Académique Documents
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From Netter
Atlas of
Human
Anatomy,
1989
What exactly are PFTs?
The term encompasses a wide variety of objective
methods to assess lung function. (Remember that the
primary function is gas exchange).
Examples include:
Spirometry
Lung volumes by helium dilution or body plethysmography
Blood gases
Exercise tests
Diffusing capacity
Bronchial challenge testing
Pulse oximetry
Why do I care about PFTs?
Add to diagnosis of disease (pulmonary
and cardiac)
May help guide management of a disease
process
Can help monitor progression of disease
and effectiveness of treatment
Aid in pre-operative assessment of certain
patients
Yes, PFTs are really wonderful
but
They do not act alone.
They act only to support or exclude a
diagnosis.
A combination of a thorough history and
physical exam, as well as supporting
laboratory data and imaging will help
establish a diagnosis.
Where would I perform PFTs?
At home--peak expiratory flow meter/pulse
ox
Doctors office
Formal PFT laboratory
When would I order PFTs?
INDICATIONS FOR SPIROMETRY Monitoring
Diagnostic To assess therapeutic interventions
To evaluate symptoms, signs, or abnormal
laboratory tests -bronchodilator therapy
-Symptoms: dyspnea, wheezing, orthopnea, -Steroid treatment for asthma, interstitial lung
cough, phlegm production, disease, etc.
chest pain -Management of congestive heart failure
-Signs: diminished breath sounds, overinflation, -Other (antibiotics in cystic fibrosis, etc.)
expiratory slowing, To describe the course of diseases affecting lung
cyanosis, chest deformity, unexplained crackles function
-Abnormal laboratory tests: hypoxemia, -Pulmonary diseases
hypercapnia, polycythemia, Obstructive airways diseases
abnormal chest radiographs Interstitial lung diseases
To measure the effect of disease on pulmonary -Cardiac diseases
function Congestive heart failure
To screen individuals at risk of having pulmonary -Neuromuscular diseases
diseases Guillain-Barre Syndrome
-Smokers To monitor persons in occupations with exposure
-Individuals in occupations with exposures to to injurious agents
injurious substances To monitor for adverse reactions to drugs with
-Some routine physical examinations known pulmonary toxicity
To assess preoperative risk
To assess prognosis (lung transplant, etc.) (From ATS, 1994)
To assess health status before enrollment in
strenuous physical activity
programs
When would I order PFTs
(cont)?
Disability/Impairment Evaluations
To assess patients as part of a rehabilitation program
-Medical
-Industrial
-Vocational
To assess risks as part of an insurance evaluation
To assess individuals for legal reasons
-Social Security or other government compensation programs
-Personal injury lawsuits
-Others
Public Health
Epidemiologic surveys
-Comparison of health status of populations living in different
environments
-Validation of subjective complaints in occupational/environmental
settings
Derivation of reference equations
From
Chest,
2002
Lung Volumes and Capacities
4 volumes: inspiratory
reserve volume, tidal
volume, expiratory
reserve volume, and
residual volume
2 or more volumes
comprise a capacity.
4 capacites: vital
capacity, inspiratory
capacity, functional
residual capacity, and
total lung capacity
Lung Volumes
Tidal Volume (TV): volume of
air inhaled or exhaled with
each breath during quiet
breathing
Inspiratory Reserve Volume
(IRV): maximum volume of air
inhaled from the end-
inspiratory tidal position
Expiratory Reserve Volume
(ERV): maximum volume of
air that can be exhaled from
resting end-expiratory tidal
position
Lung Volumes
Residual Volume
(RV):
Volume of air
remaining in lungs
after maximium
exhalation
Indirectly measured
(FRC-ERV) not by
spirometry
Lung Capacities
Total Lung Capacity (TLC):
Sum of all volume
compartments or volume of air
in lungs after maximum
inspiration
Vital Capacity (VC): TLC minus
RV or maximum volume of air
exhaled from maximal
inspiratory level
Inspiratory Capacity (IC): Sum
of IRV and TV or the maximum
volume of air that can be inhaled
from the end-expiratory tidal
position
Lung Capacities (cont.)
Functional Residual
Capacity (FRC):
Sum of RV and ERV or the
volume of air in the lungs at
end-expiratory tidal position
Measured with multiple-
breath closed-circuit helium
dilution, multiple-breath
open-circuit nitrogen
washout, or body
plethysmography (not by
spirometry)
What information does a
spirometer yield?
A spirometer can be used to measure the
following:
FVC and its derivatives (such as FEV1, FEF 25-75%)
Forced inspiratory vital capacity (FIVC)
Peak expiratory flow rate
Maximum voluntary ventilation (MVV)
Slow VC
IC, IRV, and ERV
Pre and post bronchodilator studies
Forced Expiratory Vital Capacity
The volume exhaled after a subject inhales
maximally then exhales as fast and hard as
possible.
Approximates vital capacity during slow
expiration, except may be lower (than true VC)
patients with obstructive disease
(Hyatt,
2003)
Spirometry Interpretation:
Obstructive vs. Restrictive Defect
Obstructive Disorders Restrictive Disorders
FVC nl or FVC
FEV1 FEV1
FEF25-75% FEF 25-75% nl to
FEV1/FVC FEV1/FVC nl to
TLC nl or TLC
Spirometry Interpretation: What do
the numbers mean?
FVC FEV1
Interpretation of % Interpretation of %
predicted: predicted:
80-120% Normal >75% Normal
70-79% Mild reduction 60%-75% Mild obstruction
50%-69% Moderate 50-59% Moderate
reduction obstruction
<50% Severe reduction <49% Severe obstruction
<25 y.o. add 5% and >60
y.o. subtract 5
Spirometry Interpretation: What do
the numbers mean?
FEF 25-75% FEV1/FVC
Interpretation of % Interpretation of
predicted: absolute value:
>79% Normal 80 or higher
60-79% Mild Normal
obstruction 79 or lower
40-59% Moderate Abnormal
obstruction
<40% Severe
obstruction
What about lung volumes and
obstructive and restrictive disease?
(From Ruppel,
2003)
Maximal Inspiratory Flow
Do FVC maneuver and then inhale as
rapidly and as much as able.
This makes an inspiratory curve.
The expiratory and inspiratory flow volume
curves put together make a flow volume
loop.
Flow-Volume Loops
(Rudolph and
Rudolph, 2003)
How is a flow-volume loop helpful?
Helpful in evaluation of air flow limitation on inspiration
and expiration