Spirometry: Procedure, “Normal” Values, and Test Results (2023)

Spirometry is a standard test doctors use to measure how well your lungs are functioning. The test works by measuring airflow into and out of your lungs.

To take a spirometry test, you sit and breathe into a small machine called a spirometer. This medical device records the amount of air you breathe in and out as well as the speed of your breath.

Doctors use spirometry tests to diagnose these conditions:

  • COPD
  • asthma
  • restrictive lung disease, such as interstitial pulmonary fibrosis
  • other disorders affecting lung function

They also allow your doctor to monitor chronic lung conditions to check whether your current treatment is improving your breathing.

Spirometry is often done as part of a group of tests known as pulmonary function tests.

You can do a number of things to make sure you’ll be able to breathe comfortably and receive an accurate result during your spirometry test.

Keep these tips in mind:

  • Wear loose clothing.
  • If you smoke, avoid smoking for at least 1 hour before the test.
  • If you drink alcohol, avoid consuming it for at least 4 hours before the test.
  • Avoid eating or drinking for at least 2 hours before the test.
  • Avoid heavy physical effort or exercise for at least 30 minutes before the test.
  • Check with a healthcare professional about whether you should avoid are any medications, such as inhalers, before the test, since they may interfere with the accuracy of the results.

A spirometry test usually takes about 15 minutes and generally happens in your doctor’s office. In some cases when more in-depth tests are necessary, it may take place at a respiratory laboratory.

(Video) How to do a spirometry test and interpret the results

Here’s what happens during a spirometry procedure:

  1. You’ll sit in a chair in an exam room at your doctor’s office. The doctor or a nurse will place a clip on your nose to keep both nostrils closed. They’ll also place a cup-like breathing mask around your mouth.
  2. Your doctor or nurse will next instruct you to take a deep breath in, hold your breath for a few seconds, and then exhale as hard as you can into the breathing mask.
  3. You’ll repeat this test at least three times to make sure that your results are consistent, especially if there is a lot of variation between your test results. They’ll take the highest value from three close test readings and use it as your final result. Your entire appointment should last about 30 to 90 minutes.

If you have evidence of a breathing disorder, your doctor might then give you an inhaled medication known as a bronchodilator to open up your lungs after the first round of tests.

They’ll then ask you to wait 15 minutes before doing another set of measurements. Afterward, your doctor will compare the results of the two measurements to see whether the bronchodilator helped increase your airflow.

When used to monitor breathing disorders, a spirometry test is typically done once every 1 or 2 years to monitor changes in breathing in people with well-controlled COPD or asthma.

Those with more severe breathing concerns or breathing complications that aren’t well managed are advised to have more frequent spirometry tests.

Few complications typically occur during or after a spirometry test. However, you may want to be aware of the following.

You may feel a bit dizzy or have some shortness of breath immediately after performing the test, according to the American Thoracic Society. In this case, stop immediately and tell your doctor. In very rare cases, the test may trigger severe breathing problems.

When you do this test, it will increase the pressure in your head, chest, stomach, and eyes as you breath out. So, it is unsafe if you have heart problems or hypertension, or if you’ve had surgery to your chest, abdomen, head, or eyes.

Risks after a spirometry test

(Video) Spirometry Results Explained

There are few risks related to the spirometry test itself. However, there is a minor risk that you may get an indirect infection.

This could happen in several ways:

  • Although there is no data widely available on spirometer disinfection, there is potentially a concern that if the spirometer tubing is not disinfected correctly after each test, people may be at risk of infections by a variety of fungi microorganisms. These include respiratory illnesses such as influenza, measles, chicken pox, pneumonia, and tuberculosis. According to a 2015 research review, researchers in at least one study found bacterial growth on spirometer tubing.
  • Other equipment pieces, such as the breathing valve and mouthpiece, may also transmit infection. It should be disinfected and replaced between patients. In addition, you may want to be careful about the laboratory infrastructure — the chair you’re sitting on, nearby tables and surface areas, and anything else you may come into contact with. Use hand sanitizer liberally and wash your hands after the test. This may also help protect you against the coronavirus that causes COVID-19 and other viruses.
  • Since spirometry involves breathing aerosolized particles, there’s a risk of spreading airborne viral illnesses. This risk applies both to the medical staff and to patients who may be breathing in air where a previous patient was present. While a variety of illnesses can spread through the air, the gravest concern at present is the coronavirus that causes COVID-19. Speak with your doctor before your test if you think you may have symptoms of COVID-19.
  • People with cystic fibrosis require more frequent lung function tests. However, they are also at a higher risk of infections in the upper respiratory tract from contact with equipment related to the test and the personnel performing the test.

