Spirometry/PFT Report (Pre/Post Bronchodilator)

Report Header

Laboratory/Facility: [Facility name and site]

Patient Name: [Full name]

MRN: [Medical record number]

DOB: [MM/DD/YYYY] — Age at test: [Age in years]

Sex (for reference equations): [Female / Male / Unknown]

Height (cm): [Value] ([measured today / historical / unknown])

Weight (kg): [Value] (Optional; omit if not documented)

Smoking Status: [never / former / current / unknown]; Pack-years: [Value / unknown]

Test Date/Time: [MM/DD/YYYY HH:MM]

Ordering Clinician: [Name, credentials]

Interpreting Clinician: [Name, credentials]

Indication: [Clinical indication for testing]

Reference Equation: [Name/version used for predicted values and LLN]

Pre-Test Conditions

• Bronchodilator withholding status: [yes / no / partial / unknown] (If withheld: [Drug class] — last dose: [Date/time])
• Symptoms affecting effort: [None / Cough / Dyspnea / Chest tightness / Fatigue / Other] (Include only if relevant to interpretation)
• Supplemental oxygen use during testing: [No / Yes — flow and delivery method]
• Adverse events during testing: [None / Description of event]
• Early termination: [No / Yes — reason and which data remain usable]

Test Quality Summary

Pre-Bronchodilator Session

• Maneuvers attempted: [#]
• Acceptable maneuvers: [#]
• Repeatability met: [yes / no]
• Quality grade FEV₁: [A / B / C / D / E / F]
• Quality grade FVC: [A / B / C / D / E / F]
• If quality reduced, reasons: [submaximal effort / cough during first second / early termination / poor start of test / variable effort / leak / glottic closure / poor reproducibility / other] (Include only if applicable)
• Technologist comments: [Comments affecting interpretability] (Include only if applicable)

Post-Bronchodilator Session

(Include only if post-bronchodilator testing was performed)

• Maneuvers attempted: [#]
• Acceptable maneuvers: [#]
• Repeatability met: [yes / no]
• Quality grade FEV₁: [A / B / C / D / E / F]
• Quality grade FVC: [A / B / C / D / E / F]
• If quality reduced, reasons: [submaximal effort / cough during first second / early termination / poor start of test / variable effort / leak / glottic closure / poor reproducibility / other] (Include only if applicable)
• Technologist comments: [Comments affecting interpretability] (Include only if applicable)

Spirometry Results — Pre-Bronchodilator

Parameter	Observed (Best)	Predicted	LLN	z-score	% Predicted
FEV₁ (L)	[##.##]	[##.## / not calculated]	[##.## / not calculated]	[#.# / not calculated]	[### / not calculated]
FVC (L)	[##.##]	[##.## / not calculated]	[##.## / not calculated]	[#.# / not calculated]	[### / not calculated]
FEV₁/FVC	[#.##]	[#.## / not calculated]	[#.## / not calculated]	[#.# / not calculated]	[### / not calculated]
PEF (L/s)	[##.##]	[##.## / not calculated]	[n/a]	[n/a]	[### / not calculated]
FET (s)	[##.##]	[n/a]	[n/a]	[n/a]	[n/a]

Limitations: [Missing critical data and which calculations could not be performed] (Include only if applicable)

Bronchodilator Administration

(Include only if post-bronchodilator testing was ordered)

• Agent (generic): [Drug name]
• Dose and actuations: [Dose; # actuations]
• Route/device: [MDI + spacer / Nebulizer / Other]
• Administration time: [HH:MM]
• Wait time before post-BD testing: [Minutes]
• Patient tolerance: [Well tolerated / Adverse effects noted — description]

(If post-bronchodilator testing was ordered but not performed, state: "Post-bronchodilator spirometry not performed — [reason]" and omit subsequent post-BD sections)

Spirometry Results — Post-Bronchodilator

(Include only if post-bronchodilator testing was performed)

Parameter	Observed (Best)	Predicted	LLN	z-score	% Predicted
FEV₁ (L)	[##.##]	[##.##]	[##.##]	[#.#]	[###]
FVC (L)	[##.##]	[##.##]	[##.##]	[#.#]	[###]
FEV₁/FVC	[#.##]	[#.##]	[#.##]	[#.#]	[###]
PEF (L/s)	[##.##]	[##.##]	[n/a]	[n/a]	[###]
FET (s)	[##.##]	[n/a]	[n/a]	[n/a]	[n/a]

Bronchodilator Response

(Include only if both pre- and post-bronchodilator testing were performed)

• FEV₁ change: [Δ in L] ([% change] of baseline; [% change] of predicted)
• FVC change: [Δ in L] ([% change] of baseline; [% change] of predicted)
• Classification: [Positive bronchodilator response / No positive bronchodilator response by laboratory criteria] (Positive defined as FEV₁ or FVC increase >10% of predicted)
• Parameter driving classification: [FEV₁ / FVC / Neither] — [Magnitude of change]

Impression

[One-sentence statement on overall test quality, acceptability, and any limitations affecting interpretation confidence]

Physiologic pattern (LLN/z-score framework): [Normal spirometry / Obstructive ventilatory impairment / Restrictive pattern suggested (TLC required for confirmation) / Mixed pattern / Non-specific pattern]

• Severity: [Mild (z −1.65 to −2.5) / Moderate (z −2.5 to −4) / Severe (z < −4)] — based on [FEV₁ / FVC] (Include only if impairment present)
• Bronchodilator response: [Positive / Negative] by criteria — [Parameter and magnitude driving response] (Include only if BD testing performed)

(Do not assign disease diagnoses such as asthma or COPD; report physiologic classification only)

Interpret in clinical context and correlate with symptoms, examination, imaging, and prior studies.

Comparison to Prior Studies

(Include only if prior PFTs are available; otherwise state: "No prior PFTs available for comparison.")

• Prior study date: [MM/DD/YYYY]; [Pre-BD only / Pre- and Post-BD]
• Key parameter changes: FEV₁: [Δ L, Δ%]; FVC: [Δ L, Δ%]; FEV₁/FVC: [Δ absolute]
• Comparability limitations: [Different reference equations / Different equipment / Different medication withholding status / Quality differences / None] (Include only if applicable)

Authentication

Performing Technologist: [Name], [Credentials] — [Date/Time]

Interpreting Clinician: [Name], [Credentials] — [Date/Time] — [Signature attestation]

(If interpretation is preliminary, label as such and identify clinician responsible for final sign-off)