Respiratory part 1

Unit 3 objectives: to know, apply

and interpret:

• Pulmonary function symptoms

• Pulmonary function tests.
• Pulmonary diseases where laboratory
contributes to good patient care.
 NPLEx tests
• Spirometry
• Blood gas analyses
• Pulse oximetry
• Lactate
 How do you know you have a
lung disease? One or more of
• Cough
• Dyspnea – difficulty breathing
• Haemoptysis – spitting blood
• Sputum
• Cyanosis
• Sometimes chest pain
 Investigations if respiratory
disease seems likely:
• Spirometry
• Blood gases
• Lactate
• Pulse oximetry
• Other special tests for diagnosis
Pulmonary function: spirometry
1. Hold the spirometer and take a deep
breath in
2. Place the mouth piece in your mouth,
wrap your lips round it.
3. Breathe put as hard and fast as you can.
4. Repeat the measurement three times
and record the best value.
 Pulmonary function tests:
Spirometry = measurement of breathing capacity
of lungs.
Forced expiration time FET – time to empty the
lungs
Peak expiratory flow rate (PEFR) – depends on
age, height and gender
Forced expiration volume (FEV1) expressed as
% of non forced expiratory volume VC [vital
capacity]/second
 Spirometer traces
100
90

80
70
60
normal
50
obstruction
40 restriction

30

20
10
0
1 sec 2 sec 3 sec 4sec
 Spirometer traces
• Forced vital capacity (FVC)
• Forced expiration volume in one second (FEV1)

• Obstruction: FEV1/FVC reduced as in asthma.

• Restriction: FEV1/FVC unchanged as in
pulmonary fibrosis.
Spirometer
 Respiratory function
• Diurnal variation in bronchomotor tone –
greatest in early morning.
• In asthma this is exaggerated. Problems in
early morning.
 Arterial blood gases, north
america versus the rest
• pH or [H+] nmol/L,
• pH lethal levels: <6.8 or >7.65.
• pCO2 mm Hg or kPa. (kilo Pascals)
• Range 35-45 mm Hg. But could see 15 –
80 in diseases.
• pO2 mm Hg or kPa. 90-100, below 60
dangerous
 Acid base problems, the tests:
• Blood/serum/plasma electrolytes
• Blood pH (hydrogen ion concentration)
• Blood pCO2
• Blood bicarbonate – calculated.
• Blood pO2 (oxygen saturat’n, pulse
oximetry)
• Blood lactate
• Spirometry.
 Pulse oximetry
• Measures the red colour of
oxyhaemoglobin.
• Electrode clipped to ear lobe, finger tip or
toe.
 Acid-base:
Kidney/metabolic problem:
• Bicarbonate decreased then metabolic acidosis
• Bicarbonate increased then metabolic alkalosis.
Lung problem:
• pCO2 increased then respiratory acidosis
• pCO2 decreased then respiratory alkalosis.
But compensation happens!
 Respiratory acidosis

• Acute could be choking.

• Acute could be an asthma attack.

• Chronic = bronchopneumonia.
 Chronic
• There is usually maximal renal
compensation. pCO2 may be double
normal and pO2 be depressed.
• Chronic bronchitis COPD, usually “blue
bloaters”.
But could be emphysema SOB, “pink
puffers”.
COPD