Lung

Functions

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 Functions of lungs
●
Respiratory: Ventilation, Diffusion
●
Non-respiratory
– Act as a reservoir of blood, fine tuning preload
to the left heart - optimize cardiac output.
– Acts as a filter against endogenous and
exogenous emboli, preventing them from
accessing systemic circulation.
– Pulmonary epithelium forms the first line of
defence against inhaled particles.
– Pulmonary endothelial cells - uptake,
metabolism, and biotransformation of sever al
exogenous and endogenous substances.

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 Spirometry
●
A method of assessing ventilatory function of
the lungs by measuring the volume/rate of
flow of air that the subject can expel from
the lungs after a maximal inspiration.

3
 Inspiratory reserve volume Inspiratory
capacity

Total lung
capacity
Tidal volume

Vital
Expiratory reserve volume
capacity

Functional
residual capacity

Residual volume
 Capacities & Volumes
●
Total Lung Capacity = IRV +TV + ERV + RV

●
Vital Capacity = IRV + TV + ERV

●
Inspiratory Capacity = IRV + TV

●
Functional Residual Capacity = ERV +RV
NORMAL TIME - VOLUME CURVE
5 FVC

4
FEV1 = 4L
Volume 3
FVC = 5L
2
FEV1/FVC = 0.8
1

1 2 3 4 5 6
Time, seconds
Flow – Volume Curve
Peak expiratory flow
(PEF)

Expiratory
flow rate
L/sec

TLC FVC Residual

Volume

Inspiratory
flow rate
L/sec

Volume (L)
 Spirometry:Indications
●
FOR DIAGNOSIS
– Symptoms : Cough, dyspnea, sputum
– Signs : Abnormal breathsounds, cynosis
– Lab tests : Hypoxemia, abnormal CXR
– Effect of disease on lung functions
– Assess preoperative risk/prognosis
– Screen persons at risk (smokers)

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 Spirometry:Indications
●
FOR MONITORING
– Bronchodilator Rx
– Steroid Rx
– Antibiotic Rx in cystic fibrosis
– Adverse reaction to pulmotoxic drugs
●
FOR DISABILITY ASSESSMENT
– Assess as part of rehabilitation
– Assess for insurance/industrial claims
–
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 Contraindications
●
Hemoptysis of unknown origin
●
Pneumothorax
●
Unstable angina / recent MI
●
Recent eye/thoracic/abdo. Sx
●
Thoracic/cerebral/abd. Aneurysm
●
H/o syncope on forced expiration

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 Standard Spirometric Indices
●
FEV1 Forced expiratory volume in one
second:
●
The volume of air expired in the first
second of the blow.
●
FVC Forced vital capacity:
●
The total volume of air that can be forcibly
exhaled in one breath.
●
FEV1/FVC ratio The fraction of air
exhaled in the 1st second relative to the
total volume exhaled.
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PREDICTED NORMAL VALUES
●
Affected by
– Age

– Height

– Sex

– Ethnicity

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Normal Post B’dilator results

– FEV1: %Predicted >80%

– FVC : %Predicted >80%

– FEV1/FVC: %Predicted >70%

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 Obstructive Defect
FEV1 < 80%, FEV1/FVC <70%

5 FVC
Obstructive
4
FEV1 = 3L
Volume 3
FVC = 5L
2
FEV1/FVC = 0.6
1

1 2 3 4 5 6
Time, seconds
Obstructive disorders

●
COPD
●
Asthma
●
Bronchiectasis
●
Cystic Fibrosis
●
Post-tuberculosis
●
Lung cancer
●
Obliterative Bronchiolitis
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 Restrictive Defect
FEV1 < 80%, FVC < 80%, FEV1/FVC >70%
Normal Time-Volume Curve
5

FVC
Volume 3

2
FEV1 = 2.5L Restrictive
FVC = 3.0L
1
FEV1/FVC = 0.83
1 2 3 4 5 6
Time, seconds
 Restrictive disorders

●
Intrinsic Restrictive Lung Disorders
– Sarcoidosis, Tuberculosis, pneumonia,
●
Extrinsic Restrictive Lung Disorders
– Ankyl. Spondylitis, Kyphosis, pleural effusion
●
Neuromuscular Restr. Lung Disorders
– Diaphragmatic palsy, M.gravis, poliomyelitis

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 Restrictive+Obstructive Defect
FEV1 < 80%, FVC < 80%, FEV1/FVC <70%
Normal Time-Volume Curve
5

4
FEV1 = 0.5L Combined
Volume 3
FVC = 1.5L
s
2 FEV1/FVC = 0.3
FVC
1

1 2 3 4 5 6
Time, seconds
 Flow Volume Curve Patterns
Spirometry:What to know

Obstructive Restrictive

Expiratory flow rate

Expiratory flow rate

Volume (L) Volume (L)

Reduced peak flow, Normal shape,
scooped out mid- normal peak flow,
curve reduced volume
 Time- Volume Curve : Asthma

Volume
Spirometry:What to know

FEV1
Normal Subject

Asthmatic (After Bronchodilator)

Asthmatic (Before Bronchodilator)

1 2 3 4 5
Time (sec)
Note: Each FEV1 curve represents the highest of three repeat measurements
 Reversibility

 Improvement in FEV1 by 12-

15% or 200 ml in repeating
Spirometry:What to know

spirometry after 15-30 min

following treatment with
nebulized Sulbutamol
 Reversibility- characteristic
feature of Broncial Asthma.
 In c/c asthma, there may be
only partial reversibility of
airflow obstruction
 In COPD the airflow is
irreversible
COPD : SPIROMETRIC Dx
●
COPD is confirmed by
post–bronchodilator
FEV1/FVC < 0.7

●
Post-bronchodilator
FEV1/FVC measured 15
minutes after 400µg
salbutamol or equivalent
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 Emphysema
Airways may
collapse on forced
Spirometry:What to know

expiration
(destruction of
supporting lung
tissue) very
reduced flow at low
lung volume and a
typical (dog-leg)
appearance
 Bedside Assessment
●
Resp. rate & Pulse-Resp. ratio
●
Chest expansion
●
Forced Expiratory Time
●
Single breath holding (Sabrazes)
●
Single breath counting
●
3-min walk test
●
SpO2, resting & post exercise
●
Hand-held spirometry (Microspirometer)
●
Schnider’s Match test
●
De Bono’s whistle for PEFR
●
ABG

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Assessment of Diffusion
●
Clinical - cyanosis
●
SpO2
●
Post exercise change in
parameters
●
Arterial blood gases
● D CO
L
●
Capnography

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