Respiratory Screening

Spirometry is contraindicated when:

recent unstable angina
recent pneumothorax (air trapped between the outside of the lung and the chest wall - often incorrectly called a punctured lung)
heart attack or stroke in the last month
recent eye or abdominal surgery
recently coughed up blood and cause is not known
known thoracic, cerebral or abdominal aneurysm.

If any of above exists, refer to GP to assess if spirometry is required at this time. NB Spirometry is NOT an emergency procedure.

Objective:

Please ensure that patient is informed and consents to the care plan information being shared with others involved in their care.

This is a:

real patient.
test patient.

Age:
Smoking status:
"Do you cough regularly?"	Yes No
"Do you cough up phlegm regularly?"	Yes No
"Do even simple chores make you short of breath?"	Yes No
"Do you wheeze when you exert yourself, or at night?"	Yes No
"Do you get frequent colds that persist longer than those of other people?"	Yes No
Is patient well?	Yes No Spirometry should be rescheduled for 2 weeks. Do not continue with spirometry today.
Spirometry recommended for this patient.
Spirometry not indicated for this patient.

Ethnicity: For calculation of predicted values only
Height:	cm
Weight:	kg

	Actual	Predicted	% of Predicted
FEV₁:
FVC:
Ratio (FEV₁:FVC):
Post-bronchodilator FEV₁:
Were inhalers withheld today:	Yes No Record inhaler use in notes below.
Is patient well?	Yes No Spirometry should be rescheduled for 2 weeks. Do not continue with spirometry today.

RESPIRATORY DIAGNOSIS AND MANAGEMENT