

• Evaluasi terapi : baik, memburuk, tetap

Faktor berpengaruh

• Usia

• Jenis kelamin

• Tinggi badan• Tinggi badan

• Berat badan

• Ras

• Bentuk tubuh

INDIKASI SPIROMETRI

• Diagnostik

• Evaluasi

• Kesehatam masyarakat• Kesehatam masyarakat

• Screening

• Data base

Contraindications

• Recent Eye surgery (3 months)

• Recent thoracic or abdominal surgery (3 • Recent thoracic or abdominal surgery (3 months)

• Pregnancy (1st Trimester contraindicated but in 2nd and 3rd

Trimester results may be effected by uterus size)

PERSIAPAN PEMERIKSAAN

• Operator : pengetahuan memadai tentang resiko, instruksi, dll

• Persiapan alat• Persiapan alat

• Persiapan Subjek : pemahamn terhadap proses pemeriksaan, pakaian, makan, dll

• Kondisi lingkungan : nyaman

MANUVER SPIROMETRI

1. KV (Kapasitas Vital ) : Sub. inspirasi dan ekspirsi maksimal tanpa paksa

2. KVP ( Kapasitas Vital Paksa ) : Sub. inspirasi paksa dan ekspirsi maksimal

2. KVP ( Kapasitas Vital Paksa ) : Sub. inspirasi paksa dan ekspirsi maksimal paksa dengan hentakan

3. VEP1 ( Volume Ekspirasi Paksa detik pertama : manuver sama dengan KVP

MANUVER SPIROMETRI

4. APE ( Arus Puncak Ekspirasi ) : Kecepatan arus ekspirasi maksimal pada saat ekspirasi paksa

5. MVV ( Maksimum Voluntary 5. MVV ( Maksimum Voluntary Ventilation ) : Volume udara maksimal yang di hirup selama 10 -15 detik

Indices Measured

Normal Results

• FEV1 > 80% predicted

• FVC > 80% predicted• FVC > 80% predicted

Obstruction

• FEV1 < 80% predicted

• FVC > 80% predicted

• Ratio <70%

Caution

If ratio is low but FEV1 and FVC are normal there is still obstruction present

Obstructive Disorders• COPD

• Asthma

• Bronchiectasis• Bronchiectasis

• Tumour

• Foreign Body

NICE 2010

Consider alternative diagnoses in:

• Older people without typical • Older people without typical symptoms of COPD where the FEV1/FVC is <0.7

• Younger people with symptoms of COPD where the FEV1/FVC ration is ≥ 0.7

Restriction

• FEV1 <80% predicted

• FVC < 80% predicted

• Ratio >70%• Ratio >70%

Restrictive Disorders

• Kyphoscoliosis

• Muscular Dystrophy Problems

• Arthritis• Arthritis

• Pleural Problems

• Interstitial Lung Disease

• Obesity

• Drugs

Combined

• FEV1 <80% predicted

• FVC <80% predicted

• Ratio <70%• Ratio <70%

Combined Disorders

• Severe COPD

• Multiple Pathology e.g.

– Kyphscoliosis and COPD– Kyphscoliosis and COPD

– Tumour and COPD

Severity of Obstruction

• Based on % Predicted of FEV1

• Good predictor of Prognosis

• Poor Predictor of Disability and Quality of Lifeof Life

• Categories;• BTS (1997)

• GOLD (2001)

• NICE (2004)

• NICE (2010)

Severity of ObstructionNICE Guideline (2004)

ATS/ERS (2004)

GOLD (2008) NICE Guideline (2010)

Post-Bronchodilator FEV1/FVC

FEV1 % Predicted

Severity of Airflow Obstruction

Post -Bronchodilator

Post -Bronchodilator

Post -Bronchodilator

<0.7 ≥ 80% Mild Stage 1-Mild Stage 1-Mild*

<0.7 50-79% Mild Moderate Stage 2-Moderate

Stage 2-Moderate

<0.7 30-49% Moderate Severe Stage 3-Severe Stage 3-Severe

<0.7 < 30% Severe Very Severe Stage 4-Very Severe**

Stage 4-Very Severe**

*Symptoms should be present to diagnose COPD with mild airflow obstruction

**or FEV1 <50% with respiratory failure