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Important Topics

This Focus Area highlights select healthcare information provided by leading experts in their respective fields. Contributors are listed alphabetically.

NOTE: Any product mentioned is not an endorsement of that product and only serves to clarify the intended message.

Contributor Brief Bios

+  Ellen Becker, PhD, RRT-NPS, RPFT, AE-C, FAARC, is a Emerita Professor, in the Department of Cardiopulmonary Sciences, Rush University, Chicago, IL, USA. Her research interests span the education topics of respiratory care professionalism and disease management. Ellen has expanded her research into patient education, addressing the best ways to educate both in community and health care settings, and pulmonary function testing. She is a nationally recognized educator, and previously taught courses related to pulmonary diseases, cardiopulmonary diagnostics, education, and research.

+ Jeffrey M. Haynes RRT, RPFT, FAARC, FCCP, is currently the Clinical Coordinator, Pulmonary Function Laboratory at the Elliot Health System located in Manchester, New Hampshire, USA. Jeffrey has lectured throughout the United States, has published extensively in peer-reviewed journals, on pulmonary diagnostics topics, is highly regarded as a researcher and being a leader in this field. He also regularly posts videos to his popular YouTube® channel, “PFT Tutor with Jeffrey Haynes”.

+ Garry W. Kauffman, MPA, FACHE, RRT, FAARC, is currently the founder and owner of Kauffman Consulting, LLC, located in North Carolina, USA. His Respiratory Care career provided him with a chance to serve in clinical, educational, and administrative roles in a variety of healthcare organizations and venues. Garry is nationally recognized for numerous peer-reviewed journal publications, as author/coauthor of respiratory care textbooks, and as a frequent speaker. His focus continues to be on communicating the value of respiratory care services, delivered by respiratory therapists, by connecting the science of respiratory care, documenting outcomes secondary to respiratory care services, and implementing improved operational and clinical protocols to improve quality, safety, satisfaction, and financial performance.

+ Carl D. Mottram RRT, RPFT, FAARC, is Associate Professor of Medicine – Emeritus at the Mayo Clinic, in Rochester, MN, USA and President – PFWConsulting LLC. Carl has lectured extensively throughout the United States and internationally and has published numerous book chapters and articles in peer-reviewed journals. He is the author and editor of “Ruppel’s Manual of Pulmonary Function Testing” and is highly regarded as being a leader in pulmonary diagnostics.

+ Heather Murgatroyd, BA, RRT, CPFT, AE-C, is based in Illinois, USA, and is currently a Senior Clinical Specialist with Methapharm, Inc. Heather worked, at Centegra Health Systems, in pulmonary function testing for 6.5 years and sleep for 17 years. She took her first job as a Clinical Specialist in 2011. As a Clinical Specialist, Heather has developed and provided continuing education programs and workshops, on respiratory and sleep topics, throughout North, Central and South America. Heather is a past American Association for Respiratory Care (AARC) recipient, of the Specialty Practitioner of The Year (SPOTY) award, for the Diagnostics Specialty Section.

+  Linda Nozart-Frierson, MPH, BSRT, RRT, AE-C, (“Thee Asthma Lady”) is currently the CEO of Noz Health ED, LLC, a healthcare consultant business, the host of RTs Share Tea” podcast and a nationally recognized public speaker on asthma education and community health program development. Linda is also an Adjunct Professor at the Mandl School, The College of Allied Health, New York, NY, USA. She has held numerous asthma program related leadership positions, within her state, and actively promotes community engagement and patient advocacy. Additionally, Linda is the American Respiratory Care Foundation (ARCF) Mike West, Patient Education Achievement Award 2024 Winner.

+ Additional Biographies to be added in this section

Topics

I. Height Measurement for Pulmonary Function Testing

Jeffrey M. Haynes

Video Link: https://youtu.be/QvdFh9GdBUE?si=11udC3wgI7xI1HwM

Description: Height is a key demographic used by reference equations to determine normal ranges for patients undergoing pulmonary function testing. This video will review how to accurately measure height and perform basic quality control on height measuring devices.

II. PFT Spirometer Calibration Myths

Jeffrey M. Haynes

Video Link:  https://youtu.be/HvfCp0fJ9WQ?si=1gvHR8Wflhvr8XfQ

Description: This video discusses common myths associated with spirometer calibration and cal verification, important components pulmonary function testing quality assurance.

III. Using z-scores to Interpret Pulmonary Function Test (PFT) Data

Jeffrey M. Haynes

Video Link: https://youtu.be/bHTt6A4PadU?si=g3o5YgLSWXGLSPjI

Description: The 2022 European Respiratory Society/American Thoracic Society (ATS/ERS) PFT interpretation standards recommended that z-score be used to grade PFT results.  This video will provide a concise definition of z-scores, and guidance on how z-scores are used to determine whether or not a measured PFT value should be categorized as normal or abnormal.

