M.

Lung/PHYO2202/RespPract/14-15

LUNG FUNCTION TESTS

I. Measurement of Lung Volumes and Vital Capacity

This session is concerned with measurements of tidal volume, inspiratory reserve
volume, expiratory reserve volume and vital capacity of the respiratory system. You are
advised to do three times each measurement and record only the highest value for your
information. Remember to bring a calculator to do all calculations in class.

Experiment
The subject sits upright on a stool. With the mouthpiece in place and the nose
clipped, the subject breathes quietly as usual into a flow head which is connected to the
Spirometer Pod of the PowerLab and computer system. After a period of about 10
seconds, while the nose-clip and mouthpiece are still in place, inspire to maximum and
then exhale to maximum. The vital capacity is the maximum amount
of air that can be exchanged between the
lungs and atmosphere in a single breath, and
Calculations is the volume of air that can be forcibly
Tidal volume expired from the lungs following a maximal
L.
Expiratory reserve volume L.expiration. The vital capacity is the sum of
the three primary volumes that can be
Inspiratory reserve volume L.
directly exchanged with the atmosphere (VC
Vital Capacity L. = IRV + TV + ERV).
Tidal volume increases with activity to accommodate increased need for gas exchange.
Questions IRV & ERV decrease with exercise.
1. Under what conditions will there be changes in tidal volume, inspiratory volume
and expiratory reserve volume?
2. What is the lung volume that cannot be measured in this practical? How could its
measurement be made?
the residual volume and the TLC, by nitrogen washout method
3. What percentage of vital capacity is normally used as tidal volume? Under what
10%
conditions will there be a decrease or an increase in vital capacity?
Vital capacity is determined by power of respiratory muscles, elastic
properties of the chest wall and lung parenchyma, size and patency of
airways at low lung volumes, sex and body size
II. Timed Vital Capacity (Forced Expiratory Volume)
Although vital capacity is chiefly the measurement of the lung size, it can be made
to measure the dynamics if the vital capacity measurement is timed. That is, to measure
how much of the total vital capacity can be achieved in the first, second, or third second.
High resistance in the respiratory system and lack of elastic force will make the patient
achieve a lesser portion of the total vital capacity, whereas in normal subject in the first
second, 80% of the total vital capacity is reached.
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 Asthma is defined as a reversible obstructive defect. Therefore, a patient with an
FEV1/FVC ratio < 80% can be given a bronchodilator (i.e. albuterol) and the
spirometry can be repeated. If the FEV1 increases by more than 12%, it is indicativeM.Lung/PHYO2202/RespPract/14-15
of reversible airway disease. If the FEV1 does not increase by more than 12%, it is
considered nonreversible or fixed airway disease(i.e. COPD). Because asthma is a
reversible obstructive defect, the spirometry may be normal at the time of
Experiment evaluation.
From a maximal inspiration, the subject (with nose clipped) expires as deeply and
as fast as possible for at least 3 seconds into flow head which is connected to the
Spirometer Pod of the PowerLab and computer system.
In obstructive lung disease, e.g. emphysema, the FEV1 is reduced
Calculations due to an obstruction of air escaping from the lungs. Thus, the
1. FVC (forced vital capacity) FEV1/FVC ratio will be reduced
2. FEV1.0 (volume of gas expired in the first second)
3. FEV1.0/FVC. In restrictive lung disease, e.g. pulmonary fibrosis, the FEV1 and
FVC are equally reduced due to fibrosis or other lung pathology (not
obstructive pathology). Thus, the FEV1/FVC ratio should be
Question
approximately normal, or even increased due to an increased FEV1
How would FEV1.0/FVC be changed in emphysema, asthma and pulmonary fibrosis?
value (because of the decreased compliance associated with the
presence of fibrosis in some pathological conditions)
III. Maximal Expiratory Pressure
The forces employed for ventilation are difficult to ascertain. However, the
pressure generated during maximal expiratory phase can be measured easily and can be
used as an index of the muscle force available for ventilation. The earliest abnormality
resulting from respiratory muscle weakness is reduction in either the maximal
inspiratory or the maximal expiratory pressure.

