NOTE: If your answers are yes - go to the LEFT of the algorithm

If your answers are no - go to the RIGHT of the algorithm

How to compute for FEV1/FVC/ratio/FEV1%:

FEV1 X 100
FVC

How to compute for % predicted:

Actual__ X 100 OR Observed X 100
Predicted Normal

Steps for simple spirometry: pag pre and post BD: FVC neb FVC(post)
1. Identify ventilatory pattern
First Question: Is the FEV1/FVC greater than 70%? (look at the actual/observed ratio)
Second Question: Is the FVC greater than 80%? (look at the % predicted of FVC)
2. Identify degree of severity (for restrictive, obstructive or mixed)
USE THE SEVERITY GRADING BELOW
For RESTRICTIVE VENTILATORY PATTERN - look at FVC % predicted value
For OBSTRUCTIVE VENTILATORY PATTERN- look at FEV1 % predicted
value
3. Identify significant bronchodilator response if with post BD
To identify bronchodilator response: (use the actual pre and post values)
Post fev1-Pre fev 1 X 100
Pre fev 1
How to interpret:
-If result is greater than 12% then it is with SIGNIFICANT BRONCHODILATOR
RESPONSE
-If result is 11% and below then it is WITHOUT/NO SIGNIFICANT
BRONCHODILATOR RESPONSE
4. Determine presence of small or large airway resistance
Small airway resistance (parameters: FEF (less than 100) and SGAW/RAW)
-if one parameter only has less than 80% (% pred) then it is POSSIBLE
SMALL AIRWAY RESISTANCE
 -if two parameters have less than 80% (% pred) with SMALL AIRWAY
RESISTANCE
Large airway resistance (parameter: FEF (greater than 100))
-if less than 80% (% pred) then with LARGE AIRWAY RESISTANCE
5. Determine severity of DLCO
First Question: Is the DLCO greater than 80%? (look at the % pred of DLCO)
Second Question: If the DLCO is reduced, what is its severity?
6. Compute for MVV
a. FEV1 (% pred) X 41 = A NOTE: no need to change to decimal value
b. MVV (% pred) /A = B

How to interpret:
If B is equal or greater than o.8 or 80% = normal (no need to write normal MVV)
If B is less than o.8 or 80% = MVV is low relative to FEV1 suggestive of poor effort
and/or neuromuscular disorder
7. Determine need for post BD studies and/or lung volume studies

Steps for complete spirometry: pag pre and post BD: DS neb DS(post)
1. Identify ventilatory pattern
First Question: Is the FEV1/FVC greater than 70%? (look at the actual/observed ratio)
Second Question: Is the FVC greater than 80%? (look at the % predicted of FVC)
2. Identify degree of severity
USE THE SEVERITY GRADING BELOW
For RESTRICTIVE VENTILATORY PATTERN - look at FVC % predicted value
For OBSTRUCTIVE VENTILATORY PATTERN- look at FEV1 % predicted
value
3. Identify significant bronchodilator response if with post BD
To identify bronchodilator response: (use the actual pre and post values)
Post fev1-pre fev 1 X 100
Pre fev 1
How to interpret:
-If result is greater than 12% then it is with SIGNIFICANT BRONCHODILATOR
RESPONSE
-If result is 11% and below then it is WITHOUT/NO SIGNIFICANT
BRONCHODILATOR RESPONSE
4. Determine presence of small or large airway resistance
Small airway resistance (parameters: FEF (less than 100) and SGAW/RAW)
-if one parameter only has less than 80% (% pred) then it is POSSIBLE
SMALL AIRWAY RESISTANCE
-if two parameters have less than 80% (% pred) with SMALL AIRWAY
RESISTANCE
Large airway resistance (parameter: FEF (greater than 100))
-if less than 80% (% pred) then with LARGE AIRWAY RESISTANCE
5. Determine if there is air trapping and/or hyperinflation
RV/TLC% - Normal range 20% to 35% (look at actual/observed value)
Interpretation:
 If RV/TLC is higher than 35% = air trapping
If RV/TLC is higher than 35% with an increased TLC = air trapping and
hyperinflation
TO INTERPRET SEVERITY OF AIR TRAPPING and HYPERINFLATION
For AIR TRAPPING - look at RV % predicted value
For HYPERINFLATION - look at TLC % predicted value
6. Determine severity of DLCO
First Question: Is the DLCO greater than 80%? (look at the % pred of DLCO)
Second Question: If the DLCO is reduced, what is its severity?
7. Compute for MVV
a. FEV1 (% pred) X 41 = A NOTE: no need to change to decimal value
b. MVV (% pred) /A = B

