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 Introduction
 Pulmonary function tests or lung function tests are useful in assessing the functional
status of the respiratory system both in physiological and pathological conditions.

 Lung function tests are based on the measurement of volume of air breathed in and
out in quiet breathing and forced breathing.

 These tests are carried out mostly by using spirometer.

Types Of Lung Function Tests: Lung function tests are of two types:
1. Static lung function tests
2. Dynamic lung function tests.

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 Introduction
1. Static Lung Function Tests
• Static lung function tests are based on volume of air that flows into or out of lungs. These
tests do not depend upon the rate at which air flows.
• Static lung function tests include static lung volumes and static lung capacities.

2. Dynamic Lung Function Tests

• Dynamic lung function tests are based on time, i.e. the rate at which air flows into or out
of lungs.
• These tests include forced vital capacity (FVC), forced expiratory volume (FEV), maximum
ventilation volume and peak expiratory flow (PEF.)
• Dynamic lung function tests are useful in determining the severity of obstructive and
restrictive lung diseases.

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 Lung volumes
3000ml

500ml
1200ml

1200ml
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 Lung volumes
• Static lung volumes are the volumes of air breathed by an individual.
• Each of these volumes represents the volume of air present in the lung under a specified static
condition (specific position of thorax.)
Static lung volumes are of four types:
1) Tidal Volume (TV): Volume of air inhaled or exhaled with each breath during normal
breathing (500 ml.)
2) Inspiratory Reserve Volume (IRV): Maximal volume of air inhaled at the end of a
normal inspiration (tidal volume) (3000 ml)
3) Expiratory Reserve Volume (ERV): Maximal volume of air exhaled at the end of a tidal
volume (1200 ml.)
4) Residual Volume (RV): The volume of gas remains in the lung after maximal expiration.
(1-1.2 L). Some quantity of air always remains in the lungs even after the forced
expiration.

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 Lung capacities
4700ml 3500ml

5900ml

2400ml
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Static lung capacities are the combination of two or
more lung volumes.
Static lung capacities are of four types:

5) Inspiratory capacity (IC): Maximal volume of air inhaled after a normal expiration (3.6 L)
(TV+IRV) = 500 + 3000 = 3500 ml.
6) Vital capacity (VC): The volume of air moved between TLC and RV. (4-5 L) (IRV+ERV+TV) = +3000
4700 = 500+1200ml
7) Functional Residual Capacity (FRC): The volume of gas that remains in the lung at the end of a
passive expiration. (2-2.5 L) or (40 % of the maximal lung volume)
(ERV+RV)= 1200 + 1200 = 2400 ml
)7 Total Lung Capacity (TLC): The maximal lung volume that can be achieved voluntarily. (5-6 L)
(IRV+ERV+TV+RV) = 3000 + 1200 + 500 + 1200 = 5900ml
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The respiratory dead space is the space in the conducting
zone of the airways occupied by gas that does not
exchange with blood in the pulmonary vessels.
 Total minute volume
Multiplying the tidal volume at rest by the number of breaths per minute gives the total minute
volume (6 L/min) .e.g if the rate of breathing per minute is 12 breath/min
The Total minute volume = 12 X 500 = 6000ml / min

 During exercise the tidal volume and the

number of breaths per minute increase to
produce a total minute volume as high as
100 to 200 L/min.
 FRC and RV can not be measured with an
ordinary spirometer.

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 FACTORS THAT AFFECT THE VITAL CAPACITY (VC)
1. Posture : The VC is greater in the standing or sitting positions than in the recumbent
position, because in the latter position the lung capacity is decreased due to 2 factors
A. The viscera press on the diaphragm (which limits its descent.)
B. The blood volume in the lungs increases (because the venous return increases as a result
of loss of the effect of gravity.)
2. Movement of the diaphragm : Conditions that limit the diaphragmatic descent (e.g.
pregnancy and ascites) decrease the VC specially in the recumbent position (see above.)

