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Silhouette of John Hutchinson and his spirometer, illustrating correct body positioning for performance of the vital capacity manoeuvre (Reproduced from reference 1)
Source publication
Three recent advances in assessment of routine lung function are reviewed. In both normal subjects and patients with obstructive lung disease, the flows during the forced vital capacity (FVC) manoeuvre depend significantly on the pattern of the preceding inspiratory manoeuvre. Accordingly, the latter should be standardized in clinical and epidemiol...
Citations
... Von Recklinghausen's cumulative recordings are not unique, even if they are rare. The modern spirometer is an 1846 invention, credited to John Hutchinson (1811-1861) (Milic-Emili, Marranazzini, & D' Angelo, 1997;Hutchinson, 1846;Spriggs, 1977Spriggs, , 1978. Von Recklinghausen's system, constructed by instrument maker J.U. A. Bosch (von Recklinghausen, 1896, p. 459), was a simple modification of charting techniques already in use for decades (see Panum, 1868, p. 150). ...
Although the cumulative record and cumulative recorder have become closely identified with B.F. Skinner and the experimental analysis of behavior, they actually predate both. The purpose of this article is to describe some early examples of cumulative records in psychology and physiology, as well as the techniques used to generate them. Among the work of Walther Poppelreuter, Heinrich von Recklinghausen, Fletcher Dresslar, Colin Stewart, James Slonaker, and others are early examples of “telescoping” to save space on the printed page, the automatic resetting of the pen at the top of the page, and other anticipations of Skinner’s own development of the technique. In most early instances, the cumulative recording was not used to display discrete operant responses such as lever presses, but to depict wheel running and respiration over extended periods. The historical approach here is illustrative rather than comprehensive, with the hope that these examples will serve as a starting point for those who might investigate further. © 2017, Sociedad Mexicana de Analisis de la Conducta. All rights reserved.
Introduction:
In patients with chronic obstructive pulmonary disease (COPD), static and dynamic hyperinflation, together with expiratory flow limitation and gas exchange abnormalities, is one of the major causes of dyspnea, decreased exercise performance and ventilatory failure. An increase in functional residual capacity (FRC) is accompanied by a decrease in inspiratory capacity (IC), which is a volume readily available, repeatable, and simple to measure with any spirometer. Changes in IC and FRC after bronchodilation, contrary to changes in FEV1, have been closely associated with improvements in dyspnea and exercise performance. We systematically searched PubMed and Embase databases for clinical trials that assessed the effects of dual bronchodilation on inspiratory capacity in patients with COPD.
Areas covered:
Despite their pivotal role in COPD, IC and static volumes have rarely been considered as primary outcomes in randomized clinical trials assessing the efficacy of bronchodilators. Available studies on dual bronchodilation have shown a significant and persistent positive impact on IC focusing mainly on patients with moderate-to-severe COPD, whereas dynamic hyperinflation is also present at milder disease stages.
Expert opinion:
This narrative review discusses the pathophysiological and clinical importance of measuring IC in patients with COPD and how IC can be modified by maximizing bronchodilation combining long-acting muscarinic antagonists and long-acting β2 agonists.
Zusammenfassung
Fahrradergometrische Untersuchungen werden zur Therapiesteuerung und zur Feststellung der körperlichen Leistungsfähigkeit und Belastbarkeit bei sportmedizinischen Untersuchungen eingesetzt. Dabei haben sich die sitzende und halbliegende Fahrradergometrie etabliert. Zur Übertragbarkeit der durch die unterschiedlichen Belastungssituationen ermittelten Ergebnisse gibt es nur wenige Veröffentlichungen, die zudem ohne eindeutige Aussagen sind. Ziel der Studie ist es, durch eine Einzelfalluntersuchung exemplarisch die Vergleichbarkeit der beiden Belastungssituationen anhand von spirometrischen und kardiozirkulatorischen Parametern zu ermitteln. Die vorliegenden Ergebnisse legen die Vermutung nahe, dass eine Limitierung der Übertragbarkeit von spiroergometrisch gewonnenen Belastbarkeitswerten auf die jeweils adäquate Sitz- bzw. Halbliegeposition im Ergometertraining nicht angebracht scheint.
Spirometry is a useful test of pulmonary function and can be safely performed in a variety of clinical situations. Although the technique for performing the maneuver is straightforward, there are many sources of variability in results. Specific criteria must be met in order for the test to be considered valid. For the best results, proper instruction and coaching is essential, and patient understanding and effort must be maximized. Appropriate interpretation of spirometry requires several steps, including recognition and reporting of technically sound maneuvers, comparison to an appropriate reference population, and finally application of a well-developed interpretation scheme utilized in the context of patient symptoms and findings. Failure at any point along this path from performance to interpretation can yield misleading results that may ultimately poorly impact patient care. A clear understanding by the provider of proper coding and billing for spirometry is necessary to receive appropriate reimbursement from payers.
John Hutchinson, a surgeon, recognized that the volume of air that can be exhaled from fully inflated lungs is a powerful indicator of longevity. He invented the spirometer to measure what he called the vital capacity, ie, the capacity to live. Much later, the concept of the timed vital capacity, which became known as the FEV(1), was added. Together, these two numbers, vital capacity and FEV(1), are useful in identifying patients at risk of many diseases, including COPD, lung cancer, heart attack, stroke, and all-cause mortality. This article cites some of the rich history of the development of spirometry, and explores some of the barriers to the widespread application of simple spirometry in the offices of primary care physicians.
