Pulmonary Function Testing in Small Animals
Elizabeth A. Rozanski and Andrew M. Hoffman
Pulmonary function testing (PFT) may be used to help provide
objective information concerning the respiratory system in dogs
and cats. Available techniques for PFT include spirometry, tidal
breathing flow-volume loop analysis, barometric whole-body
piethysmography, dynamic and static compliance, and lung and
upper airway resistance. The information gained from PFT may
help both in patient management and also Jn gaining
understanding of the pathophysiology of the pulmonary system.
Copyright 1999 by W.B. Saunders Company
piratory diseases are a common problem in veterinary
R~ edicine. Traditionally, however, the initial assessment of
respiratory status and subsequent evaluation of therapeutic
response have depended on subjective evaluation on the part of
the owner or clinician. Pulmonary function testing is used
extensively in human medicine to objectively evaluate and
diagnosis pulmonary diseases as well as to follow up the
response to therapy. 1 Pulmonary function tests (PFTs) provide
useful information to the clinician to both better define the
abnormalities within respiratory system and to better under-
stand the pathophysiological changes within the lungs. ~ The
goal of PFTs is not to replace other forms of diagnostic testing,
but rather to strengthen the understanding of respiratory
mechanics. Additionally, PFTs may be more useful before a
disease is fulminant. For example, in the evaluation of an
animal with mild to moderate tachypnea, PFTs may be able to
better clarify the underlying problem and support further
diagnostic testing than in the patient with extreme respiratory
embarrassment, where all PFTs will be grossly abnormal.
Despite the high degree of acceptance and utility in the field
of human pulmonary medicine, PFTs have not been widely
used in veterinary patients. Many PFTs have been developed
that require cooperation on the part of the patient. For
example, the forced expiratory volume (FEV) is able to
evaluate abnormalities in lung function in people, but requires
the test subject to forcibly expire air after a large inspiration. 1
Clearly, small animal patients are unable to cooperate to this
extent. Other forms of PFTs have been designed for experimen-
tal use in dogs and cats, but are frequently too invasive to be
used in a clinical setting. 23 In the past 15 years, several
noninvasive PFTs suitable for clinical use have been described
in dogs and cats. 4-n
From the Department of Veterinary Clinical Sciences, Tufts University
School of Veterinary Medicine, North Grafton, MA.
Address reprint requests to Elizabeth A. Rozanski DVM, Department of
Veterinary Clinical Sciences, Tufts University School of Veterinary Medl-
cine, 200 Westboro Rd, North Grafton, MA 01536.
Copyright 1999 by W.B. Saunders Company
1096-2867/99/1404-0008510.00/0
Clinical Techniques in Small Animal Practice, Vol 14, No 4 (November), 1999: pp 237-241
Spirometry
Splrometry is perhaps the easiest of the PFTs. A spirometer is a
device that measures the volume of air or rate of airflow. A
spirometer may be connected to an endotracheal tube in an
animal that is intubated or may be applied using an airtight
face mask to an awake animal. The tidal volume (TV) and
minute ventilation (MV) may be calculated (See Table 1 for
normal values of various respiratory parameters in small
animals). Spirometry has been most useful in evaluating the
ventilatory abilities of an animal recovering from anesthesia,
for example, after thoracotomy or neuromuscular blockade, i2
Spirometry requires minimal equipment and is able to provide
some information about the ventilation.
Tidal Breathing Flow-Volume Loops
Tidal breathing flow-volume loops (TBFVL) are another type
of pulmonary function test that has been used in small
animals.4513,14 TBFVL were initially developed for use in
human infants, who are also unable to cooperate with instruc-
tions for maximal respiratory efforts. TBFVL rely on analysis of
airflow patterns. Airflow is measured through a pneumotacho-
graph with an associated differential pressure transducer. The
rate of airflow through the pneumotachograph results in a
detectable pressure decrease between the two sides of the
device, This pressure decrease is proportional to the airflow
rate. The flow rate may then be integrated to measure the
volume. The flow and the volume are plotted on the X and Y
axis, respectively. Predictable changes occur within the loop
shape and within flow and timing indices with airway obstruc-
tion. The loops may be plotted by hand or with computer
assistance.
Dog~ and cats are typically evaluated while standing or
sitting'comfortably. A tight-fitting face mask is placed over the
mouthl, including the lip commissures. The loops are recorded
for several minutes until loop shape appears consistent. Loops
that are free of artifacts such as meowing, purring, movement,
or panting are chosen for further analysis. Some investigators
have added a nonspecific respiratory stimulant such as 10%
CO2 or doxapram chloride as a means to try to increase the
sensitivity of the loops, particularly in animals with minor
clinical abnormalities. 15
Normal TBFVL appearances and indices have been reported
in small animals. 4,5 The evaluation of the loop requires analysis
of both the visual appearance of the loop and also the
calculated loop indices. The normal loop appears similar to the
letter D. Inspiration begins at the right-hand side of the loop,
on the X axis, and continues in a clockwise direction.
Inspira :ory flow rates are maximal near the end of inspiration,
wherea expiratory flow rates peak early in expiration. Loop
indices
which describe the relationship of the flow rates to
their ti: within the respiratory cycle, are useful for providing
he
obj ectr ,e data for loop comparisons. The mspiratory and
I
237
 depicts output, not the work or "driving pressure" that was
TABLE 1, Normal Reported Values for Respiratory
Parameters in Dogs and Cats expended, so they provide a limited measure of lung mechan-
ics.
Parameter Units Dog Cat

