Is my lung function really that good? Flow-type spirometer problems that elevate test results

Most spirometry errors reduce test results, and it is widely assumed that measurement accuracy is guaranteed by frequent spirometer calibrations or calibration checks. However, zero errors and changes in flow-type spirometer sensors may occur during testing that significantly elevate test results, even though the spirometer was calibrated recently. To draw attention to these often-unrecognized problems, this report presents anomalous spirograms and test results obtained from occupational medicine clinics and hospital pulmonary function laboratories during quality assurance spirogram reviews. The spurious results appear to have been caused by inaccurate zeroing of the flow sensor, or by condensation, mucus deposition, or unstable calibration of various flow-type spirometers. These errors elevated some FVCs to 144 to 204% of predicted and probably caused 40% of 121 middle-aged working men in respirator medical clearance programs to record both FVC and FEV1 > 120% of predicted. Since spirometers report the largest values from a test, these errors must be recognized and deleted to avoid false-negative interpretations. Flow-type spirometer users at all levels, from the technician to the interpreter of test results, should be aware of the potential for and the appearance of these errors in spirograms.