IV. Spirometry: Excessive Back Extrapolated Volume  What Is It And How Can I Correct It?

Jeffrey M. Haynes

Video Link: https://youtu.be/XFEDvHOBgqk?si=103PT8u4JLZ_mK5z

Description: This video will cover a common error encountered during spirometry testing: excessive back extrapolated volume. The presentation will explain what back extrapolated volume error is, how to identify it and coaching strategies to help your patient avoid this error.

V. Should You Always Report the Largest FEV1?

Jeffrey M. Haynes

Video Link:  https://youtu.be/qN1Wc8aYNrc?si=bI2YPT7aC_tZ-7Xd

Description: Computer software will always report the largest acceptable FEV1; however, the largest FEV1 is not always the true FEV1.

VI. Submaximal Inhalation Error (FIVC > FEVC) During Spirometry Testing

Jeffrey M. Haynes

Video Link:  https://youtu.be/yiB-2bF5daY?si=TaXsER_kVb0i7yrU

Description: This video reviews a common error during spirometry testing: submaximal inhalation error.  This video will show how to identify this error and reviews ways to correct it.

VII. What Should You Do When PFT Values Appear Too Good To Be True?

Jeffrey M. Haynes

Video Link:  https://youtu.be/zGAbOYFheuE?si=tZU1B1pzqC6kdj0Q

Description:  This video reviews the steps that should be taken when PFT values are higher than normal.  Only through careful investigation can determine whether the reported values are accurate or erroneously high.

VIII. Methacholine Challenge Testing

Jeffrey M. Haynes

Video Link: https://youtu.be/pH6EVI4rLl0?si=_7Kf8TSCD1ryU-1c

Description:  This video will explain the how and why’s about performing methacholine challenge testing in accordance with the 2017 ERS technical standards. In my practice I don’t follow all of the ERS recommendations but I will explain why.  Many laboratories follow old and outdated protocols, this presentation will get you up-to-speed with current practice.

VIIII. 6 Minute Walk Test (6MWT)

Jeffrey M. Haynes

Video Link:   https://youtu.be/yP6_9Hn3034?si=KEm86nOe87_yEApn

Description: The six minute walk test(6MWT)  provides valuable information regarding functional capacity, prognosis, and the response to treatment.  The 6MWT is not complicated, but is often not performed correctly which can greatly affect the results.  This video will review the proper way to perform the 6MWT according to the ERS/ATS technical standards.

IX. Biologic Control Testing

Jeffrey M. Haynes

Video Link: https://youtu.be/7anNXgFL4xY?si=LGFY16R6TtThenTj

Description: This video reviews the importance of performing biologic control testing in the pulmonary function laboratory. I also review how to set up and manage a biologic control program.

X. Is There Only One Way to Measure Vital Capacity During Lung Volume Testing?

Jeffrey M. Haynes

Video Link: https://youtu.be/ZyHzkTuUixA?si=B8xcVP9ncpwTCcE8

Description: Vital capacity is a critical determinant of lung volumes and subdivisions. The 2023 ERS/ATS lung volume testing technical standards recommend one method to measure vital capacity. In this video, I will try to convince you that this is not the best approach.

XI. Reducing Pain Associated with Arterial Blood Gas (ABG) Puncture

Jeffrey M. Haynes

Video Link: https://youtu.be/q7IfVbQL0kg?si=EYsjdf8Us-1sNec2

Description: This video will show the effectiveness of ice application in reducing the pain associated with arterial blood gas (ABG) puncture

XII. Diffusing Capacity (DLCO) Simulation

Jeffrey M. Haynes

Video Link: https://youtu.be/t1cyeCyiQC0?si=RADHUKqJkbOgWt4z

Description: This video shows an easy method for performing DLCO simulation with a standard 3L calibration syringe.  DLCO simulation is an important feature of a pulmonary function laboratory quality assurance program. Web address to Westgard QC tools for plotting DLCO simulation data: https://www.westgard.com/qctools

XIII. Diffusion Capacity (DLCO) Using The Morgan Scientific ComPas2 Software

Jeffrey M. Haynes

Video Link:  https://youtu.be/9H3vNHjxDQk?si=ou7j7GQNreZ8bAdy

Description: This video will review performing DLCO simulation testing using a 3L calibration syringe with the Morgan Scientific ComPAS2 software. There is valuable information about DLCO simulation even for those who aren’t using the ComPAS2 software

XIV. Is This Asthma, Vocal Cord Dysfunction, Or Both?

Jeffrey M. Haynes

Video Link: https://youtu.be/iJuN0WvuXBM?si=xTC8rElPbPfh2D_Q

Description: This is a quick report about a patient with asthma who developed debilitating shortness of breath despite multiple asthma medications. Exercise laryngoscopy revealed inducible laryngeal obstruction, commonly referred to as vocal cord dysfunction.