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.3 Pulmonary blood volume : Pulmonary congestion (= increased blood volume in the lungs)
e.g. in left ventricular failure , decreases the VC specially in the recumbent position.
.4 Strength of the respiratory muscles : The VC is greater in athletes than in sedentary
people, and is decreased in all muscle diseases, myasthenia gravis, and diseases associated
with paralysis (e.g. poliomyelitis.)

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5. Lung compliance {stretchability: )
A decrease in the lung compliance reduces the VC. This commonly occurs in
i. Lung fibrosis [e.g. after a severe TB (tuberculosis) infection.]
ii. Pneumothorax (collection of air in the pleural sac
iii. Hydrothorax (collection of fluid in the pleural sac.)
.5 Lung elasticity : Reduction of the elastic property of the lungs decreases the VC e.g. in
emphysema, in which the lungs are well inflated and their compliance increases, but
expiration becomes difficult.

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7. Resistance to air flow : An increase in the resistance to air flow reduces the VC. This occurs
in obstructive lung diseases e.g. asthma, in which the resistance to air flow occurs mainly
during expiration.
8. Expansibility of the thoracic wall : A decrease in the expansion of the thorax reduces the
VC. This commonly occurs due to deformities in either the thoracic cage or the vertebral
column (e.g. kyphosis and scoliosis.)

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• The diseases that limit the lung or thoracic wall expansibility are called restrictive lung
diseases. In these diseases, as well as in cases of pulmonary congestion and limited
diaphragmatic movement, both the TLC as well as the VC are reduced.
• On the other hand, in diseases characterized by difficult expiration (e.g. emphysema and
asthma), the TLC is almost normal while the VC is decreased and the RV is increased.

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Vital capacity is decreased in the following respiratory diseases:
1. Asthma
2. Emphysema
3. Weakness or paralysis of respiratory muscle
4. Pulmonary congestion
5. Pneumonia
6. Pneumothorax
7. Hemothorax
8. Hydrothorax
9. Pulmonary oedema
10. Pulmonary tuberculosis.

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Restrictive Respiratory Disease
• Restrictive respiratory disease is the abnormal respiratory condition characterized by
difficulty in inspiration. Expiration is not affected.
• Restrictive respiratory disease may be because of abnormality of lungs, thoracic cavity
or/and nervous system.

Obstructive Respiratory Disease

• Obstructive respiratory disease is the abnormal respiratory condition characterized by
difficulty in expiration.

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 Measurement Of The Lung Volumes And Capacities
• The lung volumes already described are called static volumes, because they are measured while
the subject is in the resting mid thoracic position.
• All can be measured by an apparatus called the spirometer except the residual volume.
• Therefore, the capacities that include the residual volume (i.e. FRC and TLC) can not be
measured by this apparatus.

Dr. Asma’a19
Al-Henhena 19
 spirometry
• Spirometry is the method to measure lung volumes and capacities.
• A simple diagnostic test called "spirometry“ measures how much
air a person can inhale and exhale, and how fast air can move into
and out of the lungs
• Spirometry can detect COPD history long before its Symptoms
appear.

• Simple instrument used for this purpose is called

spirometer.
• Modified spirometer is known as respirometer.
• Nowadays plethysmograph is also used to measure
lung volumes and capacities.

a -27Feb-22 20
 Spirometry - Measurement
• Vital capacity is measured by spirometry. The subject is asked to take a deep inspiration and
expire forcefully.
• Forced Vital Capacity : Forced vital capacity (FVC) is the volume of air that can be exhaled
forcefully and rapidly after a maximal or deep inspiration. It is a dynamic lung capacity.
• Normally FVC is equal to VC. However in some pulmonary diseases, FVC is decreased.

Forced Expiratory Volume Or Timed Vital Capacity

Definition
Forced expiratory volume (FEV) is the volume of air, which can be expired forcefully in a given unit
of time (after a deep inspiration.)