Experiment
At the peak of a maximal inspiration, insert a mouth-piece and expire with
maximal effort into the aneroid manometer. Hold it for a moment and read the dial.
Record the maximal expiratory pressure. Repeat the experiment at functional residual
volume (end-expiratory position).

Question
What is the relationship between lung volume and maximal expiratory pressure?

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LUNG FUNCTION TESTS

On Elastic Property of the Lungs

Lung Compliance

Static Lung Volumes & Capacities

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 Compliance (distensibility)

= change in volume
change in distending pressure

= slope of the volume/pressure curve

Compliance = 1
elasticity

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 Measurement of lung volumes & capacities

4 lung volumes 4 lung capacities

IRV (inspiratory reserve volume) TLC (total lung capacity)
TV (tidal volume) VC (vital capacity)
ERV (expiratory reserve volume) IC (inspiratory capacity)
RV (residual volume) FRC (functional residual capacity)

From: Clinical Cardiovascular & Pulmonary Physiology, ed. C. Rosendorff, Raven Press 3
 Fowler's method
Measurements of Functional Residual Capacity (anatomical dead space)

Air

Prewashed
with O2
measure all lung vol. and capacity by measuring the amount of N2

O2 40 L

From The Lung Clinical Physiology & Pulmonary Function Tests , 4

ed. Comroe et al, Year Book Medical Publishers
On Airway Function

Airway Resistance

Peak Flow

Forced Expiration

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 Airway Resistance (Raw)

= Trans-airway pressure / airflow

= (PA - PB) / V (cm H2O.sec/L)
where PA, alveolar pressure
PB, barometric pressure
V, instantaneous airflow

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 Measurement of Peak Flow
Obstructive lung disease e.g. asthma

1. Inspire maximally
2. Expire fully & rapidly
through the peak flow
meter
3. Maximal expiratory
peak flow ~ 400 L/min
4. Maximal inspiratory
peak flow ~ 300 L/min

From: Clinical Cardiovascular & Pulmonary Physiology, ed. C. Rosendorff, Raven Press
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 Airflow Obstruction: Both asthma and COPD are
characterised by airflow obstruction. Airflow obstruction
is defined as a reduced FEV1 and a reduced FEV1/FVC
A Forced Expiration
ratio, such that FEV1 is less than 80% of that predicted,
and FEV1/FVC is less than 0.7.

MIP FEV1.0 FVC

In restrictive lung diseases (such as
pulmonary fibrosis), the vital capacity is
reduced to below normal levels.
However, the rate at which the vital
capacity is forcefully exhaled is normal.
In obstructive lung disease (such as
asthma, emphysema, bronchitis) the vital
capacity is normal because lung tissue is
not damaged and its compliance is
unchanged. In asthma the small airways
(bronchioles) constrict,
bronchoconstriction increases the
resistance to airflow. Although the vital
capacity is normal, the increased airway normal
resistance makes expiration more MEP
difficult and takes longer time.
Obstructive disorders are therefore
diagnosed by tests that measure the rate sec
of forced expiration, such as the FEV1
and FEF25-75. A significant decrease in
these values suggests an obstructive lung
disease. FEV1.0 = 4 L; FVC = 5 L
FEV1.0 / FVC = 80 % (normal)
FEV1.0 / FVC indicates airway obstruction
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Assessment of Respiratory Muscle Performance
respiratory muscle strength

Maximal Inspiratory Pressure (PImax Test)

The maximal mouth (intrathoracic) pressure when a subject
attempts to inspire as forcefully as possible against an
occluded airway while at residual volume

Maximal Expiratory Pressure (PEmax Test)

The maximal mouth (intrathoracic) pressure when a subject
attempts to expire as forcefully as possible against an
occluded airway while at total lung capacity

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Learning objectives:

You should now be able to:

1. understand the tests commonly used to assess

the elastic and resistive properties of the
respiratory system and the performance of the
respiratory muscles.

2. understand the value of measurement of static

lung volumes and capacities in assessing lung
function.

3. understand the value of forced expiration in

assessing lung function.
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