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DIS)
CONSULTANT PULMONOLOGIST
ASTHMA,ALLERGY RESPIRATORY CARE
G.K.N.M.HOSPITAL, COIMBATORE
Doctors make diagnoses,
not spirometers.
First, look at all the curves.
Two basic patterns of abnormality:
Normal
Low FEV1/FVC = Obstruction
A) FEV1
B) FVC
C) FEF 25-75%
D) FEV1/FVC
After looking at the curves,
look at the numbers.
% Predicted
FEV1
% Predicted
FVC
FEV1 / FVC
FEV1 / FVC%
Low Normal
FVC
FVC
Severity FEV1
Intermittent Normal
Moderate 60-80%
FEV1 post
BD
At risk smoker Normal
Mild 80%
Moderate 50-80%
Severe 30-50%
Very Severe 30%
Interpretation pitfalls
10
FEV1
=
3.3 L
Pattern ?
FVC 4.0 L
PEF
Exp. Flow(L.s1)
5
A) Normal
FEV1 B) Obstruction
0
0
TLC
2 4
C) Restriction
Volume (L)
5 D) Mixed
Insp. Flow(L.s1)
MIFV
A 55 year old female smoker with dyspnea climbing stairs
FEV1
=
2.4 L
Pattern ?
FVC 3.7 L
A) Normal
B) Obstruction
TLC RV C) Restriction
0 2 4
Volume (L) D) Mixed
A 66 year old man with a history of COPD admitted for
an exacerbation. How severe is his airway obstruction?
10 FEV1 0.8 L
=
FVC 2.2 L
A) Mild
5
B) Moderate
0 C) Severe
RV
D) Very severe
Volume (L)
5
A 50 year old female had admission for organophosphorus
poisoning and had prolonged ventilation. What is the most
likely cause of this flow-volume loop pattern?
FEV1 3.2 L
=
FVC 3.8 L
5
Exp. Flow(L.s1)
A) Asthma
B) COPD
TLC
0
0 2 4
C) Narrow trachea
Insp. Flow(L.s1)
Volume (L)
D) Pulmonary fibrosis
Types of Upper Airway Obstruction (UAO)
A) Fixed intrathoracic
FEV1
TLC RV
B) Variable intrathoracic
0
0 2 4
C) Fixed extrathoracic
D) Variable extrathoracic
FEV1
=
2.7 L
3.4 L
A) Vocal cord paralysis
FVC
5
B) Tracheal stenosis
FEV1
C) A large goiter
TLC RV D) Cancer at the carina
0
0 2 4
A) Parkinsons
B) Vocalization
C) Coughing
D) Sleep apnea
0 3
Ms.
Anisha
Mr. DMello
Spirometric Diagnosis:
52%
Mike Mello
35
Airway obstruction commonly causes
hyperinflation, lowering the FVC.
Over
9 Distention
8 Small
Hyper
Airway Inflation
7 Closure
LC
6 T
liters
5
4 FRC
3
2 RV
1
37
Mr. Roy:
Case Study 3:
Mr. Roy
Acceptable?
Pattern ?
A) Severe obstruction
B) Severe restriction
C) Mixed abnormality
D) Poor effort
Rob Roy
Mr. Roy
Mr. Roy:
FVC range as %
of predicted Severity grade
values
60 80 Mild
45 60 Moderate
< 45 Severe
Suniel Sakahram
Case Study 4: Mr.
Sakharam
Blue = post BD
Pattern ?
Spirometric Diagnosis:
POORLY CONTROLLED
ASTHMA CAN LEAD
TO FIXED AIRWAY
OBSTRUCTION
LEADING TO
DIFFICULT TO TREAT
ASTHMA!
Poorly Controlled Asthma
haemoptysis since
FVC(L) 4 3 3 2.5
6 months.
FVC% 75 75
O/E--- grade 3
clubbing and signs FEV1(L 3 2.5 2.5 2
of right upper lobe )
obstructive FEV1/FV 75 75
collapse. C
75%
LOW
50%
MODERA
TE
25%
HIG
H
25 50 75% FVC
Summary