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2
 Some Physical Laws Of Gases
Gas molecules are in a continuous random movement. They expand and occupy all the available
volume, and also hit the wall of the container, resulting in pressure.
Gases obey the following laws:
Temperature –
Pressure -
Volume

.1 Boyle's-law: «At a constant temperature,

the pressure of a given quantity of gas is
inversely proportional to its volume-"

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 Physical Laws Of Gases
2. Charles' Law: "At a constant pressure, the volume of a gas is directly proportional
to the absolute temperature."
3. Dalton's Law: " In a mixture of gases, each gas exerts a pressure according to its
own concentration". This is called its partial pressure, and the total pressure of the
mixture equals the sum of the partial pressures of all gases present in this mixture.
4. Henry's Law: "The volume of a certain gas that is dissolved in a liquid is directly
proportional to the partial pressure of this gas."

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 The partial pressure of gases (P)
The (P) of a certain gas is the pressure exerted by this gas when present in a gas mixture,
and it equals : The percentage of this gas in the mixture x Total pressure Of the gas mixture

• For example, the barometric pressure at the sea level is 760 mmHg and the composition of
dry air is as follows : (20.98 %) 02, (0.04 %) C02, (78.06 %) N2 and (0.92%) inert gases (argon,
helium, neon, xenon and krypton.)
• Accordingly, the (P) of these gases in dry air is as follows:
PO2 = (20.98 /100) x 760 = 160 mmHg.
PCo2 = (0.04 / 100) x 760 = 0.3 mmHg.
PN2 and inert gases = (78.98 / 100 ) X 760 = 600 mmHg.

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 The partial pressure of gases (P)
The presence of water vapor decreases the percentages of other gases, and since it also exerts a
(P) of 47 mmHg at the body temperature, it also decreases the (P) of other gases

e.g. in the inspired air, which is saturated with

water vapor, the O2 % is only 19.6%
(compared with 20.98 % in the dry air), and
its (P) is only 149 mmHg (compared with 160
mmHg in the dry air.)

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 Gas Diffusion Through Membranes
Gases diffuse from regions of high partial pressures to regions of lower partial pressures, and
their rate of diffusion through membranes depends on the following factors:

1. The pressure gradient: The greater the difference between the gas pressures at the 2 sides of
the membrane, the more will be the rate of gas diffusion.

2. The molecular weight of the gases : The rate of gas diffusion is inversely proportional to the
square root of the molecular weight of the gas.

3. The solubility of the gas : The rate of gas diffusion is directly proportional to the solubility of
the gas in the fluid medium, in the membrane.

4. The nature of the membrane: The rate of gas diffusion is directly proportional to the surface
area of the membrane and inversely proportional to its thickness. In conditions like fibrosis
and edema, the diffusion rate is reduced, because the thickness of respiratory membrane is
increased.
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 Diffusion Coefficient And Fick Law Of Diffusion
• Relation between Diffusing Capacity and Factors Affecting it
is expressed by the following formula:

 Diffusion Coefficient
Diffusion coefficient is defined as a constant (a factor of proportionality), which is the
measure of a substance diffusing through the concentration gradient.
It is also known as diffusion constant. It is related to size and shape of the molecules of
the substance.

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 Diffusion Coefficient And Fick Law Of Diffusion
 Fick Law of Diffusion
Diffusion is well described by Fick law of diffusion. According to this law, amount of a
substance crossing a given area is directly proportional to (the area available for
diffusion, concentration gradient and a constant) known as diffusion coefficient.

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 Functional Units of Gas Exchange
 Third generations of respiratory bronchioles
 Three generations of alveolar ducts
 20-15clusters— sacs → alveoli

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 Gas Exchange In The Lungs
 O2 is essential for the cells. CO2, which is produced as waste product in the cells must be
expelled from the cells and body.
 Lungs serve to exchange these two gases with blood.

 This occurs by simple diffusion, and is affected by the factors explained in F'ick's law.

 The alveolo - capillary membrane favors O2 and CO2 exchange because

1. Its surface area is large.
2. It is very thin.
3. It is freely permeable to these gases (these gases are fat-soluble.)

so they dissolve easily in the membrane cells, which facilitates their transport.)

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 O2 continuously diffuses in the alveoli into the bloodstream, and CO2 continuously diffuses
into the alveoli from the blood.