This risk may be higher in different countries, where there are other standards and protocols for preventing the spread of infection.

The American Thoracic Society and the European Respiratory Society have official technical standards for conducting spirometry. These include disinfection guidelines and recommend disposable mouthpieces with filters to avoid infections.

“Normal” results for a spirometry test vary from person to person. They’re based on your:

  • age
  • height
  • race
  • sex

Your doctor calculates the predicted “normal” value for you before you do the test. Once you’ve done the test, they look at your test score and compare that value to the predicted score. Your result is considered “normal” if your score is 80 percent or more of the predicted value.

Spirometry measures two key factors: expiratory forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Your doctor also looks at these as a combined number known as the FEV1/FVC ratio.

If you have obstructed airways, the amount of air you’re able to quickly blow out of your lungs will be reduced. This translates to a lower FEV1 and FEV1/FVC ratio.

FVC measurement

One of the primary spirometry measurements is FVC, which is the greatest total amount of air you can forcefully breathe out after breathing in as deeply as possible. If your FVC is lower than expected, something is restricting your breathing.

“Normal” or “abnormal” results are evaluated differently between adults and children.

For children ages 5 to 18:

(Video) Understanding Spirometry - Normal, Obstructive vs Restrictive

Percentage of predicted FVC valueResult
80% or greaternormal
less than 80%abnormal

For adults:

FVCResult
is greater than or equal to the lower limit of normalnormal
is less than the lower limit of normalabnormal

An “abnormal” FVC could be due to restrictive or obstructive lung disease, and other types of spirometry measurements are required to determine which type of lung disease is present.

An obstructive or restrictive lung disease could be present by itself, but it’s also possible to have a mixture of these two types at the same time.

FEV1 measurement

The second key spirometry measurement is FEV1. This is the amount of air you can force out of your lungs in 1 second.

It can help your doctor evaluate the severity of your breathing issues. An FEV1 reading that’s lower than expected shows you might have a significant breathing obstruction.

Your doctor will use your FEV1 measurement to grade how severe any breathing concerns are. The following chart outlines what’s considered “normal” and “abnormal” when it comes to your FEV1 spirometry test results, according to guidelines from the American Thoracic Society:

Percentage of predicted FEV1 valueResult
80% or greaternormal
70%–79%mildly abnormal
60%–69%moderately abnormal
50%–59%moderate to severely abnormal
35%–49%severely abnormal
less than 35%very severely abnormal

FEV1/FVC ratio

Doctors often analyze the FVC and FEV1 separately, then calculate your FEV1/FVC ratio. The FEV1/FVC ratio is a number that represents the percentage of your lung capacity you’re able to exhale in 1 second.

In the absence of restrictive lung disease that causes a normal or elevated FEV1/FVC ratio, the higher the percentage gotten from your FEV1/FVC ratio means the healthier your lungs are.

A low ratio suggests that something is blocking your airways. Here’s what’s considered a low ratio:

AgeLow FEV1/FVC ratio
5 to 18 years oldless than 85%
adultsless than 70%

Spirometry produces a graph that shows your flow of air over time. If your lungs are healthy, your FVC and FEV1 scores are plotted on a graph that could look something like this:

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If your lungs were obstructed in some way, your graph might instead look like this:

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(Video) Spirometry: Procedure and Results

If your doctor finds that your results fall into the “abnormal” category, they’ll likely perform other tests to determine whether your impaired breathing is caused by a breathing disorder. These could include chest X-rays, sinus X-rays, and blood tests.

The primary lung conditions that will cause unexpected spirometry results include obstructive diseases such as asthma and COPD and restrictive diseases such as interstitial pulmonary fibrosis.

