INCENTIVE SPIROMETRY

An incentive spirometer is a medical device that

facilitate SMI with incorporated visual indicators of
performance (inspiratory effort) in order to aid the
therapist in coaching the patient to optimal
performance and likewise patients uses this visual
feedback to monitor their own efforts.

Incentive spirometry is performed using devices which provide

visual cues to the patients that the desired flow or volume
has been achieved.

The purpose of incentive spirometry is

 to facilitate a sustained slow deep breath.

  to mimic natural sighing by encouraging patients to take
slow, deep breaths.

The basis of incentive spirometry involves having the patient

take a sustained, maximal inspiration (SMI). An SMI is a
slow, deep inspiration from the Functional Residual
Capacity up to the total lung capacity, followed by ≥5 seconds
breath hold.

The device gives the individual visual feedback regarding flow

and volume and also prevent and reverse atelectasis when used
appropriately and regularly

The visual dimension of the therapy serves as a motivation or

goal for the patient to try to meet by repeating the maximal
effort frequently.

There are typically two types of incentive spirometer, namely:

 Flow-oriented incentive spirometer (Triflow

Device) –
o Has three chambers with one ball in each chamber.
Capacity up to 1200ml.

 Volume-oriented incentive spirometer –

o Has one-way valve with capacity up to 4000ml.
o Current evidence tells us that using this type of
spirometer requires lesser work of breathing and
improves diaphragmatic function
o Using this device improves pulmonary function
better compared to Triflow.
Guidelines on appropriate use
1. Therapist demonstrates using a separate device and
provides an information sheet regarding technique,
prescription of use and cleaning advice based on
manufacturers instructions.
2. Patient should be in a relaxed position suitable for deep
breathing (e.g. sitting upright in a chair or side lying if
extra volume is required in one lung due to ventilation
perfusion matching).
3. Patient creates a tight seal around the mouthpiece
and inhales deeply and slowly. The patient watches the
flow meter for visual feedback. If possible the patient
sustains the inhalation to create an end-inspiratory
hold. Ideally, the inhalation is sustained for 4-5
seconds.
4. Patient relaxes seal around the mouthpiece and exhales;
normal breathing is resumed with relaxed shoulder girdle.

Further pointers:

 Advise patient to take approximately ten incentive

spirometry breaths per waking hour (use clinical
reasoning to prescribe using Frequency, Intensity, Time
and Type principles).
 Patients with an oxygen requirement can use the
device with a nasal cannula or a device, which
entrains oxygen.
 Deep breathing offers a similar effect. However, using
an incentive device as feedback may create greater inhaled
volumes, greater control of flow and more motivation to
participate in therapy.
Indications
 at risk of postoperative complications
 pulmonary atelectasis
 Conditions predisposing to atelectasis such as:
1. Abdominal or thoracic surgery [7]

2. Prolonged bed rest

3. Surgery in patients with COPD
4. Presence thoracic or Abdominal binders [8]

5. Lack of pain control

 Restrictive lung disease inspiratory capacity less

than 2.5 litres
 neuromuscular disease or spinal cord injury

Contraindications
 Patients who cannot use the device appropriately or
require supervision at all times
 Patients who are noncompliant or do not understand or
demonstrate proper use of the device
 Very young patients or paediatrics with developmental
delay
 Hyperventilation
 Hypoxaemia secondary to interruption of oxygen therapy
 Fatigue
 Patients unable to take deep breathe effectively due to
pain, diaphragmatic dysfunction, or opiate analgesia.
 Patients who are heavily sedated or comatose
 severe dyspnoea.
Precautions
 The technique is inappropriate as the sole treatment for
major lung collapse or consolidation.
 Hyperventilation may result from improper technique.
 There is potential for barotrauma in emphysematous
lungs.
 Discomfort may occur secondary to uncontrolled pain.
 Development of bronchospasm may occur in susceptible
patients.
 Close monitoring of patients with hyper-reactive airways
should be maintained.