What are the contraindications of spirometry?

Contraindications of Spirometry

Spirometry is contraindicated in patients with certain medical conditions including active hemoptysis, pneumothorax, recent myocardial infarction or unstable angina, recent thoracic/abdominal/eye surgery, thoracic or abdominal aortic aneurysm, acute respiratory distress, severe nausea or vomiting, and acute cerebral events due to increased risk of complications or inaccurate results. 1

Absolute Contraindications

The following conditions represent high-risk situations where spirometry should not be performed:

• Active hemoptysis (coughing up blood)
• Pneumothorax (collapsed lung)
• Recent myocardial infarction or unstable angina
• Thoracic or abdominal aortic aneurysm
• Recent thoracic, abdominal, or eye surgery
• Acute respiratory distress
• Severe nausea or vomiting
• Acute cerebral events (stroke, increased intracranial pressure) 1, 2

Relative Contraindications

These conditions may present risks that should be weighed against the potential benefits of performing spirometry:

• Chest or abdominal pain of any cause
• Oral or facial pain exacerbated by mouthpiece
• Stress incontinence
• Dementia or confused state that prevents proper test performance
• Recent pulmonary embolism
• Patients on certain infection precautions where equipment contamination is a concern 2

Timing Considerations After Medical Events

Modern surgical techniques and recovery protocols have reduced the waiting period needed before performing spirometry:

• Major thoracic or abdominal surgery: 2-3 weeks (reduced from traditional 6 weeks)
• Myocardial infarction: 1-2 weeks if stable (reduced from traditional 6 weeks)
• Eye surgery: 1-2 weeks
• Neurosurgery: 3-4 weeks depending on intracranial pressure status 2

Infection Control Considerations

While spirometry itself is generally safe, proper infection control measures are essential:

• Regular cleaning and disinfection of equipment
• Use of disposable mouthpieces for each patient
• Proper ventilation of testing areas
• Disposable bacterial/viral filters when testing patients with known respiratory infections 1, 3

Research has shown that while mouthpieces and proximal tubing may become contaminated with patients' respiratory pathogens (14% of cases), the interior surfaces of spirometers rarely become contaminated, making cross-transmission between patients unlikely when proper infection control protocols are followed 3.

Clinical Implications

When spirometry is contraindicated, clinicians should:

1. Postpone testing until the contraindication resolves
2. Consider alternative, less demanding pulmonary function tests if information is urgently needed
3. Rely on clinical assessment and other diagnostic modalities until spirometry can be safely performed

The risks of performing spirometry in contraindicated conditions primarily relate to increased cardiovascular stress during forced expiratory maneuvers, potential for worsening existing injuries or surgical sites, and possible spread of infection in certain circumstances 2.

For patients with recent surgical procedures, the traditional recommendation of waiting 6 weeks can often now be reduced to less than 3 weeks with modern less invasive surgical techniques, but this should be evaluated on a case-by-case basis 2.