Tidal volume mL 10-20 mL/kg 12 10-20 mL/kg 12

460 _+ 1804 57 9 +_ 15.45 Barometric Whole-body Plethysmography
35 -+ 3.96
Minute ventilation mL/min 150-250 mL/kg q2 150-250 mL/kg 12 Baromemc whole-body plethysmography (BWBP) is another
Respiratory rate bpm 32 +_ 104 43 + 75 non invasive PFT that has been apphed to small ammals.
58 + 86
Insplratory time msec 920 _+ 3504 716.6 _+ 139.55 BWBP was initially designed for use in small laboratory
470 2 405 mammals as a tool for quantifying ventilation and evaluating
Expiratory time msec 1170 -+ 4804 703.7 _+ 133.05 bronchoconstriction. BWBP signals are produced as the net
730 + 106
Peak respiratory
result of both thoracic and nasal airflow (Fig 2). While these
flow mL/sec 740 _+ 2404 110 9 + 26.65 two flows are equal, a signal ls produced because the exhaled
Peak expiratory flow mL/sec 780 +_ 2304 113.7 _+ 29 15 a r is warmed and humidified and results m larger pressure
Dynamic compli-
ance mL/cmH20 117 _+ 467 19 89 changes than the cooler air. These signals seem similar to the
50-958 flow signal produced wath a face mask and pneumotachograph,
Static compliance mL/cmH20 42 25 _+ 32 l NA but because their sources are quite different, they are termed
Lung resistance cm H20/L/sec 0.8-4.2a 28.99
Upper airway resis-
pseudo-flow. 6,16 BWBP actually measures the relauonship be-
tance cm H20/L/sec 7.1 _+ 0 5011 NA tween effort and flow in terms of their amplitude and timing,
Pause unitless NA 0.631 _+ 0.036 and therefore depicts pulmonary resistance and elastance.
Enhanced pause unitless NA 0 465 4-_ 0 036
Other parameters, including tidal volume and respiratory
NOTE. Superscript numbers refer to references m the reference list at nming as well as more specific mdices of bronchoconsmction
the end of the article. Data are d~splayed as the mean _+ standard (pause and enhanced pause) may also be calculated. BWBP is
dewation for references 4, 8, and 9 and the mean -+ standard error of
mean for references 5, 6, 9, and 11 NA = Not available. performed by placing an animal in an airught but ventilated
chamber. A single-screen pneumotachograph with a known
resistance is mounted on the chamber wall. A differential
expiratory times are not seen on visual loop analysis, but are pressure transducer connected is connected to a preamphfier
provided by computer analysis. The respiratory rate will affect and pulmonary function computer. The ammal is able to move
the loop shape, with higher rates resulting in changes in tidal around the chamber at will.
volume and flow patterns. BWBP is very well tolerated in cats, even cats wath sigmfl-
TBFVL analysis has been reported in both dogs and cats with cant resDratory &stress. Experimental studies in cats have
respiratory diseases45,13a4 (Fig 1). Moderate to severe airflow shown that BWBP effectively measures a dose-related effect of a
obstruction results in predictable changes in both visual loop bronchoconstriction agent. 6 Preliminary studies have also
appearance and also loop indices. Airflow obstructions may be shown that BWBP is effective in detecting bronchoconstriction
fixed or dynamic. Examples of fixed airway obstrucuons assomated with naturally acquired feline asthma as well as
include masses and strictures. Fixed obstructions wall result in assessing the bronchodiliatory response to mhaled albuterol. 17
airflow hmitations in both the inspiratory and expiratory cycle BWBP evaluation in dogs has been hmited. Dogs have a
and will tend to make the loop shape appear flatter as the peak tendency to pant when confined within a box, even without
airflow is diminished. Dynamic airflow obstructions will affect restramt. However, because of the high incidence of broncho-
only one phase of loop, with upper airway obstruction pulmonary disease in small breed dogs, BWBP may be useful m
affecting the respiratory phase and lower airway obstructions this species as well.
affecting the expiratory phase. The initial report of TBFVL use
in dogs described the changes in loop shape and indices in
dogs with naturally acquired laryngeal paralysis.* Laryngeal
Lung Mechanics
paralysis is typically a dynamic upper airway obstruction. In Lung mechanics includes the measurement of compliance and
many dogs with laryngeal paralysis, loop shape was dramati- resistance of the lung. These tradiuonal measurements provtde
cally changed. 13 TBFVL have also been used to evaluate dogs valuable information concerning the elasucKy of the lung as
with chronic bronchitis and brachycephalic airway syndrome well as airway function and size. Calculation of lung mechan-
as well as to assess efficacy of therapy for con&tions such as ics reflects the relationship between airflow rates, tidal volume,
tracheal collapse or laryngeal paralysis. 13,1. TBFVL have also and pleural pressure. Lung mechanics measurements have
been examined in cats with chrome bronchitis/asthma. 5 In been widely made in research animals, but frequently research
affected cats, signs of airflow limitation in the lower airways techniques are not &rectly applicable to the clinical pauent. 23
compatible wath bronchoconstriction, excessive mucus, and Lung compliance is a measure of the distensibility of the
smooth muscle hypertrophy have been documented. 5 lung parenchyma. The units for compliance are mL/cm H20.
In summary, TBFVL are useful and wefl-tolerated PFTs in The higher the compliance value, the easmr it is to fill the lung
small animals. Common respiratory diseases produce predict- with air. Clearly, the actual number for compliance is size
able changes m loops. Changes in loop shape and indices dependent. The compliance value for an Irish wolfhound
provide objective and reproducible informanon concerning the would certainly be much higher than for a toy poodle. As a
respiratory system. The theoretical limKation of TBFVL is the result, compliance may be calculated based on body weight or
normal reserves of the pulmonary system, which may prevent lung volume (specific compliance). Any disease process that
signs of obstruction from appearing in loops obtained from affects the lung parenchyma will affect lung compliance.
mild to moderately affected animals. Ad&tionally, TBFVL only Common climcal condiuons that would result in a decreased

