PULMONARY FUNCTION
TESTING
AND
SPIROMETRY
INTRODUCTION
Spirometry is a physiological test that
measures how an individual inhales or
exhales volumes of air in a particular
time.
With spirometry PT can measure lung
function or pulmonary function
INTRODUCTION
It mainly includes different lung
volumes, flow rates and capacitates.
However, on its own, spirometry does
not give clinicians directly to an
etiological diagnosis.
The procedure is known as spiometry /
PFT
Results can
be
represented
as numerical
values of
graphical
presents ,
know as
spirogram
PURPOSE
1. Diagnostic
2. Monitoring
3. Disability evaluations & Public
health
DIAGNOSTIC PURPOSE
To evaluate signs or symptoms disease
To measure effect of disease on
pulmonary function
To screen individuals at risk of having
pulmonary disease
To assess pre-operative risk
To assess prognosis
MONITORING PURPOSE
To assess therapeutic intervention
To describe the course of diseases that
affect lung function
To monitor people exposed to injurious
agents
To monitor for adverse reactions to
drugs with known pulmonary toxicity
DISABILITY EVALUATIONS &
PUBLIC HEALTH
To assess pts as part of a rehab
program
Epidemiological surveys
Clinical research
For insurance eligibility
INDICATION
COPD
Restrictive disease e.g. interstitial lung
disease
Occupational lung disease
Neurological disease (to assess
involvement of lungs) e.g. SCI, TBI, MS,
GBS, Parkinson's disease
Musculoskeletal conditions such as
Scoliosis
CONTRAINDICATIONS
Recent abdominal, thoracic, or eye surgery
Symptoms of acute severe illness
Chest pain, nausea, vomiting, high fever,
dyspnea
Recent hemoptysis
Pneumothorax
Recent history of abdominal, thoracic, or
cerebral aneurysm
COMMON TERMINOLOGY
Tidal volume: VT /(TV):
Volume of air normally inhaled or
exhaled with each breath during quiet
breathing
Inspiretory reserve volume:
volume of air can be taken
additionally after normal tidal
inhalation
COMMON TERMINOLOGY
Expiratory reserve volume:
Volume of air can be let out
additionally after normal tidal
exhalation Additional
Residual volume: RV:
Volume of air remains in the lungs
after a forceful expiration
COMMON TERMINOLOGY
Inspiretory capacity: IC= TV + IRV
Max amount of air that can be
inhaled after normal tidal exhalation
Functional residual capacity: FRC=
ERV + RV
Amount of air remaining in the lungs
at the end of normal tidal exhalation
COMMON TERMINOLOGY
Vital capacity: VC= IRV + ERV
Max amount of air that can be exhaled
following a maximum inhalation
Total lung capacity:
TLC=sum of all lung volumes
Max volume to which lung can be
expanded
Forced vital capacity: FVC
max volume of gas th pt can inhale as
forcefully and quickly as possible
Lung Volumes andTV:
capacities
normal inhalation
& Exhalation
IRV: additional
inspiration
ERV: Additional
IRV exhalation
IC
RV: Reaming air after
VC
TV
TLC
forceful
exhalation
ERV
FRC
RV RV
IC = TV+IRV
FRC = ERV+RV
VC = IRV+ERV
TLC =
PROCEDURE
Pt position – upright sitting
Nose clip should be used
Mouth piece – tight fitting
Explain to the pt what test will
analyze and the importance of his
involvement for best results
Pt breath in and out in mouthpiece
according to PT instructions
PRIOR TO SPIROMETRY
Avoid Smoking / alcohol within 2-4 hour
of testing
Avoid vigorous exercise within 30 min
of testing.
Wearing appropriate clothes
Avoid eating a large meal within 2
hours of testing.
Short acting inhaled drugs within 6
hours of testing.