Your doctor may also screen for conditions that commonly occur together with breathing disorders that can make your symptoms worse. These include heartburn, hay fever, and sinusitis.

Read more: How spirometry results track COPD progression.

Read this article in Spanish.

(Video) Taking a Spirometry Test

FAQs

What are normal values for spirometry test results? ›

The Measured column represents the total volume exhaled during the first second, in liters. Normal values in healthy males aged 20-60 range from 4.5 to 3.5 liters, and normal values for females aged 20-60 range from 3.25 to 2.5 liters.

How do you read spirometry test results? ›

This number represents the percent of the lung size (FVC) that can be exhaled in one second. For example, if the FEV1 is 4 and the FVC is 5, then the FEV1/ FVC ratio would be 4/5 or 80%. This means the individual can breath out 80% of the inhaled air in the lungs in one second.

What a spirometry test score can tell you about your COPD? ›

Spirometry is a type of pulmonary function test. It measures how well your lungs are working. Your doctor uses the test results to help determine whether you have COPD or other possible lung disease. If you have COPD, the results also show how severe your COPD is.

What is a good result for a lung function test? ›

Normal results typically range between 80% and 120% of the prediction. If your lung volume results fall outside of this normal range, this may suggest you have an obstructive or restrictive lung condition.

Why is a spirometry test important? ›

Spirometry is used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other conditions that affect breathing. Spirometry may also be used periodically to monitor your lung condition and check whether a treatment for a chronic lung condition is helping you breathe better.

What is the lower limit of normal in spirometry? ›

For spirometry, only low values are considered to be abnormal, so the lower limit of normal (LLN) is taken to be equal to the 5th percentile of a healthy, non-smoking population.

How much lung capacity is normal? ›

Lung capacity or total lung capacity (TLC) is the volume of air in the lungs upon the maximum effort of inspiration. Among healthy adults, the average lung capacity is about 6 liters.

What value indicates a lung problem? ›

The ratio of FVC and FEV1 can help doctors diagnose the specific type of lung disease a person has. To calculate this ratio, a doctor divides the FVC reading by the FEV1 result. When the value of FEV1 is less than 70% of an FVC in adults or below 85% in those aged 5–18 years, an obstruction may be present.

How many mL is normal on a spirometer? ›

The typical value for a young adult male of normal size is about 3000 mL. C. The expiratory reserve volume, ERV, is the additional volume of air that can be expired after a normal or tidal expiration. A typical value is about 1100 mL for a young adult male.

How do you fail a spirometry test? ›

Hesitation and or Slow start. Spirometry is a test of maximal effort, therefore, a slight hesitation or a delayed start can affect results, and so is one of the common mistakes when performing Spirometry. A hesitation in blowing out before the initial blast affects most spirometry test results early in the manoeuvre.

How can you tell the difference between asthma and COPD on spirometry? ›

Commonly used spirometry measurements of relevance for the differentiation of asthma from COPD include the volume of air that can be forcibly exhaled in a single breath after a maximum inspiration (forced vital capacity [FVC]), the FEV1 of this maneuver, and the ratio of these measurements (FEV1/FVC).

Can spirometry detect early COPD? ›

Spirometry can detect COPD even in its earliest stage, even before any obvious symptoms are noticeable. Along with diagnosing COPD, this test can also help track progression of the disease, assist in staging, and even help to determine treatments that might be most effective.

What percentage should lung function be? ›

Lung volume is measured in litres. Your predicted total lung capacity (TLC) is based on your age, height, sex and ethnicity, so results will differ from person to person. Normal results typically range between 80% and 120% of the prediction.

What is a normal FEV1 in liters? ›

Volume of First Second of Exhalation (FEV1)

It is abbreviated as FEV1 on your report. This volume is also measured in liters. For males, age 20-60 normal values range from 3.5 to 4.5 liters. For females 20-60, the normal range is 2.5 to 3.25 liters.

How do I know if my lungs are damaged? ›

Wheezing: Noisy breathing or wheezing is a sign that something unusual is blocking your lungs' airways or making them too narrow. Coughing up blood: If you are coughing up blood, it may be coming from your lungs or upper respiratory tract. Wherever it's coming from, it signals a health problem.