238 ROZANSKI AND HOFFMAN

 NORMAL NONFIXED FIXED
A (TYPE1 N=3) B (TYPE 2 N = 17) C (TYPE3 N = 10)

1.0-
10. PEF
EF50
5
rr
E.

i~ 4;o
00 0.0
o 6(?0 0.0 6(?0
r,r"
E
o3
Z
0.5
/ IF25
1.0- PIF IF50
1.C
VOLUME (ML)

D E F

LU ~"
"5

o~
o~

L - V o l u m e (1,5 00 mL dw) __ Volume (15 00 mL dlv) Volume (20 00 mL dw)

Fig 1. Representative examples of tidal breathing flow-volume loops (TBFVL) from dogs and cats. Time is not visible on the
loops. Loop A is an example of a loop from a normal dog. Loop A also shows the points at which various indices of loop shape
may be calculated. Peak inspiratory flow (PIF) occurs late in inspiration, and peak expiratory flow (PEF) occurs near the
beginning of expiration. Loop B is from a dog with a dynamic laryngeal obstruction; note the early PIF. Loop C is from a dog with
a fixed laryngeal obstruction; note that both inspiratory and expiratory flows are blunted. Loop D is from a normal cat; note that
the appearance is similar to the normal dog. Loop E is from a cat with chronic bronchial disease; note the expiratory flow
limitation. Loop F is from a small dog with tracheal collapse (extrathoracic) causing inspiratory flow limitation. Reproduced
with permission. 4,14,15