MEASUREMENT OF
VOLUMES & CAPACITIES
TIDAL VOLUME
Measure total amount of air moved
into lungs during either exhalation or
inhalation in a specific time usually 1
min
Normally 400 to 600 mL
Resultant value outside of normal
range indicates underlying disease
IRV & ERV
IRV: Component of IC
It Important to know resting lung
hyperinflation
ERV:
pt have to exhale max after few
breathes
Normal ERV: approx 1000 mL
Decreases in Restrictive Disease
VITAL CAPACITY - VT
Pt inhale as much deep as he can and
exhale fully taking time necessary to
exhale completely
Normal VC: 4000 to 5000 mL
It is 80% approx of TLC
May be normal in early disease process
INSPIRATORY CAPACITY - IC
Ask pt to normally exhale and than
inhale maximally
Normally between : 3000 to 4000 ml
RESIDUAL VOLUME - RV
It can not be measured by direct
spirometry
Can be calculate by formula:
RV= FRC – ERV
Can be measured by any 1 method of
3 helium dilution, nitrogen washout or
body plethysmography
MEASUREMENT OF
FLOW RATES
FVC
Max volume of gas the pt can exhale as
forcefully and quickly as possible
Breath in max and exhale as forcibly and as
quickly as possible
Pt’s force dependent measure
It is necessary to coach pt prior to
measurement
When the amount of air exhaled in 1st sec of
forced expiration (FVC) it is known as FORCED
EXPIRETORY VOLUME in 1 SEC (FEV1)
FVC
FEV1 and FVC reflexes airway in larger
airways
Normally 75% of FVC should be exhaled in 1 st
sec (FEV1)
Forced expiratory flow (FEF25-75)
Volume of air exhaled over middle half of FVC
RESULT OF PFT INDICATES
FEV1 > 2 L Little or no obstruction
FEV1 >1 L to <2 L Mild to moderate
obstruction
MAX VOLUNTARY
VENTILATION (MVV)
Max volume of gas a patient can
move during 1 min
Pt is asked breath as deeply and as
rapidly for 10 or 15 sec
Normally 160 to 180 L/Min
COMPLIANCE - CL
Volume change in lung per unit of
pressure change
A complex procedure using catheter
is required to measure lung
compliance
POST BRONCHODILATOR
TEST
After 5
Bronc to 20
Variou
hodila mins
s test
tors all
are
are tests
done
admini are
once
stered repeat
ed
POST BRONCHODILATOR
TEST
In normal person or person with
restrictive disease no change or very
little change in pre and post test data
In person with obstructive disease
noticeable changes in pre and post test
data
when changes are 15% or greater in at
least any 2 parameters out of FVC, FEV1,
FEF25-75 than the obstruction is
reversible
FLOW VOLUME LOOPS
FLOW VOLUME LOOPS - FVL
Loops represent
events occurred
during forced
inspiration and
expiration
Simply records
flow against
volume on an
graph
FLOW VOLUME LOOPS - FVL
Following a quiet breathing pt is
instructed to perform a max
inspiratory maneuver than to hold
the breath for 1-2 sec and then do
forceful expiration
FLOW VOLUME LOOPS - FVL
Initial portion of
PEFR
the expiatory
loop is effort
dependent ,
however after
1/3rd of
expiratory curve
the curve is
effort
independent
FLOW VOLUME LOOPS - FVL
Highest point
PEFR
indicates peak
expiratory flow
rate (PEFR)
Line connecting
PEFR and RV
are normally
straight
Disease alters
this effort
COMPARISON OF LOOPS
• Mild obstruction look
normal except slight
scooping at end of
expiration (Red line)
• As Disease progress PEFR
and scooping reduces
increases
INTERPRETATION OF PFT
Universally formatted to present data as
predicted , observed and % of predicted
values
Predicted values are derived from pt’s age
group, gender, ht, wt, race
Comparison of observed data with
predicted data gives a idea about
diagnosis
IMPORTANT POINT OF
INTERPRETATION
Determine whether the result are normal or
not
Results indicate Obs / Res
For Obs disease check reversibility
Consider H/O and examination of pt and
correlate with PFT to confirm diagnosis
DIFFERENCE B/T OBS. & RES DISEASE IN
PFT
Measurement Obstructive Restrictive
Tidal volume N or N or
Inspiretory N or N or
capacity
Expi. reserve N or N or
volume
Vital capacity N or
Forced vital N or
capacity
Residual volume N or N or
Total lung capacity N or
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