 In the steady state, inspired air mixes with the

alveolar gas, replacing the O2 that has entered the
blood and diluting the CO2 that has entered the
alveoli. Part of this mixture is expired.

 The O2 content of the alveolar gas then falls and its

CO2 content rises until the next inspiration.

 Likewise, CO2 is produced and taken with water from

the capillaries into the alveoli and then exhaled.

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 Respiratory membrane
 Respiratory membrane is a membranous structure through
which exchange of respiratory gases takes place.

 Diffusion of gases (O2 and CO2) across alveolar membrane made up of

 The pulmonary epithelium of respiratory unit
 The capillary endothelium of pulmonary capillary
 and their fused basement membranes)

The walls of the alveoli as well as the capillary are very thin so
that the gases diffuse readily.

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 Average diameter of pulmonary capillary is only 8 μ, which means that the RBCs with a diameter
of 7.4 μ actually squeeze through the capillaries.

 Therefore, the membrane of RBCs is in

close contact with capillary wall.
 This facilitates quick exchange of O2 and
CO2 between the blood and alveoli.

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 Exchange Of Respiratory Gases At Alveoli Level
Diffusion of Oxygen from Alveoli into Blood
 When blood passes through pulmonary capillary, RBC is
exposed to O2 only for 0.75 second at rest and only for
0.25 second during severe exercise. So, diffusion of O2
must be quicker and effective.
 Fortunately, this is possible because of pressure gradient.
 Partial pressure of O2 in the pulmonary capillary is 40
mm Hg and in the alveoli, it is 104 mm Hg. Pressure
gradient is 64 mm Hg.
 It facilitates the diffusion of oxygen from alveoli into the
blood.
Diffusion of oxygen from alveolus
15 0 3/03/2 02 2
to pulmonary cap illa ry
Diffusion of Carbon Dioxide from Blood into Alveoli
 Partial pressure of CO2 in alveoli is 40 mm Hg whereas in the blood it is 46 mm Hg.
 Pressure gradient of 6 mm Hg is responsible for the diffusion of carbon dioxide from blood
into the alveoli.

Diffusion of CO2 from Alveoli into atmospheric Air

 In atmospheric air, partial pressure of CO2 is very
insignificant and is only about 0.3 mm Hg whereas, in the
alveoli, it is 40 mm Hg.
 So, CO2 enters passes to atmosphere from alveoli easily.

Diffusion of carbon dioxide from

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pulmonary capillary 0t3o/03a/2l0v22eolus
 Exchange Of Respiratory Gases At Tissue Level
Diffusion Of Oxygen From Blood Into The Tissues
 Partial pressure of O2 in venous end of pulmonary
capillary is 104 mm Hg.

 However, partial pressure of oxygen in the arterial end of

systemic capillary is only 95 mm Hg.
 It may be because of physiological shunt in lungs. Due to
venous admixture in the shunt, 2% of blood reaches the
heart without being oxygenated.
Diffusion of oxygen from
capillary to tissue

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 Average O2 tension in the tissues is 40 mm Hg.
 It is because of continuous metabolic activity and constant
utilization of O. 2

 Thus, a pressure gradient of about 55 mm Hg exists

between capillary blood and the tissues so that oxygen can
easily diffuse into the tissues

Diffusion of oxygen from capillary

to tissue

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Partial pressure and content of oxygen and carbon dioxide in blood, alveoli and tissues
Diffusion Of Carbon Dioxide From Tissues Into The
Blood
 Due to continuous metabolic activity, CO2 is produced
constantly in the cells of tissues.
 So, the partial pressure of CO2 is high in the cells and is
about 46 mm Hg.

• Partial pressure of CO2 in arterial blood is 40 mm Hg.

• Pressure gradient of 6 mm Hg is responsible for the
diffusion of CO2 from tissues to the blood.
Diffusion of carbon dioxide
from tissue to capillary

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• CO2 passes through all biological membranes with
ease, and the diffusing capacity of the lung for CO2
is much greater than the capacity for O.2

• It is for this reason that CO2 retention is rarely a

problem in patients with alveolar fibrosis even
when the reduction in diffusing capacity for O2 is
severe.

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