Indications for Spirometry and Contraindications to Testing
Indications for Spirometry and Contraindications to Testing
This domain tests whether you can justify a spirometry test, recognize when it must be deferred, and document the decision. NIOSH-aligned practice treats spirometry as a physiological stress test: forced exhalation raises intrathoracic, intra-abdominal, intraocular, and intracranial pressure.
Core indications
- Detect and quantify airflow obstruction or restriction in symptomatic patients (dyspnea, cough, wheeze, chest tightness).
- Monitor known lung disease, response to therapy, or decline over time.
- Occupational surveillance: respirator users and workers exposed to dusts, fumes, or vapors.
- Preoperative risk assessment and disability evaluation.
Contraindications (relative; defer, do not necessarily cancel)
- Recent myocardial infarction (generally within 1 month) or unstable angina.
- Recent thoracic, abdominal, or ocular surgery; thoracic or abdominal aneurysm.
- Pneumothorax, active hemoptysis, or acute respiratory infection.
- Conditions that make a forced maneuver unsafe or unreliable: severe uncontrolled hypertension, recent stroke, confusion, inability to seal lips.
Worked example
A 58-year-old worker scheduled for respirator fit testing reports chest pain at rest that began yesterday. Reasoning: unstable chest pain is a relative contraindication because the forced maneuver increases myocardial oxygen demand and intrathoracic pressure. Defer spirometry, document the reason, and refer for medical evaluation; do not simply record 'unable to test.'
Traps
- Treating every contraindication as permanent; many are temporary and time-limited.
- Missing occupational indications because the worker is asymptomatic.
- Failing to record why a test was deferred.