Spirometry Pre-Screening

PRE-TEST RECOMMENDATIONS: 

Please wear loose and non-restrictive clothing which do not restrict you taking a full breath. 

PLEASE NOTE: We are unable to perform Spirometry if you have any of the following conditions: 

  • Covid-19
  • Recent Stroke
  • Recent MI (heart attack) or unstable angina
  • Pneumothorax
  • Pulmonary Embolism
  • Thoracic, abdominal or cerebral aneurysm >6cm or bulging
  • Haemoptysis of unknown origin
  • Active Infection
  • Nausea and vomiting

PRE-TEST INFORMATION LEAFLET: 

Please read the pre-test information leaflet here.

Spirometry Pre-Screening Information

Please only complete this form if you have been asked to do so by a health professional at Newton Drive Health Centre. Please answer all questions fully.

DD slash MM slash YYYY
Name
Date of birth
Gender
Smoking Status
Smoking Status
Please enter a number from 0 to 100.

In the last 6 weeks have you had a chest injury or surgery involving the eye, ear (e.g. ruptured tympanic membrane), chest, abdomen or been hospitalised for a heart attack?
Are you under a clinician’s care for high blood pressure?
PLEASE DO NOT USE BRONCHODILATOR (SALBUTAMOL INHALER)FOR 6 HOURS PRIOR TO APPT IF POSSIBLE
PLEASE DO NOT SMOKE TOBACCO OR VAPE IN THE 24 HOURS BEFORE YOUR TEST
PLEASE DO NOT EAT A FULL MEAL IN THE 2 HOURS BEFORE YOUR TEST
Have you had a respiratory infection (such as flu, pneumonia, bronchitis, or a chest cold) in the last 6 weeks?