compliance would include pulmonary edema, pneumonia,
pulmonary contusion, and pulmonary fibrosis. In people,
emphysema may result in increased compliance, perhaps
through alternations in the elasticity of the surrounding
tissues. In dogs and cats, emphysema is rare and almost all
pulmonary diseases result in decreased compliance. Compli-
ance values may also be diminished by prolonged recumbency
or general anesthesia because of atelectasis and decreased
functional residual capacity/
Two separate methods for measuring compliance have been
described for clinical use in small animals. ~-1 The first is the
evaluation of the static compliance (Cstat). Cstat measurements
have the advantage of requiring a limited amount of addiuonal
equipment (spirometer and water manometer). Normal values
for healthy dogs have been published, l C~t~t measurement
include the comphance of both the lung parenchyma and the
chest wall. Measurement is generally made by inflating the
lungs to a known pressure (25 cm H20) and then recording the
volume of exhaled air against transpulmonary pressure at
several steps of deflation. The Cstat may be calculated by
calculating the slope of the pressure-volume curve during
deflation. Cstat shows potential promise in momtoring anlmals
that are mechanically vennlated to follow changes over time.
The only disadvantage of Cstat is the requirement for general
anesthesia and complete relaxation or apnea.
Compliance measurements may also be made dynammally
(ie, during breathing). This measurement is termed dynamic
compliance (Cdyn) and reflects the elasticity of the lung
parenchyma as well as the diameter of the small (peripheral)
airways. Cdyncalculations require simultaneous measurements
of changes in volume and transpulmonary pressure. Dynamic
compliance is the ratio of the change in volume to the change
in pressure. Volume changes are recorded with a pneumotacho-
graph. Signals may be recorded from eKher an endotracheal
tube or an airtight face mask. Changes in transpulmonary
pressure are typically measured from an esophageal balloon
placed in the midthoracic esophagus. At points of zero airflow
(le, end inspiranon and end expiration) alveolar pressure is

PULMONARY FUNCTION TESTING 239

 20-
Y',
@
O- I I I : l
,nsirt,o'
;
Ti
w i
PIF
-2 5 -2 0 -1 5
Fig 2. Barometric whole-body plethysmography produces signals that appear similar to airflow. BWBP signals are produced
as the net result of both thoracic and nasal airflow (see text for explanation). Ti, inspiratory time; "re, expiratory time; PIF, peak
inspiratory pseudo-flow; PEF, peak expiratory pseudo-flow.
equal to airway pressure, so the intrapleural (esophageal) and
transpulmonary pressures are considered equal. Normal values
for dynamic compliance have been reported m healthy cats?
Cats with significant bronchopulmonary disease have been
found to have significantly lower Cdy~than healthy cats. Cdyn
values have also been reported in dogs, but because of the
tremendous variation in size in dogs, may be less directly
applicable to the clinical patient. 78 Cdy~ measurement in the
individual animal may the most useful in following trends
within an individual over time.
When small airways (<2 mm) are narrowed by &seas< the
airflow rates to these areas will be further limited, particularly
at high respiratory rates. This fact may be exploited to
document a phenomenon called the frequency dependence of
dynamic compliance. This means that declines in Cdynat high
respiratory rates may be used to document small airway
disease. This test is only useful in ammals with otherwise
normal PFT results, so has not been used extensively in
veterinary medicine.
Lung resistance (RL) may also be measured to document the
nonelastic component of the respiratory system. Resistance
values may be measured using the isovolumetric method. This
technique reflects changes in flow rate and airway pressures at
points of equal volume. The units for RL are cm H20/L/sec.
Increases in RLprimarily reflect narrowing in the larger airways
(>2 mm) that contribute to greater than two thirds of the total
RL. Lung resistance measurements can be made using the same
equipment that is used to measure Cdyn.
Cats with naturally occurring bronchial disease have been
shown to have significantly increased RL when compared with
normal cats? Normal values for RL have been reported in
research dogs but testing has been performed in a relatively
limited number of climcal cases. Resistance measurements
across the upper airway (Ruaw) have also been described in
dogs. n Ruawmeasurement may be useful to provide objective
240
PEF
;
.j,Expiration
' T~ ~,I
/
I :
V
-i 0 -6.5 0.0
data about the relative successes of various laryngeal or
brachycephalic surgeries.
Conclusion
PFT measurements offer the opportunity to objectively classify
respiratory diseases in small ammal patients. This knowledge
increases the understanding of the pathophysiology associated
with different disease processes and may allow for better
patient care. Directions for future study include further refine-
ment of techmques with better applicability to the clinical
patients and a better understanding of noninvasive methods
such as BWBE
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241