Heart of Australia Pty Ltd
Level 1, 109 Honour Avenue, Chelmer QLD 4068
P: 
07 3162 5310  F:  07 3077 7153
E: reception@heartofaustralia.com
W: www.heartofaustralia.com.au



Patient Information and Consent Form

What does the procedure involve?

Spirometry is a breathing test that measures thevolume of air that we can breathe in and out. The graphs and information provide information on how well the lungs work. The measurements for spirometry are valuable for a screening tool for respiratory health, however, spirometry alone cannot lead to a diagnosis. The test involves using a nose clip to block the airflow from the nose whilst breathing through the mouth ona mouthpiece. You will be instructed to breathe normally to begin with, then to take a deep breath to fill the lungs, then blast it out hard and fast to empty all the air out of the lungs. A maximum of eight blows can be performed to obtain three acceptable results. You may also be given a bronchodilator such as Ventolin to measure the effects on your lungs and help determine any limitation of airflow in your airways. If you have any questions, please do not hesitate to ask one of our friendly staff.

What are the risks associated with the procedure?

Spirometry is generally safe and non-invasive. However it does require a maximal effort, cooperation and some coordination. It is not unusual for spirometry to result in;

  • Transient breathlessness

  • Oxygen desaturation

  • Sensation of fainting

  • Chest pain

  • CoughInduced bronchospasm in patients with poorly controlled asthma

What will happen after the procedure?

Upon completion of the spirometry the results will besent to your referring doctor and any other specified doctor. 

Consent to procedure

I have read this information sheet and had a chance to answer questions. I understand the test which will be performed and understand the associated risks. I consent to participate in this procedure (or as a guardian) I provide consent for the procedure to be performed on the person named below. 

I understand that the signing of this form is voluntary, and I am free to deny consent if I desire.

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Technician's Confirmation

The procedure and the risks involved have been explained to the patient. The patient has been given the opportunity to ask questions and has confirmed their understanding of the procedure and the risks involved.

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