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TEST
Lung Volumes and Capacities
11) ABG.
CATEGORIZATION OF PFT
1) MECHANICAL VENTILATORY FUNCTIONS OF
LUNG / CHEST WALL:
A) STATIC LUNG VOLUMES & CAPACITIES – VC, IC, IRV,
ERV, RV, FRC.
B) DYNAMIC LUNG VOLUMES –FVC, FEV1, FEF 25-75%,
PEFR, MVV, RESP. MUSCLE STRENGTH
C) VENTILATION TESTS – TV, MV, RR.
CATEGORIZATION OF PFT
2) GAS- EXCHANGE TESTS:
A) Alveolar-arterial po2 gradient
B) Diffusion capacity
C) Gas distribution tests- single breath
N2 test.
- Multiple Breath N2 test
- Helium dilution method.
- Radio Xe scinitigram.
D) ventilation – perfusion tests
A) ABG
B) single breath CO2 elimination test
C) Shunt equation
CATEGORIZATION OF PFT
3) CARDIOPULMONARY INTERACTION:
A) Qualitative tests:
- History , examination
- Abg
- Stair climbing test
B) Quantitative tests
- 6 min. Walk test (gold standard)
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STATIC LUNG VOLUMES AND
CAPACITIES
• SPIROMETRY : CORNERSTONE OF ALL
PFTs.
• John hutchinson – invented spirometer.
• “Spirometry is a medical test that
measures the volume of air an individual
inhales or exhales as a function of time.”
• Measures VC, FVC, FEV1, PEFR.
• CAN’T MEASURE – FRC, RV, TLC.
PREREQUISITIES
• Prior explanation to the patient
• Not to smoke /inhale bronchodilators 6 hrs
prior or oral bronchodilators 12hrs prior.
• Remove any tight clothings/ waist belt/
dentures
• Pt. Seated comfortably
If obese, child < 12 yrs- standing
PREREQUISITES
• Nose clip to close nostrils.
• Exp. Effort shld last ≥ 4 secs.
• Should not be interfered by coughing, glottic
closure, mechanical obstruction.
• 3 acceptable tracings taken & largest value is
used.
SPIROMETER
• Double walled cylinder with water to maintain
water tight seal
• Inverted bell attached to pulley which carries
a counterweight and pen – moves up and
down as volume of bell changes
• BREATHING ASSEMBLY i.E. Unidirectional
breathing valves with mouth piece.
Flow-Volume Curves and Spirograms
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Spirometry Interpretation: So what
constitutes normal?
• Normal values vary and depend on:
– Height
– Age
– Gender
– Ethnicity
Acceptable and Unacceptable
Spirograms (from ATS, 1994)
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Measurements Obtained from the FVC
Curve
• FEV1---the volume exhaled during the first second of the FVC
maneuver
(Hyatt,
2003)
Spirometry Interpretation: Obstructive
vs. Restrictive Defect
• Obstructive Disorders • Restrictive Disorders
– FVC nl or↓ – FVC ↓
– FEV1 ↓ – FEV1 ↓
– FEF25-75% ↓ – FEF 25-75% nl to ↓
– FEV1/FVC ↓ – FEV1/FVC nl to ↑
– TLC nl or ↑ – TLC ↓
Spirometry Interpretation: What do the
numbers mean?
• FVC FEV1
• Interpretation of % Interpretation of % predicted:
predicted: – >75% Normal
– 80-120% Normal – 60%-75% Mild obstruction
– 70-79% Mild reduction – 50-59% Moderate obstruction
– 50%-69% Moderate reduction – <49% Severe obstruction
– <50% Severe reduction
Spirometry Interpretation: What do the
numbers mean?
• FEF 25-75% • FEV1/FVC
• Interpretation of % • Interpretation of
predicted: absolute value:
– >79% Normal – 80 or higher
– 60-79% Mild Normal
obstruction – 79 or lower
– 40-59% Moderate Abnormal
obstruction
– <40% Severe obstruction
What about lung volumes and obstructive
and restrictive disease?
MEASUREMENTS OF VOLUMES
• TLC, RV, FRC – MEASURED USING
Nitrogen washout method
Inert gas (helium) dilution method
Total body plethysmography
CONTINUED………..
1) HELIUM DILUTION METHOD:
Patient breathes in and out of a spirometer filled with 10%
helium and 90% o2, till conc. In spirometer and lung
becomes same (equilibirium).
