Coaching and Maneuver Technique for Acceptable Spirometry
Coaching and Maneuver Technique for Acceptable Spirometry
This domain tests whether you can elicit a maximal, artifact-free forced expiratory maneuver and coach it consistently.
Core rules
- Start from a full inspiration to total lung capacity; demonstrate and ask for a full breath in, then a blast out.
- Aim for a sharp peak flow with no hesitation; the back-extrapolated volume should be under 5% of FVC or 0.150 L.
- Coach throughout: 'Keep going, keep going, blast, blast.' Do not stop at 3 seconds.
- Continue until a plateau (less than 0.025 L change in 1 second) or 15 seconds, whichever comes first; a 6-second exhalation is the minimum goal.
- Watch for cough in the first second, glottic closure, variable effort, leaks, and tongue obstruction.
- Test standing if possible; use a chair with arms if the participant cannot stand safely.
Worked example
A participant exhales for 4 seconds and stops, with a curve that rises then flattens abruptly. Reasoning: the abrupt stop suggests glottic closure or early termination, not a physiological plateau. Re-demonstrate, encourage a longer blast, and repeat; if the pattern persists, mark the maneuver unacceptable.
Traps
- Accepting a 2-second blow because the FEV1 looks fine.
- Talking over the participant instead of coaching during the effort.
- Allowing a second attempt immediately without correcting the first technique.