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Lung Function Tests: Dr. Partha Pratim Deka
Lung Function Tests: Dr. Partha Pratim Deka
Tests
Dr. PARTHA PRATIM DEKA
Pulmonary function tests
(PFTs)
• Pulmonary function testing is a valuable
tool for evaluating the respiratory system
• comparing the measured values for
pulmonary function tests obtained on a
patient at any particular point with normal
values derived from population studies.
• The percentage of predicted normal is
used to grade the severity of the
abnormality.
Pulmonary Function
Tests
• Evaluates 1 or more major
aspects of the respiratory
system
PFTs
• Four lung components include :
The airways (large and small),
Lung parenchyma (alveoli,
interstitium),
Pulmonary vasculature, and
The bellows-pump mechanism
PFTs
• PFTs can include:
simple screening spirometry, Flow Volume Loop
Formal lung volume measurement,
Bronchoprovocation testing
Diffusing capacity for carbon monoxide, and
Arterial blood gases. Measurement of
maximal respiratory pressures
• These studies may collectively be referred to as a
complete pulmonary function survey.
Spirometry
• Measurement of the pattern of air
movement into and out of the lungs
during controlled ventilatory
maneuvers.
• Often done as a maximal expiratory
maneuver
Importance
• Patients and physicians have inaccurate
perceptions of severity of airflow
obstruction and/or severity of lung disease
by physical exam
• Provides objective evidence in identifying
patterns of disease
Spirometry
Simple, office-based
Measures flow, volumes
Volume vs. Time
Can determine:
Preoperative assessment
Indications — Diagnosis
Preoperative assessment
Indications — Diagnosis
■ Assess severity
■ Disability
Contraindications for
spirometry
• Relative contraindications for spirometry include hemoptysis
of unknown origin, pneumothorax, unstable angina pectoris,
recent myocardial infarction, thoracic aneurysms, abdominal
aneurysms, cerebral aneurysms, recent eye surgery
(increased intraocular pressure during forced expiration),
recent abdominal or thoracic surgical procedures, and
patients with a history of syncope associated with forced
exhalation
Spirometry
• Spirometry requires a voluntary maneuver in which a seated
patient inhales maximally from tidal respiration to total lung
capacity and then rapidly exhales to the fullest extent until
no further volume is exhaled at residual volume
Spirometry
• The maneuver may be performed in a forceful manner to
generate a forced vital capacity (FVC) or in a more
relaxed manner to generate a slow vital capacity (SVC).
• In normal persons, the inspiratory vital capacity, the
expiratory SVC, and expiratory FVC are essentially equal.
However, in patients with obstructive airways disease, the
expiratory SVC is generally higher than the FVC.
Interpretation of spirometr y
results(1)
• should begin with an
assessment of test quality.
to inspect the graphic data
(the volume-time curve and
the flow-volume loop)
Interpretation of
spirometry results(2)
• to ascertain whether the study
• 4 Volumes
• 4 Capacities
IRV • Sum of 2 or more
IC lung volumes
TV ERV VC
TLC
FRC
RV RV
Spirometry
Lung Factors Affecting
Spirometry
• Mechanical properties
• Resistive elements
Mechanical Properties
• Compliance
• Describes the stiffness of the lungs
• Change in volume over the change in pressure
• Elastic recoil
• The tendency of the lung to return to it’s resting state
• A lung that is fully stretched has more elastic recoil and thus
larger maximal flows
Resistive Properties
• Determined by airway caliber
• Affected by
• Lung volume
• Bronchial smooth muscles
• Airway collapsibility
Factors That Affect Lung Volumes
• Age
• Sex
• Height
• Weight
• Race
• Disease
Technique
• Have patient seated comfortably
• Closed-circuit technique
• Place nose clip on
• Have patient breathe on mouthpiece
• Have patient take a deep breath as fast as possible
• Blow out as hard as they can until you tell them to stop
Terminology ):
be
FE F
Terminology
(<0.8)
• Increased or
Normal: TLC
Spirometry in Obstructive
Disease
• Slow rise in upstroke
• May not reach plateau
Restrictive Lung Disease
• Characterized by diminished lung
volume due to:
• change in alteration in lung
parenchyma (interstitial lung
disease)
• disease of pleura, chest wall
(e.g. scoliosis), or neuromuscular
apparatus (e.g. muscular dystrophy)
• Decreased TLC, FVC
• Normal or increased: FEV1/FVC ratio
Restrictive Disease
• Rapid upstroke as n
i normal
spirometry
• Plateau volume
is low
Large Airway Obstruction
• Characterized by a
truncated
inspiratory or
expiratory loop
Normal Spirometry
Obstructive Pattern
■ Decreased FEV1
■ Decreased FVC
■ Decreased FEV1/FVC
- <70% predicted
Asthma
COPD
- chronic bronchitis
- emphysema
Bronchiectasis
Bronchiolitis
Decreased FEV1
Decreased FVC
Pleural
Parenchymal
Chest wall
Neuromuscular
Spirometry Patterns
Bronchodilator Response
Fixed obstruction
Upper Airway Obstruction
Lung Volumes
Measurement:
- helium
- nitrogen washout
- body plethsmography
Indications:
- Diagnose restrictivecomponent
- Differentiate chronic bronchitis from
emphysema
Pulmonary Function Testing
Restrictive
- TLC < 80% predicted
- RV < 80% predicted
Diffusing Capacity
Depends on:
- alveolar—capillary membrane
- hemoglobin concentration
- cardiac output
Diffusing Capacity
Decreased DLCO Increased DLCO
(<80% predicted) (>120-140% predicted)
Expensive!
Bronchoprovocation
Useful for diagnosis of asthma in the setting of normal
pulmonary function tests
Common agents:
- Methacholine, Histamine, others
SYMPTOMS
↓
PFTs
↓
OBSTRUCTION?
↓ ↓
YES NO
↓ ↓
BRONCHOPROVOCATION
TREAT
↓ ↓
No Obstruction?
Obstruction? Other Diagnosis
TREAT
PFT Interpretation Strategy
What is “normal”?
Spirometry
FEV1, FVC: decreased
FEV1/FVC: decreased (<70% predicted)
FV Loop “scooped”
Lung Volumes
TLC, RV: increased
Bronchodilator responsiveness
Restrictive Pattern –
Evaluation
Spirometry
FVC, FEV1: decreased
FEV1/FVC: normal or increased
FEV1/FVC
<70% DLCO decreased
“Scooped” FV curve
TLC increased
Increased
compliance
FEV1/FVC <70%
“Scooped” FV curve
TLC normal
Normal compliance
DLCO usually
normal
PFT Patterns
Asthma