PULMONARY FUNCTION TESTS (PFT)

Anatomy

Lungs comprised of

Airways Alveoli

http://www.aduk.org.uk/gfx/lungs.jpg

The Airways

Conducting zone: no gas exchange occurs Anatomic dead space Respiratory zone: contain the alveolar sacs

The Alveoli

Approximately 300 million alveoli 1/3 mm diameter Total surface area if they were complete spheres 85 sq. meters (size of a tennis court)

Mechanics of Breathing

Inspiration

Active process

Expiration
Quiet breathing: passive Can become active

Pulmonary Function Tests

Evaluates 1 or more major aspects of the respiratory system

Assessment and diagnosis of pulmonary disease Evaluate extent and monitor course of disease Aid in determining of the necessary course of treatment Lung volume and air flow rate

Respiratory Function Test

Static lung functions volumes Dynamic lung functions volume and velocity

Spirometry

Measurement of the pattern of air movement into and out of the lungs during controlled ventilatory maneuvers.

Factors That Affect Lung Volumes

Age Sex Height Weight Race Disease

Static lung functions

Lung Volumes

IRV TV ERV IC VC TLC

4 Volumes 4 Capacities

Sum of 2 or more lung volumes

FRC
RV RV

Tidal Volume (TV)

IRV TV ERV

IC VC TLC

Volume of air inspired and expired during normal quiet breathing (0.5L)

FRC
RV RV

Inspiratory Reserve Volume (IRV)

IRV TV ERV

IC VC TLC

FRC
RV RV

The maximum amount of air that can be inhaled after a normal tidal volume inspiration (2.5-3.5 L)

Expiratory Reserve Volume (ERV)

IRV TV ERV

IC VC TLC

FRC
RV

Maximum amount of air that can be exhaled from the resting expiratory level 1.0 L

RV

Residual Volume (RV)

IRV TV ERV

IC VC TLC

Volume of air remaining in the lungs at the end of maximum expiration

FRC
RV RV

Vital Capacity (VC)

IRV TV ERV

IC VC TLC

Volume of air that can be exhaled from the lungs after a maximum inspiration VC = IRV + TV + ERV

FRC
RV RV

Inspiratory Capacity (IC)

IRV TV ERV

IC VC TLC

The amount of air that the lung will hold after normal expiration IC = IRV + TV

FRC
RV RV

Functional Residual Capacity (FRC)

IRV TV ERV

IC VC TLC

Volume of air remaining in the lungs at the end of a TV expiration FRC = ERV + RV

FRC
RV RV

Total Lung Capacity (TLC)

IRV TV ERV

IC VC TLC

Volume of air in the lungs after a maximum inspiration TLC = IRV + TV + ERV + RV

FRC
RV RV

Dynamic Functions

Dynamic Functions
SVC (slow vital capacity) Lung volume measured from complete expiration following deep inspiration

Dynamic Functions
M V V (maximum voluntary ventilation) Maximum volume of air which can be moved on expiration while breathing as deeply and as rapidly as possible.

Dynamic Functions
MV (minute ventilation) Volume of expired air in liters per minute measured over a minimum of one minute.

Dynamic Functions

Forced vital capacity (FVC):

Total volume of air that can be exhaled forcefully (quickest exhalation) after maximum inhalation ( from TLC) The majority of FVC can be exhaled in <3 seconds in normal people, but often is much more prolonged in obstructive diseases

Terminology

Forced expiratory volume in 1 second: (FEV1)

Volume of air forcefully expired from full inflation (TLC) in the first second Measured in liters (L) Normal people can exhale more than 75-80% of their FVC in the first second; thus the FEV1/FVC can be utilized to characterize lung disease

FVC

Interpretation of % predicted:

80-120% 70-79% 50%-69% <50%

Normal Mild reduction Moderate reduction Severe reduction

FVC

FEV1

Interpretation of % predicted:

75%-80% 69% or lower 88-90% or higher

Normal obstruction restrictive

FEV1

FVC

In patients with obstructive diseases, the lung's air volume will be more slowly expelled and will be a smaller volume over the time course of the FVC test than would be expected in a normal, healthy individual. In patients with restrictive lung disease, the FVC will be smaller because the amount of air that can be forcefully inhaled or exhaled from the lungs is smaller to start with because of disease. This may be due to the fact that thoracic cage does not have the ability to expand very much.

Technique
Have patient seated comfortably Closed-circuit technique

Place nose clip on Have patient breathe on mouthpiece Have patient take a deep breath as fast as possible Blow out as hard as they can until you tell them to stop