Spirometry Testing Standards in Spinal Cord Injury

Chest, 2003 · DOI: · Published: March 1, 2003

Simple Explanation

This study investigates whether individuals with spinal cord injuries (SCI) can perform spirometry tests according to the standards set by the American Thoracic Society (ATS). Muscle paralysis from SCI can impact respiratory function, making it uncertain if standard spirometry is appropriate. The researchers found that many SCI patients could perform spirometry, but those with more severe respiratory muscle impairment often failed to meet standard ATS criteria. These patients may have shorter exhalation times or excessive back-extrapolated volume (EBEV). The study suggests modifying spirometry testing standards for SCI patients to include efforts with EBEV and shorter exhalation times if there is a plateau in expiratory flow. This would reduce bias in studies of respiratory function in SCI by including individuals with more impaired respiratory muscles.

Study Duration

Between October 1994 and July 1997

Participants

278 subjects with chronic SCI

Evidence Level

Cross-sectional study

Key Findings

1
A significant proportion of SCI patients, particularly those with complete cervical injuries, could not meet standard ATS spirometry acceptability criteria.
2
Relaxing the ATS standards to include efforts with EBEV and shorter exhalation times (but with a 0.5-s plateau) significantly increased the proportion of SCI patients who could produce acceptable and reproducible spirometry results.
3
Modified standards may prevent bias in reporting results in cohorts with other neuromuscular diseases.

Research Summary

The study examined the ability of subjects with SCI to perform spirometry according to ATS standards, finding that many, especially those with severe respiratory muscle impairment, could not meet these standards. Modifying ATS standards to include efforts with EBEV and short exhalation times (with a 0.5-s plateau) increased the number of SCI patients able to produce acceptable and reproducible spirometry, particularly those with complete cervical injuries. The researchers suggest that strict application of all ATS acceptability criteria is not necessary for SCI patients, and that modified standards are appropriate to prevent bias in longitudinal studies of pulmonary function in this population.

Practical Implications

Revised Testing Protocols

Clinicians should consider modifying spirometry testing standards for SCI patients to include efforts with EBEV and shorter exhalation times when a plateau is present.

Reduced Bias

Adopting modified standards can help reduce bias in research and clinical assessments of respiratory function in SCI by including individuals with greater respiratory muscle impairment.

Generalizability

The modified standards may be appropriate to prevent bias in the reporting of results in cohorts with other neuromuscular diseases.

Study Limitations

1
The reason for not exhaling maximally for ≥ 6 s is not apparent to us.
2
MEP values were available for fewer subjects compared to values for MIP.
3
The study population consisted primarily of veterans, which may limit the generalizability of the findings to other SCI populations.

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