XV. Value-Based Respiratory Care

Garry W. Kauffman

Video Link: https://youtu.be/zrphtQKs09c?si=kPagfPgeMkQMbusG

Description: The days of obtaining reimbursement for every procedure, test, and intervention are only distant memories. Counting procedures and billable service units are examples of “counting what we can count” and must be replaced with “doing what counts”. This video will address the changing health care system, with attention to the current and forecasted demands on health care professionals and professional opportunities within the evolving health care system.

XVI. Pulmonary Lung Function Test Interpretation

Carl D. Mottram

Video Link: https://youtu.be/Ou8Umud3aNs?si=gfsRJ9H6MnRxpfPM

Description: This video overviews key components of the “ATS/ERS technical standard on interpretive strategies for lung function tests” as well as addressing reference sets with a focus on race and ethnicity.

XVII. Respiratory Oscillatory An Alternative Method to Assess Airway Caliber

Carl D. Mottram

Video Link: https://youtu.be/EbRuswg0gwg?si=7LaMH5b6TPfROua6

Description: This video reviews the underlying physiology behind respiratory oscillametry, overviews the ERS technical standards and case studies are presented.

XVIII. Lung Volumes by Body Plethysmography “Unraveling the Mysteries of the Box”

Carl D. Mottram

Video Link: https://www.youtube.com/live/emYwtSXCzU8?si=Q-0Xl_G11EFaEmFF

Description: This video overviews technical aspects of total body plethysmography as well as clinical applications of testing.

XIX. Indirect Bronchial Challenge Testing

Heather Murgatroyd

Video Link: https://youtu.be/fdR08K2cDGc

Description: This video reviews the clinical options available for indirect bronchial challenge testing as well as the indications, limitations, contraindications and applications of these important pulmonary diagnostic procedures.

XX. Sponsorship is the Most Powerful Tool to Move Your Career Forward 

Linda Nozart-Frierson and Ellen Becker

Video Link: https://youtu.be/LXsqn3EitWY?si=z3dAJSs2HAF4hr67

Description: What’s the real secret to leveling up your career as a Respiratory Therapist? It’s more than just hard work—it’s having the right people in your corner. In this inspiring episode of RTs Share Tea podcast, we unpack one of the most game-changing (yet often misunderstood) career tools: Sponsorship—and how it differs from Mentorship.

XXI. Is this Normal Spirometry Test Really Normal?

Jeffrey M. Haynes

Video Link: https://youtu.be/q6t3IveilUU?si=7RU6Os81KD4ri6Af

Description: This is a short case report of a patient with normal spirometry who may be showing signs of early lung disease.

XXII. Should Caffeine Be Withheld Prior to Pulmonary Function Tests?

Jeffrey M. Haynes

Video Link: https://youtu.be/NaRg3hB8Oxo?si=twzBdJnHlfie3rFy

Description: Many pulmonary function laboratories instruct their patients not to consume caffeine on the day of testing, but is this really necessary? This video will review the effects of caffeine on pulmonary function testing.

XXIII. Troubleshooting High Alveolar Volume Values From Diffusion Capacity Testing

Jeffrey M. Haynes

Video Link: https://youtu.be/ER7DVYZ2Ez4?si=8mPCwjN-fYzajCRz

Description: This video shows our troubleshooting process when alveolar volume (VA) was found to be higher than the patient’s total lung capacity (DLCO).

XXIV. How to Interpret a Diffusing Capacity (DLCO) Test

Jeffrey M. Haynes

Video Link: https://youtu.be/Yl2fIwa3NeU?si=wz-4tc-79eBAyKaW

Description: This video reviews the fundamentals needed to interpret diffusing capacity tests correctly. ……There is an error, when discussing the units of measure I correctly say ml/min/mmHg but the slide incorrectly displays ml/min/cmH2O, sorry about that.

XXV. Respiratory Oscillometry Interpretation

Jeffrey M. Haynes

Video Link: https://youtu.be/SjHdRAiGcJ0?si=0WLADvKXVLHo5ywu

Description: Oscillometry is a very useful tool in a pulmonary function laboratory but is underutilized due in part to confusion about how to interpret the recorded data. The goal of this video is to provide a basic, easy-to-understand guide to oscillometry interpretation.

XXVI. Does This Patient Have Obstructed Airways Or Dysanapsis?

Jeffrey M. Haynes

Video Link: https://youtu.be/40He_xk0Hcs?si=ReMer6JISL0XDfAA

Description: This video reviews a case of a patient with abnormal spirometry which may be due to dysanapsis not disease.

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