clinical application of pulmonary function tests
DESCRIPTION
Clinical Application of Pulmonary Function Tests. Sevda Özdoğan MD, Prof. Chest Diseases. Pulmonary Function Tests. Spirometry (SVC) Flow Volume Curve MVV Diffusion test Reversibility and Provocation tests Exercise tests 6 minutes walking test Cardiopulmonary exercise tests. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/1.jpg)
Clinical Application of Pulmonary Function Tests
Sevda Özdoğan MD, Prof.Chest Diseases
![Page 2: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/2.jpg)
Pulmonary Function Tests
• Spirometry (SVC)• Flow Volume Curve• MVV• Diffusion test• Reversibility and Provocation tests• Exercise tests
– 6 minutes walking test– Cardiopulmonary exercise tests
A physiological test that measures how an individual inhales or exales volumes of air as a function of time
a) Volumeb) Flow
![Page 3: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/3.jpg)
![Page 4: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/4.jpg)
İndications for PFT
• Diagnostic– To evaluate dispnea!! – To assess the etiology of dyspnea
(cardiac/pulmonary)– To measure the effect of the disease on
pulmonary function– To assess any airway obstruction, the
severity of the obstruction and response to bronchodilators
– To assess prognosis
![Page 5: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/5.jpg)
– To assess preoperative risk– To assess etiology of chronic cough– To assess respiratory muscle strenght– To measure gas diffusion– To monitor for adverse reactions to
drugs with known pulmonary toxicity– Disability/impairment evaluations– Epidemiological or clinical survey
![Page 6: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/6.jpg)
![Page 7: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/7.jpg)
Definitions
• Static Lung Volumes:– Tidal Volume (TV): The volume of gas inhaled
and exhaled during a respiratory cycle (resting)– Expiratory Reserve Volume (ERV): Maximum
volume of gas that can be exhaled from the end expiratory level during tidal breathing
– Inspiratory Reserve Volume (IRV): Maximum volume of gas that can be inhaled from the end inspiratory level during tidal breathing
– Total Lung Capacity (TLC): The volume of gas in lungs after maximal inspiration (Sum of all compartments)
![Page 8: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/8.jpg)
– Vital capacity (VC): Maximal volume of air exhaled from a position of full inspiration
– Residuel Volume (RV): The volume of gas remains in the lung after maximal exhalation
– Functional Residuel Capacity (FRC): The volume of gas present in the lung at end expiration during tidal breathing
![Page 9: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/9.jpg)
• Static lung volumes can be measured by:– Spirometry (SVC maneuver)– Body pletismography
PxV=k– Washout Techniques
• Nitrogen Washout:Based on washing out the N2 from the lungs when the patient breathes 100% O2
– Multipl breath Body pletismography
![Page 10: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/10.jpg)
•Helium dilution:
Based on the equlib-ration of gas in thelung with a knownVolume of gas containing helium
![Page 11: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/11.jpg)
Slow vital capacity
• After 2-3 normal breathing (TV) • Make a slow maksimum inspiration
(TLC)• Then make a slow maksimum
expiration (VC)
![Page 12: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/12.jpg)
• Static Lung volumes are decreased in – Restrictive lung diseases– Atelectasis– Lobectomy, pneumonectomy– Chest wall deformities– Diaphragmatic paralysis– Neurologic pathologies– Hiatus hernia(Normal values are calculated according to the
patients age, height, weight)
![Page 13: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/13.jpg)
• Dynamic Lung Volumes (Flow volume Curve)– Forced Vital Capacity (FVC): is the
maximal volume of air exhaled with maximaly forced effort from a maximal inspiration.
