Exploring the 175-year history of spirometry and the vital lessons it can teach us today

Abstract

175 years have elapsed since John Hutchinson introduced the world to his version of an apparatus that had been in development for nearly two centuries, the spirometer. Though he was not the first to build a device that sought to measure breathing and quantify the impact of disease and occupation on lung function, Hutchison coined the terms spirometer and vital capacity that are still in use today, securing his place in medical history. As Hutchinson envisioned, spirometry would become crucial to our growing knowledge of respiratory pathophysiology, from Tiffeneau and Pinelli's work on forced expiratory volumes, to Fry and Hyatt's description of the flow-volume curve. In the 20th century, standardization of spirometry further broadened its reach and prognostic potential. Today, spirometry is recognized as essential to respiratory disease diagnosis, management and research. However, controversy exists in some of its applications, uptake in primary care remains sub-optimal and there are concerns related to the way in which race is factored into interpretation. Moving forward, these failings must be addressed, and innovations like Internet-enabled portable spirometers may present novel opportunities. We must also consider the physiologic and practical limitations inherent to spirometry and further investigate complementary technologies such as respiratory oscillometry and other emerging technologies that assess lung function. Through an exploration of the storied history of spirometry, we can better contextualize its current landscape and appreciate the trends that have repeatedly arisen over time. This may help to improve our current use of spirometry and may allow us to anticipate the obstacles confronting emerging pulmonary function technologies.

FIGURE 1

Mercurial air holder and breathing machine developed by Humphry Davy and colleagues at the Pneumatic Institution in England, circa 1798, 48 years prior to Hutchinson's spirometer. Reproduced from [3] courtesy of the Wellcome Collection.

FIGURE 2

Diagrams 25 and 26 from Hutchinson's original publication describing the spirometer. Diagram 25 depicts the internal mechanisms of the spirometer and diagram 26 demonstrates how to position a patient in relation to the device. Reproduced from [7].

FIGURE 3

Categorization of the 2130 subjects studied by Hutchinson with his spirometer. Reproduced from [7].

FIGURE 4

Gould's unadjusted breakdown of lung capacity in cubic inches by race and health status. Reproduced from [108].