Respiratory Function Testing

Tests done to provide objective

measures of lung function
Clinical roles:
Detecting & quantifying pulmonary
impairment in cardiopulmonary disease
Following the evolution of disease and
monitoring response to treatment
Monitoring the effects of environmental,
occupational and drug exposure
associated with lung injury
Assessing preoperative risk
Assessing disability and impairment
Classification of tests:
Respiratory mechanics
Pulmonary gas exchange
Exercise
The movement of air into and out of
the lungs Spirometry
The test is using Spirometer
Gives the volume of air can be displaced
by the lungs
Doesnt give indication of the absolute
volume

Respiratory mechanics
Lung Volume
Methods
Inert gas solution
Subject breaths from closed circuit a gas mixture
containing an inert marker gas, usually helium
The helium equilibrates gradually with the gas in the
lungs, this occurs in 5 to 10 min normally FRC
After disconnection from the rebreathing circuit the
subject inspires fully IC
IC + FRC = TLC
Whole body plethysmography
subject sits within a large air-tight chamber and
makes gentle breathing efforts against a shutter,
which closes the airway at the mouth

Since the pressure within the rigid
plethysmograph changes as lung volume
changes, this allows calculation of thoracic
gas volume
total lung capacity and residual volume are
derived by full inspiration and expiration
immediately on opening the shutter
Interpretation:
increase in TLC occurs in most patients with
symptomatic diffuse airway obstruction and
asthma
large increase is characteristic of
emphysema



Forced expiration
simplicity of both the maneuver and equipment
required
relative independence of the measurements on the
effort applied by the patient, provided that its done
without excessive initial effort
The most commonly used index of mechanical
function of the lungs in hospital is the 1s forced
expiratory volume (FEV1)
Interpretation:
FVC <VC (N: FVC=VC)
Increase effort in airway obstruction patient (Decrease
FEV1)
Muscle function
perform forcible static inspiratory and expiratory
efforts against a closed airway
Indicated for patient with neuromuscular problem
Result may be confusing with COPD

Pulmonary Gas Exchange
CO uptake
Used widely as a simple test of the integrity of
the alveolar capillary membrane and of the
overall gas exchanging function of the lungs
Good sensitivity but poor specificity
Measure the effective surface area of alveoli
Sequence:
Subject takes a full inspiration of a gas mixture
containing a very low concentration of CO
Rate of uptake of gas is measured during breath
holding for 10s
Interpretation:
Decrease diffusing capacity of CO emphysema

Exercise Test
Allow observation of patients and their
performance at a time when symptoms are
present
Assessing breathlessness
Differentiate cardio and ventilation disease
Types of tests:
Simple self-paced tests of walking distance,
most commonly in 6 min, aim to mimic the real
life situation and are widely used for global
assessment of disability
Shuttle walk test. The subject increases his
walking speed each minute, giving results
which are more reproducible and closer to
laboratory-based tests of maximum
performance
Bicycle ergometer or Treadmill
Workload is increased by a constant amount,
with periods of 1 to 3 min at each level
Measurements include heart rate, ventilation,
and gas exchange (O2 and CO2) and oxygen
saturation by pulse oximetry
Subject exercises at increasing loads until no
longer able to continue because of discomfort, or
until stopped by the investigator
Interpretation:
Cardiovascular problem limit exercise by max.
HR
Pulmonary problem limit exercise by max.
ventilation achievable
Asthma patient - bronchodilation
Exercise induced bronchoconstriction