– Forced Expiratory Volume 1 (FEV1): the maximal volume of air exhaled in the first second of forced expiration from a position of full inspiration
![Page 14: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/14.jpg)
![Page 15: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/15.jpg)
![Page 16: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/16.jpg)
• Peak expiratory flow (PEF): The maximum flow rate reached during a forced expiration
• FEF 25-75%: Average expiratory flow over the middle half of FVC (MMEF)
Decreases in small airway obstructions
![Page 17: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/17.jpg)
• Maximum Voluntary Ventilation (MVV): A dynamic test in which the patient breaths rapidly and deeply for 10-15 seconds. The total volume (inhaled and exhaled) is calculated and expressed as L/min)
Decreases in obstructive and restrictive diseases as well as neuromuscular diseases
![Page 18: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/18.jpg)
• Dynamic lung volumes and flow rates are decreased in:– Obstructive lung diseases (COPD,
Asthma)
![Page 19: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/19.jpg)
• İnpiratory parameters are also important especially in upper airway pathologies– MIF; IC; FIV1
![Page 20: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/20.jpg)
![Page 21: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/21.jpg)
FEV1 FVC FEV1/FVC
FEF25-75
Obstructive
N or
Restrictive
N or N N
![Page 22: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/22.jpg)
![Page 23: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/23.jpg)
Yes No
Yes No Yes No
Further examinatio
n
Reversibility?
Asthma COPD
Yes No
![Page 24: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/24.jpg)
Staging in pulmonary function abnormalities
% FVC FEV 1 FEV1/FVC
DLCO
Normal
>80 80 75 80
Mild =79-60
79-60 74-60 79-60
Medium
=59-51
59-51 59-41 59-41
Severe <50 40 40 40
![Page 25: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/25.jpg)
Reversibility
• Assessment of postbronchodilator response in obstructive pathologies
• Spirometry is repeated 15-20 minutes after the administration of an inhaled short acting bronchodilator. An 12-15% increase in FEV1 or an absolute value of 200 ml increase represents a significant positive reversibility test.
![Page 26: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/26.jpg)
![Page 27: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/27.jpg)
Bronchoprovocation test (Challenge)
• Performed in patients who have suspected reactive airway disease with normal spirometry.
• Can be performed by – Methacoline– Histamine– Cold air inhalation?– Exercise
Most frequently
![Page 28: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/28.jpg)
• Methacoline responsiveness:• Starting with a single inhalation at a
very low concentration, patients are tested each time after progresively increasing inhaled doses until– Either a predetermined maximum dose
(16 mg/ml) has been achieved– Or FEV1 has been observed to fall by
20%
![Page 29: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/29.jpg)
![Page 30: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/30.jpg)
CO Diffusion test
• The capacity of the lung to exchange gas across the alveolocapillary interface is determined by DLCO
• This process is a passive diffusion and is a function of– Pressure difference– Surface area – Resistive properties of the membrane
• CO gas is used as the test gas because of its high affinity to hb
![Page 31: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/31.jpg)
Single breath method
![Page 32: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/32.jpg)
![Page 33: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/33.jpg)
Staging in pulmonary function abnormalities
% FVC FEV 1 FEV1/FVC
DLCO
Normal
>80 80 75 80
Mild =79-60
79-60 74-60 79-60
Medium
=59-51
59-51 59-41 59-41
Severe <50 40 40 40
![Page 34: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/34.jpg)
Cardiopulmonary Exercise Testing
• To assess a patients exercise capacity objectively
• To observe the response of the components of oxygen delivery system to this stress
• To determine the factors that limit exercise capacity or cause exertional dyspnea
![Page 35: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/35.jpg)
• Performed on – Treadmill with increasing speeds and
slope– Bicycle pedaled at a constant rate with
a variable resistance• Load is increased in a continious
ramp or at intervals• ECG, Pulse oxymeter, respiratory
rate, Vt, minute ventilation and blood gases are monitored
![Page 36: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/36.jpg)
Parameters measured
• Oxygen consumption (VO2max)• Heart rate• Oxygen pulse• Blood pressure• Ventilation (VEmax)• Anaerobic treshold• Arterial blood gases
![Page 37: Clinical Application of Pulmonary Function Tests](https://reader036.vdocument.in/reader036/viewer/2022062305/56814932550346895db6768f/html5/thumbnails/37.jpg)