Obtaining & Using Measures of
Lung Function in Asthma Care
Ben Francisco, PhD, PNP, AE-C
Associate Professor
Pulmonary Medicine & Allergy, Child Health
School of Medicine, University of Missouri, Columbia
Asthma Ready® Communities
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
Disclosure
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Dr. Francisco has intellectual property
rights and a financial interest in
IMPACT Asthma Kids© (Curators of
the University of Missouri)
Dr. Francisco will not discuss
experimental or off-label use of
medications or devices
(c) Benjamin Francisco, PhD, PNP, AE-C 2016
Assign a grade to the US Health System
for Asthma Care Quality and Value
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A - excellent
B - good
C - average
D - poor
F - failing
Dr. Ben Francisco 2008 (C)
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Forced Expiratory Maneuver
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“Spirometry light”
Why do I need to know my FEV1?
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
Digital Flow Meter – FEV1 & PEF
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Asma-1
Exacerbations
Peak flow zone
determination
$40, multi-use
$0.38/patient
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
Digital Lung Monitor
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FEV1, FEV6
& ratio
Assess control
Age, height
race & gender
$100, multi-use
$0.38/patient
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
Dr. Ben Francisco 2008 (C)
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Do people with asthma know how
to effectively inhale medications?
Resistance of 3
Common Inhalers
at different flow
rates
Flow / Resistance Profiles
5000
4500
4000
3500
(placebo versions)
3000
2500
Dry powder device
2000
1500
1000
500
pMDI aerosol “puffer”
0
0
10
15
20
25
30
35
40
45
50
55
60
Airflow (Litres per m inute)
AstraZeneca's Turbohaler
GlaxoSmithKline's Diskus
3M's HFA pMDI
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
Ref: J Bell 2004, data on file: jon@canday.freeserve.co.uk
Dr. Ben Francisco 2008 (C)
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Inspiratory Flow Influences
Drug Deposition
Inspiratory
Flow
Drug
Deposition
Too Slow
Mouth
Too Fast
Throat
Correct Speed
Lungs
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
Common MDI Inhalation Errors
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Failure to exhale fully prior to dose
resulting in inadequate volume of
inhaled air with lower net dose
Inhalation too rapid, leading to
impaction of drug against pharynx and
bifurcations of the airway
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
EPR3 Specifies IFR and IFT
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IFR= inspiratory flow rate
IFT= inspiratory flow time
MDI – 30 LPM or 3-5 seconds (p. 250)
DPI – 60 LPM or 2-3 seconds (p. 249)
How do you measure IFR & IFT?
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
Dr. Ben Francisco 2008 (C)
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What is a target time?
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Using knowledge of FEV1 to guide
self-regulation of inspiratory flow
Gently and completely exhale (~FEV1)
Lift chin and refill lungs in a calculated
amount of time
Time of refilling is a proxy for
inspiratory flow rate
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
In-Check Dial™ Device
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Set resistance
for inhaler type
Use disposable
one-way filter
Train for optimal
IFR and IFT
MDI IFT=2xFEV1
Training for Asthma Ready® Clinics
© Curators University of Missouri 2016
Asthma Ready® Goals
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Promote best practices based on national
standards, Expert Panel Report 3 (EPR3),
Guidelines for Managing Asthma
Reduce asthma burden – target geographic
areas with greatest need, by school & town
Establish asthma leaders in the clinics,
schools, hospitals and community agencies
Keep workforce current w/asthma advances
Benjamin Francisco, PhD, PNP, AE-C
Asthma Ready®, University of Missouri
Dr. Ben Francisco 2008 (C)
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www.asthmaready.org
Benjamin Francisco, PhD, PNP, AE-C
Asthma Ready®, University of Missouri
Thank you to our partners!
Dr. Ben Francisco 2008 (C)
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