As no helium is lost; (as it is insoluble in blood)
C1 X V1 = C2 ( V1 + V2)
V2 = V1 ( C1 – C2)
C2
V1= VOL. OF SPIROMETER
V2= FRC
C1= Conc.of He in the spirometer before equilibrium
C2 = Conc, of He in the spirometer after equilibrium
CONTINUED………
2) TOTAL BODY PLETHYSMOGRAPHY:
Subject sits in an air tight box. At the end of normal exhalation – shuttle of
mouthpiece closed and pt. is asked to make resp. efforts. As subject
inhales – expands gas volume in the lung so lung vol. increases and box
pressure rises and box vol. decreases.
BOYLE’S LAW:
PV = CONSTANT (at constant temp.)
For Box – p1v1 = p2 (v1- ∆v)
For Subject – p3 x v2 =p4 (v2 - ∆v)
P1- initial box pr. P2- final box pr.
V1- initial box vol. ∆ v- change in box vol.
P3- initial mouth pr., p4- final mouth pr.
V2- FRC
CONTINUED………
DIFFERENCE BETWEEN THE TWO METHODS:
• In healthy people there is very little difference.
• Gas dilution technique measures only the
communicating gas volume.
• Thus,
• Gas trapped behind closed airways
• Gas in pneumothorax
• => are not measured by gas dilution technique,
but measured by body plethysmograph
CONTINUED………
3) N2 WASH OUT METHOD:
• Following a maximal expiration (RV) or normal
expiration (FRC), Pt. inspires 100% O2 and
then expires it into spirometer ( free of N2) →
over next few minutes (usually 6-7 min.), till
all the N2 is washed out of the lungs. N2
conc. of spirometer is calculated followed by
total vol.of AIR exhaled. As air has 80% N2 →
so actual FRC/RV is calculated.
MEASUREMENT OF DYNAMIC LUNG
VOLUMES FEF25–75% = forced
expiratory flow during
• TIMED EXPIRED SPIROGRAMS expiration of 25 to 75% of
the FVC; FEV1 = forced
expiratory volume in the
first second of forced vital
capacity maneuver; FVC =
forced vital capacity (the
maximum amount of air
forcibly expired after
maximum inspiration).
FORCED VITAL CAPACITY (FVC)
Max vol. Of air which can be expired out as forcefully and
rapidly as possible, following a maximal inspiration to
TLC.
Exhaled volume is recorded with respect to time.
Indirectly reflects flow resistance property of airways.
Normal healthy subjects have VC = FVC.
Prior instruction to patients, practice attempts as it
needs patient cooperation and effect.
Exhalation should take at least 4 sec and should not be
interrupted by cough, glottic closure or mechanical
obstruction.
FORCED VITAL CAPACITY IN 1 SEC.
(FEV1)
Forced expired vol. In 1 sec during fvc
maneuver.
Expressed as an absolute value or % of fvc.
N- FEV1 (1 SEC)- 75-85% OF FVC
FEV2 (2 SEC)- 94% OF FVC
FEV3 (3 SEC)- 97% OF FVC
CONTINUED……
CLINICAL RANGE (FEV1) PATIENT GROUP
• 3 - 4.5 L • NORMAL ADULT
• 1.5 – 2.5 L • MILD – MOD.OBSTRUCTION
• <1 L • HANDICAPPED
• 0.8 L • DISABILITY
• 0.5 L • SEVERE EMPHYSEMA
CONTINUED……
FEV1 – Decreased in both obstructive &
restrictive lung disorders.
FEV1/FVC – Reduced in obstructive disorders.
NORMAL VALUE IS 75 – 85 % (FEV1/FVC)
< 70% OF PREDICTED VALUE – MILD OBST.
< 60% OF PREDICTED VALUE – MODERATE OBST.
< 50% OF PREDICTED VALUE – SEVERE OBST.
CONTINUED……
DISEASE STATES FVC FEV1 FEV1/FVC
1) OBSTRUCTIVE NORMAL ↓ ↓
- It is the max. Flow rate during fvc maneuver in the initial 0.1
sec.
(Rudolph and
Rudolph, 2003)
How is a flow-volume loop helpful?
• Helpful in evaluation of air flow limitation on inspiration and
expiration