How to interpret:
If B is equal or greater than o.8 or 80% = normal (no need to write normal MVV)
If B is less than o.8 or 80% = MVV is low relative to FEV1 suggestive of poor effort
and/or neuromuscular disorder
Degree of severity for DLCO
Mildly Reduced 60 to 79%
Moderately Reduced 40 to 59%
Severely Reduced less than 39%
Degree of severity for RV:
Mild 121 - 130% some textbooks = 121 - 135%
Moderate 131 - 140%
Moderately Severe 141 - 150%
Severe 151 - 165%
Very Severe 166% and above
Degree of severity for TLC:
Mild 121 - 130%
Moderate 131 - 140%
Moderately Severe 141 - 150%
Severe 151 - 165%
Very Severe 166% and above
EXAMPLE 1:

Normal Ventilatory Pattern with possible small airway resistance with a normal DLCO
suggestive of Normal Lungs MVV is low relative to FEV1 suggestive of poor effort
and/or neuromuscular disorder.

MVV:
a. 92 X 41 = 3772
b. 45 / 3772 = 0.012 or 1.19% or 1%

ANSWER = 0.012 or 1%

EXAMPLE 2:
Moderate Restrictive Ventilatory Pattern without/no significant bronchodilator response with
possible small airway resistance with an increased RV/TLC % suggestive of mild air trapping
with a mildly reduced DLCO suggestive of ILD or pneumoconosis MVV is low relative to
FEV1 suggestive of poor effort and/or neuromuscular disorder.

To identify bronchodilator response: (use the actual/observed pre and post values)
Post fev1-Pre fev 1 X 100
Pre fev 1

1.76-1.74 X 100 ANSWER:1.15% or 1 %

1.74

How to interpret:
-If result is greater than 12% then it is WITH SIGNIFICANT BRONCHODILATOR RESPONSE
-If result is 11% and below then it is WITHOUT/NO SIGNIFICANT BRONCHODILATOR
RESPONSE

Formula: RV X 100 What is the observed/actual RV? RV X 100 = 39.0

TLC 3.90

RV X 100 = 39.0 (3.90)

RV X 100 = 152.1
100
RV = 1.52

What is the normal/predicted RV? RV X 100 = 25.8

 4.69

RV X 100 = 25.8 (4.69)

RV X 100 = 121.002
100
RV = 1.21
What is the % predicted of RV? 1.52 X 100 = 123 %
1.21
IF: (% pred) {most of the time this happens with obstructive vent pattern}
(1) RV = 90%
TLC = 118%
Interpretation = normal (no need to write)
(2) RV = 135% (+ air trapping)
TLC = 88%
Interpretation: with an increased RV suggestive of moderate air trapping
(3) RV = 145% (+ air trapping)
TLC = 167%
Interpretation: with an increased RV and TLC suggestive of moderately severe
air trapping and very severe hyperinflation
* if RV is increased = air trapping
* if RV and TLC is increased = hyperinflation
*if TLC alone is increased pls check the RV/TLC ratio. RV/TLC ratio is above/greater
than normal range then you can say with air trapping and hyperinflation (PLEASE COMPUTE
FOR THE RV). IF WALA TALAGA SIYANG KASAMA, then you cannot DEFINITELY SAY
HYPERINFLATION IS PRESENT. No need to write hyperinflation kasi ending nito is repeat test
or may inconsistency.