Can you still have asthma with normal spirometry? ›

The diagnosis is clear cut if spirometry in a patient with a history suggestive of asthma demonstrates airflow obstruction with reversibility. However, if the test is normal, asthma cannot be excluded.

Can you have COPD with normal spirometry? ›

Despite appearing “normal” according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow.

Can a spirometry test detect asthma? ›

Spirometry. This is the recommended test to confirm asthma. During this test, you breathe into a mouthpiece that's connected to a device, called a spirometer, or to a laptop. It measures the amount of air you're able to breathe in and out and its rate of flow.

Are spirometry tests accurate? ›

Conclusions: Most spirometers tested were not accurate. The magnitude of the errors resulted in significant changes in the categorization of patients with obstruction. Acceptable-quality tests were produced for only 60% of patients.

What is FEV1 FVC lower limit of normal? ›

The BTS criteria differ from the GOLD guidelines in that not only must the FEV1/FVC be below 0.70, but FEV1 must also be less than 80% predicted. While an age related trend in the prevalence of airway obstruction was seen with the BTS criteria, it remained below 5%, except in older subjects.

What is normal lung age? ›

Your lungs mature by the time you are about 20-25 years old. After about the age of 35, it is normal for your lung function to decline gradually as you age.

Can you improve lung capacity? ›

On the other hand, lung capacity refers to the maximum amount of oxygen your body is able to use. Your lung function is set, and cannot be improved.

What does 50% lung capacity mean? ›

Likewise, if your FEV1 is 50%, your lungs are able to handle only half as much air as they should. If your FEV1 is 33%, your lungs are able to handle even less—only a third as much. The lower your FEV1 percentage, the less air your lungs are able to handle.

What is normal lung capacity for a woman? ›

The average vital capacity volume is about 4600 mL in males and 3400 mL in females. Total lung capacity. The total volume of your lungs: your vital capacity plus the amount of air you cannot voluntarily exhale. The average total lung capacity volume is about 5800 mL in males and 4300 mL in females.

What does FEV1 FVC 70 mean? ›

This is a measure of how quickly the lungs can be emptied. • FEV1/FVC: FEV1 expressed as a percentage of the FVC, gives a clinically. useful index of airflow limitation. The ratio FEV1/FVC is between 70% and 80% in normal adults; a value less than 70% indicates airflow limitation and the possibility of COPD.

What are the three 3 categories of pulmonary function testing? ›

If you are having trouble breathing, or some type of chronic respiratory illness, your doctor might order pulmonary function tests to find out how well your lungs are working. These might include spirometry, lung volume testing, and a six-minute walk test.

Which of the following spirometry results indicate restrictive lung disease? ›

A normal FEV1/FVC ratio with a decreased FVC indicates a restrictive lung condition. These can include pulmonary fibrosis and infections like pneumonia. A decreased FEV1/FVC ratio indicates an obstructive condition, such as asthma or COPD.

What is normal inspiratory volume? ›

For an adult, a normal inspiratory capacity is about 3 liters, or about 3,000 mL. What is inspiratory capacity and expiratory capacity? Inspiratory capacity is the maximum you can breathe in after you breathe out normally.

What are the 4 lung capacities? ›

Background. Four standard lung volumes, namely, tidal (TV), inspiratory reserve (IRV), expiratory reserve (ERV), and residual volumes (RV) are described in the literature. Alternatively, the standard lung capacities are inspiratory (IC), functional residual (FRC), vital (VC) and total lung capacities (TLC).

Can spirometry results be wrong? ›

Since the FEV1 is not much affected, the FEV1/FVC ratio is often falsely elevated. These false results may prevent the detection of “obstructive impairment” or be misinterpreted as indicating a “restrictive impairment.” Solution: Leaks are more common in volume spirometers.

How long should I be able to hold my breath? ›

However, most people can only safely hold their breath for 1 to 2 minutes. The amount of time you can comfortably and safely hold your breath depends on your specific body and genetics. Do not attempt to hold it for longer than 2 minutes if you are not experienced, especially underwater.

