Though it’s uncomfortable, I’m grateful for spirometry testing

I stared at the screen in disbelief. My lung function had declined more than 20 percentage points.

I was stunned. I had undergone hundreds of pulmonary function tests before, and even though I wasn’t feeling great, none had shocked me like this one.

I knew I’d need antibiotics, but hoped I wouldn’t have to be hospitalized. But I was even more terrified that my profound decline in lung function was irreparable and that this was my new baseline. I struggled to make sense of the situation, and from then on, I felt anxious before every spirometry test.

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March 6, 2025 Columns by William Ryan

Working through the trauma of pulmonary function testing

Spirometry, a type of pulmonary function test, is a regular part of living with cystic fibrosis (CF). For many of us, it’s a necessity — dreaded but tolerated. I find it fairly easy, as far as medical tests go, though that’s not always the case for folks with lower lung function or who are experiencing a disease exacerbation.

There are a lot of numbers involved in spirometry testing, but one of the most important is FEV1, or the amount of air a person can forcefully exhale in the first second of a deep breath. If asked, most of us with CF could immediately list our FEV1 number.

This figure is helpful in gauging our health, though it can also raise questions: Is a dip in our score an anomaly, simply a reflection of the daily variations in our health? Or is it indicative of a bigger problem, such as an exacerbation or a lower baseline? A few percentage points can determine whether we stay the course, start on oral antibiotics, or are hospitalized and receive intravenous antibiotics.

A beneficial tool

But despite more than one harrowing experience, I love spirometry. I genuinely believe it has been an essential part of the incredible progress we’ve seen in the CF community.

Spirometry is not new. Clinicians started using it to monitor CF in the 1970s, nearly two decades before the genetic cause of the disease was discovered.

The test can certainly be uncomfortable and intimidating — I’ve given myself countless headaches trying to improve my numbers past the point of biological plausibility — and the results can be discouraging. While my own assessment of my health is generally corroborated by my test results, there have been occasions like the one I mentioned above when I was shocked by my FEV1 number.

It can be validating when medical tests align with our lived experience, but the results may be especially beneficial when they don’t align. That gap tells us something. Sometimes a dip in my lung function precedes my own identification of exacerbation symptoms.

Historically, CF has been a catastrophic and lethal disease. Flare-ups can quickly go from mild and treatable to severe and dangerous. As CF lung disease worsens and colonized bacteria become increasingly resistant to antibiotics, people with CF fare worse, eventually leading to a lung transplant or death.

To prevent exacerbations from starting or progressing, optimizing care is essential, and spirometry testing is one of the best ways to do that. FEV1 is sensitive, reliable, and quantifiable, and comparing your current number with past results allows physicians to identify any changes in your health.

This timeliness is not only important for disease monitoring, but also for clinical trials. FEV1 is one of the primary efficacy endpoints — a measure of a drug’s effectiveness — in many pivotal trials of CF drugs.

Many other disease communities are desperate for tests that can assess health and drug efficacy in such a timely and precise manner. While CF poses immense challenges to patients, these obstacles would be even more difficult to overcome without spirometry testing.

Note: Cystic Fibrosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Cystic Fibrosis News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to cystic fibrosis.