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Effects of instructions on pulmonary function values.

D L Harm, R J Marion, T L Creer

    The Journal of Asthma : Official Journal of the Association for the Care of Asthma
    |January 1, 1985
    PubMed
    Summary
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    Instructions to blow harder during spirometry significantly improved key lung function measures like FVC and FEV1. However, instructions to blow longer sometimes decreased certain spirometric values, highlighting the importance of precise coaching.

    Area of Science:

    • Pulmonary Function Testing
    • Respiratory Physiology
    • Clinical Diagnostics

    Background:

    • Spirometry is a crucial tool for diagnosing and monitoring respiratory diseases.
    • The accuracy of spirometric values depends heavily on patient effort and adherence to instructions.
    • Standardized instructions for the forced expiratory maneuver (FEM) aim to maximize patient performance.

    Purpose of the Study:

    • To investigate how specific components of FEM instructions (blowing harder, faster, or longer) affect spirometric outcomes.
    • To identify which instructional cues optimize the reliability and validity of spirometry measurements.

    Main Methods:

    • Thirty-six subjects performed spirometry after initial practice and instruction.
    • Experimental manipulation involved providing additional instructions to blow 'harder,' 'faster,' or 'longer' during subsequent maneuvers.

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  • Key spirometric parameters including Inspiratory Capacity (IC), Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEF25-75%, and FEV1/FVC ratio were analyzed.

    • Main Results:

    • Instructions emphasizing 'blowing harder' consistently improved all measured spirometric values (IC, FVC, FEV1, FEF25-75%, FEV1/FVC).
    • Instructions to 'blow longer' resulted in a decrease in some spirometric measures, indicating potential detrimental effects.
    • The 'blowing faster' instruction's impact was less consistently defined across all parameters compared to 'blowing harder'.

    Conclusions:

    • Emphasizing maximal exhalation force ('blowing harder') is the most effective instructional strategy for optimizing spirometric performance.
    • Careful consideration of instructional wording is necessary, as cues like 'blowing longer' may negatively impact certain lung function measurements.
    • Refined coaching techniques during spirometry can enhance data quality for improved clinical interpretation.