What does it mean if you fail a pulmonary function test? ›

Abnormal results usually mean that you may have chest or lung disease. Some lung diseases (such as emphysema, asthma, chronic bronchitis, and infections) can make the lungs contain too much air and take longer to empty.

What 3 diseases make up COPD? ›

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis. COPD makes breathing difficult for the 16 million Americans who have this disease.

How do I know if I have COPD or asthma? ›

One main difference is that asthma typically causes attacks of wheezing and tightness in your chest. COPD symptoms are usually more constant and can include a cough that brings up phlegm.

What is worse COPD or asthma? ›

Which is worse: COPD or asthma? COPD is worse than asthma. With a well-designed treatment plan, asthma symptoms can be controlled sufficiently to return lung function to normal, or very close to normal, so the condition is generally considered reversible.

Can COPD be cured? ›

There's currently no cure for chronic obstructive pulmonary disease (COPD), but treatment can help slow the progression of the condition and control the symptoms. Treatments include: stopping smoking – if you have COPD and you smoke, this is the most important thing you can do.

Can spirometry miss COPD? ›

Spirometry may also lead to the misdiagnosis of COPD. According to the Gold Initiative for Chronic Obstructive Lung Disease (GOLD),8 spirometry is required to confirm the diagnosis of COPD in patients with clinical symptoms or a history of risk factor exposure.

What are the 4 stages of COPD? ›

Stages of COPD
  • What Are the Stages of COPD?
  • Stage I (Early)
  • Stage II (Moderate)
  • Stage III (Severe)
  • Stage IV (Very Severe)
3 Nov 2021

What is a good number on a spirometer? ›

Normal values in healthy males aged 20-60 range from 4.5 to 3.5 liters, and normal values for females aged 20-60 range from 3.25 to 2.5 liters.

What are normal spirometry values? ›

Normal Values of Pulmonary Function Tests
Pulmonary function testNormal value (95 percent confidence interval)
FEV180% to 120%
FVC80% to 120%
Absolute FEV1 /FVC ratioWithin 5% of the predicted ratio
TLC80% to 120%
3 more rows
1 Mar 2004

What is the most important number on a pulmonary function test? ›

The most important values are the forced vital capacity (FVC), the forced expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio. Spirometry cannot measure the residual volume or the total lung capacity.

How do you read spirometry test results? ›

This number represents the percent of the lung size (FVC) that can be exhaled in one second. For example, if the FEV1 is 4 and the FVC is 5, then the FEV1/ FVC ratio would be 4/5 or 80%. This means the individual can breath out 80% of the inhaled air in the lungs in one second.

How do you calculate FEV1 and FVC? ›

It can be described with the equation FEV1 = A x FVC + C, where A = 0.84 and C = −0.23 (−0.36) for females (males). As C is different from zero, FEV1/FVC depends on FVC because FEV1/FVC = A + C/FVC, in average.

What is FEV1 vs FVC? ›

Forced expiratory volume (FEV) measures how much air a person can exhale during a forced breath. The amount of air exhaled may be measured during the first (FEV1), second (FEV2), and/or third seconds (FEV3) of the forced breath. Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test.

Can a damaged lung heal? ›

Damaged Lungs Can Repair Themselves, But…

But there is a limit to the lungs' capacity to heal themselves. The chronic injury that is seen after years of smoking, exposure to asbestos, or other lung irritants can cause damage that requires diagnosis and treatment by a pulmonologist.

What are the most serious lung diseases? ›

The Top 8 Respiratory Illnesses and Diseases
  • Asthma. ...
  • Chronic Obstructive Pulmonary Disease (COPD) ...
  • Chronic Bronchitis. ...
  • Emphysema. ...
  • Lung Cancer. ...
  • Cystic Fibrosis/Bronchiectasis. ...
  • Pneumonia. ...
  • Pleural Effusion.
1 Apr 2020

Can lungs repair themselves? ›

Your lungs are self-cleaning, which means they will gradually heal and regenerate on their own after you quit smoking. However, there are certain lifestyle behaviors you can practice to try and accelerate the rate at which your lungs heal.

