Cleveland Family Study

11.4 Preparing for Participant Testing

11.4.1 Entering Participant Data

1. Set up the laptop by connecting the Multispiro sensor, plugging in the power supply, and turning it on.
2. Restart Computer is MS-DOS Mode.
3. At the MS-DOS prompt, type “cd..” and “sx”. This gets you to the Multispiro menu.
4. Select F7 Set Up.
5. Page down to Cake/F-V Loop. Press Enter.
6. Press Esc.
7. Select F1 Patient.
8. From this menu, select Enter New Patient Information.
9. Enter the patient’s name, ID#, height, weight, birthdate, race, and any other pertinent information from the patient’s PHYSIO sheet such as medications.
   • Also note if the individual has a cold, sinus problems, or asthma.
   • If the patient indicates that he/she has asthma, ask if he/she has an inhaler, where it is, and the last time he/she used it. Occasionally doing spirometry may precipitate an asthma attack so it is a good idea to have the inhaler handy to avoid any problems.
   • If the patient indicates that he/she has used the inhaler within the last two hours, note it in the comment section.
   • Also note if the Fev1 drops by 20% from the first test to the last test. If it has, recommend that the patient use the inhaler again especially if the test causes any discomfort. Also include the investigator’s name that performed the testing.
10. To complete patient data entry, press the Esc key. A question will appear asking “Save Changes? Y/N?” Answer Y to update the file; N to abort.
11. At the main menu, select F2 Test.
12. Select FVC TEST from the F2 pull-down menu.
13. The system will display the incentive currently active and prompt the user to Press Any Key to Zero the Sensor. It is important not to move the sensor during the brief zeroing process.
14. After zeroing, a message will be displayed to Press Any Key to Start Test. Press a key and have the patient perform the testing.

11.4.2 Coaching the Participant

Teaching the patient how to perform a spirometry test properly is critical for achieving meaningful results. Spirometry is a patient effort dependent test, so proper coaching of the subject is very important. The coach should fully explain the test to the patient. First explain that the purpose of the test is to measure the function and health of his or her lungs. Remind the patient that the test is painless. Simulate the correct maneuver using a mouthpiece reserved for that purpose. The instructions should be as follows:

1. “Take a deep breath, as much as you possibly can, until you cannot hold any more. Then, place the mouthpiece in your mouth, with your teeth around the outside, and close your lips tightly around it. Next, blow out, as hard and fast as possible and keep blowing as long as you can. Try to force all the air you can out of your lungs.”
2. Actually blow through a mouthpiece yourself, using body language to emphasize the importance of a maximal inhalation, maximal force and prolonged effort. Immediately after demonstration, ask the patient if he/she noticed how you squeezed the last little bit of air out of your lungs.
3. Seat the patient comfortably in a chair with both feet on the ground. Loosen any restrictive clothing such as a tight belt, tie or vest or a bra, girdle or corset. Seating the patient in a chair ensures that the patient doesn’t fall on the floor and injure him or herself if he/she becomes faint during the testing. It is recommended to remove loose dentures, which can become dislodged during the test. Nose clips are not necessary for forced expiratory maneuvers since the nasopharynx reflexively closes during the maneuver.
4. Instruct the patient to pick up the sensor and hold it in his/her hands. The sensor may be held in whatever way is most comfortable, providing that the exhaust in the back is not obstructed.
5. The patient, at your prompting, is to take the deepest breath that he/she possibly can, as fast as he/she can. The patient should then place the mouthpiece into his/her mouth, with the lips forming a tight seal around it. The patient should then blast out the air in his/her lungs with as much force and speed as possible and continue to exhale until told to stop. A good example to give the patient is that of blowing out the candles on a birthday cake---only one breath is allowed, and it is necessary to continue blowing for as long as possible.
6. The patient should remain erect during the procedure; leaning into the exhale is not allowed as this may cause the airway to close. The test should last about six seconds, and the greatest amount of air should be exhausted within the first second.