Spirometry Course
Combined Online + Workshop

The Spirometry course will teach individuals how to conduct quality spirometry including: knowledge of spirometers, understanding of the ATS/ERS standards for spirometry, quality control, patient instruction and basic interpretation of the results.

Canadian and international consensus guidelines for the management of asthma and COPD call for routine use of spirometry for the diagnosis and appropriate management of these diseases. In order to meet the need for more access to quality spirometry, RESPTREC® course launched a Spirometry course in 2009. The goal of the course is to improve diagnosis and management of chronic respiratory diseases by increasing access to quality spirometry.

Curriculum includes:

  • Basic Lung Anatomy and Mechanics
  • Spirometry Equipment
  • Spirometry Indications and Contraindications
  • Test Procedures
  • Criteria for Acceptability and Repeatability
  • Reversibility Testing
  • Office Procedures and Basic Interpretation

The Spirometry course takes approximately 4 months to complete and includes the following components:

  • Pre-workshop
    • Online Learning
      • Students will be given a login and password to access the online learning component in the online learning centre
      • Prior to attending a one-day workshop students must complete the following in the online learning center:
        • Required readings
        • Pre-workshop quiz (no pass mark required for completion)
  • One-day Workshop
    • Workshop provides hands-on application and practical training to learn how to conduct quality spirometry
    • 100% attendance is mandatory
    • Workshops are conducted in many locations across Canada. To find a spirometry course near you visit the Register page.
  • Post-workshop
    • Students must complete a post-workshop quiz and evaluation (available in the online learning centre). A 70% pass mark is required on the quiz for course completion.
    • Students must submit 15 spirometry tests for marking (5 per month for 3 months)

CHAPTER: Basic lung anatomy and mechanics

  1. Identify the major components of the airway.
  2. Describe the effect of airway inflammation on airflow during exhalation.
  3. Define the following terms:
    1. Tidal volume
    2. Inspiratory capacity
    3. Vital capacity
    4. Functional residual capacity
    5. Residual volume
    6. Total lung capacity
  4. Define the following spirometric measurements.
    1. FEV1
    2. FVC
    3. PEF
    4. FEV1/FVC
    5. FEF 25%-75%
  5. Identify each of the following measurements in relation to:
    1. The flow volume loop:
      1. PEF
      2. FVC
    2. The volume time graph:
      1. FEV1
      2. FET
      3. FEF25%-75%
  6. List the factors that will influence predicted normal spirometry values.
  7. Describe how age, height, gender and ethnicity influence the predicted spirometer values between adults and children.

CHAPTER: Spirometry Equipment

  1. List the ATS/ERS standards for spirometry equipment.
  2. Define BTPS.
  3. Explain the conversion to BTPS.
  4. Describe how a spirometer works.
  5. Define test accuracy.
  6. Define test precision.
  7. Describe how to perform daily spirometer calibration checks.
  8. Describe the use of biologic controls.
  9. Describe infection control in spirometry.
  10. Describe the basic principles of equipment
    1. maintenance; and
    2. safety.

CHAPTER: Spirometry

  1. List the indications for spirometry.
  2. List the contraindications for spirometry.

CHAPTER: Test Procedure

  1. List the instructions that should be given to the patient before testing regarding:
    1. activities; and
    2. medications.
  2. Identify the patient information that should be recorded including:
    1. race, gender, height, and age;
    2. accurate height and weight measurements;
    3. all medications the patient is currently taking;
    4. smoking history; and
    5. time of test.
  3. Describe the proper method for measuring height:
    1. standing; and
    2. using arm span measurement.
  4. Describe proper patient positioning.
  5. Describe the recommended testing procedure.
  6. Demonstrate coaching instructions to achieve optimal results considering:
    1. age-appropriate words; and
    2. individual characteristics.

CHAPTER: Criteria for Acceptability and Repeatability

  1. List the within-manoeuvre criteria for acceptability, according to the ATS/ERS standards, for each of the following:
    1. start of test;
    2. during test (additional criteria); and
    3. end of test.
  2. Explain the back-extrapolation technique.
  3. List the criteria for repeatability, according to the ATS/ERS standards.
  4. Differentiate among the following:
    1. useable tests; and
    2. unusable tests.
  5. Identify when testing session is complete.
  6. Describe the situations when it is acceptable to terminate the test.
  7. Describe what is meant by ‘alert values’.
  8. Describe the importance of including both the inspiratory and expiratory  components of the flow volume loop.
  9. List appropriate technician comments to be included in final report in relation to:
    1. patient effort;
    2. usable, unusable and acceptable tests; and
    3. repeatability.
  10. List the components that should be included on a standardised spirometry report.

CHAPTER: Reversibility Testing

  1. List the indications for reversibility testing.
  2. Describe the reversibility testing procedure.
  3. List the recommendations for bronchodilator dose and wait time.
  4. Demonstrate proper bronchodilator delivery device technique.
  5. List the criteria for significant reversibility.

CHAPTER: Office Procedures

  1. List the important information that should be included on the requisition.
  2. Describe the requirements regarding patient consent.
  3. List items to be included in the spirometry procedure manual.

CHAPTER: Basic interpretation

  1. Define the term lower limit of normal.
  2. Distinguish between normal, obstructive and restrictive patterns.
  3. Identify how to select the best reportable value and curves including:
    1. criteria for choosing the appropriate FEV1; and
    2. FVC.
  4. Describe when it is necessary to override the computer.
  5. Describe appropriate communication with patients regarding spirometry results.

Participants must meet the following entrance criteria:

  • Be employed in a setting where spirometry is routinely performed
  • Must be working with or under the supervision of a physician(s) who is able to interpret the spirometry results
  • Have some knowledge of medical terminology and procedures
  • Be willing to provide spirometry results for feedback

If there is a question regarding met criteria, acceptance to the program will be made on an individual basis and at the discretion of the RESPTREC® Management committee.

The course learning objectives and curriculum outline were established by a national expert committee with representation of key groups: Canadian Thoracic Society (CTS), Canadian Respiratory Health Professionals (CRHP), Family Physicians Airways Group of Canada (FPAGC), the Lung Association and various disciplines, in addition to expertise in: guidelines development, technical skills, teaching, and conducting spirometry. The Lung Association of Saskatchewan is responsible for administering the course.

Spirometry Course Expert Committee

  • Allan Coates MC CM Eng (Elect)
  • Robert Cowie MB ChB FCP(SA) MD MSc MFOM
  • Brian Graham PhD
  • Jan Neumann BPT CRE
  • Alan Kaplan MD CCFP(EM) (Chair FPAGC)
  • Marion Laroque RRT RCPT(P) CRE
  • Dilshad Moosa BSc RRT CRE
  • Donna Rennie PhD (Epidemiology) RN CAE
  • Jeremy Road MD FRCPC
  • Laura Seed RCPT(P)
  • Pat Steele RN RCPT(P) CRE
  • Amin Thawer RRT CRE

External Reviewers

  • John Hankinson PhD
  • Paul Enright MD

Administrative Assistance

  • Lori Kleiboer (Professional Education Associate)
  • Janet Sutherland (Executive Director, Canadian Thoracic Society)

Faculty Training

  • Dr. Bob Crapo

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Saskatoon, SK
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