What value indicates a lung problem? ›

The ratio of FVC and FEV1 can help doctors diagnose the specific type of lung disease a person has. To calculate this ratio, a doctor divides the FVC reading by the FEV1 result. When the value of FEV1 is less than 70% of an FVC in adults or below 85% in those aged 5–18 years, an obstruction may be present.

What is a normal FEV1 in liters? ›

Volume of First Second of Exhalation (FEV1)

It is abbreviated as FEV1 on your report. This volume is also measured in liters. For males, age 20-60 normal values range from 3.5 to 4.5 liters. For females 20-60, the normal range is 2.5 to 3.25 liters.

What does FEV1 FVC 70 mean? ›

This is a measure of how quickly the lungs can be emptied. • FEV1/FVC: FEV1 expressed as a percentage of the FVC, gives a clinically. useful index of airflow limitation. The ratio FEV1/FVC is between 70% and 80% in normal adults; a value less than 70% indicates airflow limitation and the possibility of COPD.

How much lung capacity is normal? ›

Lung capacity or total lung capacity (TLC) is the volume of air in the lungs upon the maximum effort of inspiration. Among healthy adults, the average lung capacity is about 6 liters.

How do you fail a spirometry test? ›

Hesitation and or Slow start. Spirometry is a test of maximal effort, therefore, a slight hesitation or a delayed start can affect results, and so is one of the common mistakes when performing Spirometry. A hesitation in blowing out before the initial blast affects most spirometry test results early in the manoeuvre.

Can you improve lung capacity? ›

On the other hand, lung capacity refers to the maximum amount of oxygen your body is able to use. Your lung function is set, and cannot be improved.

Can you have COPD with normal spirometry? ›

Despite appearing “normal” according to GOLD, smokers with normal spirometry but low DLCO are at significant risk of developing COPD with obstruction to airflow.

What is a normal FVC and FEV1? ›

The normal value for the FEV1/FVC ratio is 70% (and 65% in persons older than age 65). When compared to the reference value, a lower measured value corresponds to a more severe lung abnormality.

What are normal FEV1 FVC and PEF values? ›

Normal Values of Pulmonary Function Tests
Pulmonary function testNormal value (95 percent confidence interval)
FEV180% to 120%
FVC80% to 120%
Absolute FEV1 /FVC ratioWithin 5% of the predicted ratio
TLC80% to 120%
3 more rows
1 Mar 2004

How do you calculate FEV1 and FVC? ›

It can be described with the equation FEV1 = A x FVC + C, where A = 0.84 and C = −0.23 (−0.36) for females (males). As C is different from zero, FEV1/FVC depends on FVC because FEV1/FVC = A + C/FVC, in average.

What does FEV1 FVC 0.7 mean? ›

An FEV1/FVC of <0.7 (70%) is diagnostic of air flow obstruction and confirms obstructive disease (NICE, 2010). However, a lower than normal FEV1/FVC may not be abnormal for an asymptomatic older person. The FEV1 does not have to be <80% predicted for a diagnosis of airflow obstruction.

Is FEV1 88% good? ›

According to the European Respiratory Society (ERS) criteria, it is FEV1% predicted that defines when a patient has COPD—that is, when the patient's FEV1% is less than 88% of the predicted value for men, or less than 89% for women.

What is FEV1 in asthma? ›

Simply put, FEV1 “is the maximum amount of air you can forcefully blow out of your lungs in one second.” People can measure this output of air using a spirometer, either in a doctor's office or at home, using a portable device like Aluna.

What is normal lung age? ›

Your lungs mature by the time you are about 20-25 years old. After about the age of 35, it is normal for your lung function to decline gradually as you age.

What does 50% lung capacity mean? ›

Likewise, if your FEV1 is 50%, your lungs are able to handle only half as much air as they should. If your FEV1 is 33%, your lungs are able to handle even less—only a third as much. The lower your FEV1 percentage, the less air your lungs are able to handle.

How many mL is normal on a spirometer? ›

The typical value for a young adult male of normal size is about 3000 mL. C. The expiratory reserve volume, ERV, is the additional volume of air that can be expired after a normal or tidal expiration. A typical value is about 1100 mL for a young adult male.

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