AARC Webcast on Pulmonary Function Testing

Introduction

• The webcast is copyrighted by the American Association for Respiratory Care (AARC).
• Presenter: Shauna Strickland, Associate Executive Director for Education at AARC.
• Main topic: Pulmonary function testing and highlights from the Respiratory Care Journal.
• Objectives:
  • Discuss quality issues in selecting personnel for pulmonary function labs.
  • Identify clinical indications for measuring lung volumes.
  • Describe a bronchial challenge test using an indirect agent.
  • Suggest reasons for using Lower Limit of Normal (LLN) over percent predicted.
  • Name a new method for COPD screening.

Presenter Introduction

• Greg Ruple: Adjunct professor at Saint Louis University School of Medicine and chair of the NBRC Pulmonary Function Examination Committee.
• Disclosure: Relationships with Medical Graphics, Gilead Sciences, and Biomedical Systems.

Conference Overview

• The presentation is based on a 2011 conference and a subsequent publication.
• Key topics include quality issues, predicted values, and interpretation of pulmonary function tests.

Quality Issues in Pulmonary Function Testing

• Dr. Meredith Mcari discussed issues in diffusion capacity testing (DLCO).
  • Variability in DLCO testing across labs.
  • Importance of quality control and repeatability criteria.

Clinical Indications for Lung Volume Measurements

• Lung volumes are crucial when the vital capacity is low.
• Air trapping and hyperinflation can indicate bronchodilator response.
• Comparison between body plethysmography and dilution techniques.

Pediatric Considerations

• Dr. Alan Coats emphasized differences in pediatric testing compared to adults.
• Importance of adjusting quality guidelines and parameters like FEV1/FVC for children.

Exercise Testing

• Dr. Bon Pichero discussed the indications for cardiopulmonary exercise testing vs. six-minute walk tests.
• Oxygen consumption remains the gold standard.

Technologist Role in Pulmonary Diagnostics

• Jeff Haynes highlighted the importance of selecting and evaluating technologists beyond traditional qualifications.

Spirometry Utilization

• Discussion on the underutilization of spirometry in diagnosing obstructive lung disease.
• Dr. Paul Enright's opinion on not pushing spirometry in every doctor's office.

Innovations and Future Directions

• Introduction of new methods for COPD screening using Peak flow meters and questionnaires.
• Global Lungs Initiative for spirometry predicted values.

Interpretive Strategies

• Emphasis on the need for better interpretive strategies over simple percent predicted.
• Dr. Bruce Culver discussed using statistical approaches like LMS for lung function predictions.

Conclusion and Recommendations

• More training needed for technologists and physicians.
• Better quality assurance and application of spirometry are crucial for future pulmonary function labs.

Additional Resources

• All papers from the conference published in the January 2012 issue of Respiratory Care.
• Encouragement to review these papers for more detailed insights and discussions.