MVV
a. 59 X 41 = 2419
b. 59 / 2419 = 0.02 or 2.44% or 2%
EXAMPLE 3:

MILD RESTRICTIVE VENTILATORY PATTERN AND MODERATE OBSTRUCTIVE

VENTILATORY PATTERN, without significant bronchodilator response, with possible small
airway resistance, with an increased RV/TLC % suggestive of air trapping, with a mildly
reduced DLCO suggestive of either ILD & pneumoconosis or emphysema, MVV is low relative
to FEV1 suggestive of poor effort and/or neuromuscular disorder.

Bronchodilator response
2.82-2.65 X 100 = 6.42% or 6%
2.65

MVV:
a. 66 X 41 = 2 706
b. 73 / 2 706= 0.02 or 2.69% or 3%

Formula: RV X 100 What is the observed/actual RV? RV X 100 = 39.7

TLC 6.60

RV X 100 = 39.7 (6.60)

RV X 100 = 262.02
100
RV = 2.62

What is the normal/predicted RV? RV X 100 = 30.1

7.59
 RV X 100 = 30.1 (7.59)
RV X 100 = 228.46
100
RV = 2.28
What is the % predicted of RV? 2.62 X 100 = 114 %
2.28
EXAMPLE 4:

PEF 5.1 3.2 63%

DLCO 4.9 2.1 43%

OBSTRUCTIVE VENTILATORY PATTERN, with a moderately reduced DLCO suggestive of

emphysema, MVV is low relative to FEV1 suggestive of poor effort and/or neuromuscular
disorder.

106 X 41 = 4346
82 / 4346 = .018 or 1.88% or 2%

PEF 5.1 3.2 63%

DLCO 4.9 5.3 108%

OBSTRUCTIVE VENTILATORY PATTERN, with a normal DLCO suggestive of asthma,

MVV is low relative to FEV1 suggestive of poor effort and/or neuromuscular disorder.

PEF 5.1 4.7 92%

DLCO 4.9 5.3 108%

OBSTRUCTIVE VENTILATORY PATTERN, with a normal DLCO suggestive of bronchitis,

MVV is low relative to FEV1 suggestive of poor effort and/or neuromuscular disorder.
EXAMPLE 5:

*disregard RV/TLC %

Example if normal/reduced RV and TLC: no need to write normal or anything else

TLC = 66%
RV = 80%

MODERATELY SEVERE RESTRICTIVE VENT PATTERN AND VERY SEVERE

OBSTRUCTIVE VENT PATTERN, (airway resistance?), with a mildly reduced DLCO suggestive
of either ILD & pneumoconosis or emphysema (MVV?)

Example if normal/reduced TLC and increased RV = write about air trapping lang
TLC = 89%
RV = 153%

MODERATELY SEVERE RESTRICTIVE VENT PATTERN AND VERY SEVERE

OBSTRUCTIVE VENT PATTERN, (airway resistance?), with an increased RV suggestive of
moderately severe air trapping, with a mildly reduced DLCO suggestive of either ILD &
pneumoconosis or emphysema (MVV?)

Example if both RV and TLC is increased = write about air trapping and hyperinflation
TLC = 169%
RV = 145%

MODERATELY SEVERE RESTRICTIVE VENT PATTERN AND VERY SEVERE

OBSTRUCTIVE VENT PATTERN, (airway resistance?), with an increased RV and TLC
suggestive of moderate air trapping and very severe hyperinflation, with a mildly reduced
DLCO suggestive of either ILD & pneumoconosis or emphysema (MVV?)

Example if normal/reduced RV and increased TLC = walang isusulat na hyperinflation kasi

dapat both RV and TLC is increased
TLC = 139%
RV = 98%

MODERATELY SEVERE RESTRICTIVE VENT PATTERN AND VERY SEVERE

OBSTRUCTIVE VENT PATTERN, (airway resistance?), with a mildly reduced DLCO suggestive
of either ILD & pneumoconosis or emphysema (MVV?)

PROBABLE CONDITIONS:
RV/TLC X 100

TLC and RV/TLC ratio

RV and RV/TLC ratio

RV and TLC and RV/TLC ratio

RV and TLC

If RV/TLC ratio, without the RV or TLC?

RV_ X 100
TLC