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Mahler Beatrice, MD, PhD,

University Assistant,
Physiopathology and Immunology
Chair I,
UMF “Carol Davila”,
Pulmonary pysiology
There are three aspects of pulmonary
 Perfusion - relates to blood flow through
pulmonary vessels.

 Diffusion - refers to movements of oxigen

and carbon dioxide across capillary

 Ventilation - relates to air excenge

between alveolar spaces and the
Pulmonary pysiology
 In inspirations the alveolar pressure is
lowered below atmospheric pressure, and
air flow into the trachea, bronchi,
bronchioles and alveoli.
 Expiration is a passive act, the lung –
thorax sistems recoil to their resting
position and the alveolar pressure
increases above atmospheric pressure,
then the air flows out through the
respiratory tract
 The spirometry determines the
effectiveness of the various mechanical
forces involved in lung and chest wall
 The value obtained provide quantitative
information about the degree of
obstruction to airflow or the degree of
restriction of inspired air.
 The tests determine the presence,
nature and extent of pulmonary
dysfunction caused by obstruction,
restriction or both.
The ventilotory defect is:

 obstructive – increase air way

 restrictive – limitation in chest wall
 mixed defect – the ventilation is
altered by both of mechanism.
Restrictive ventilatory impairments
 chest wall disease – injuri, kyphoscoliosis,
spondylitis, muscular dystrophy,
 extratoracic conditions – obesity,
peritonitis, pregnancy,
 interstitial lung disease - fibrosis,
 pleural disease –fibrotorax, pleural
 space-occuping lesions –tumor
Obstructive ventilatory impairments
 periferal airway disease – COPD,
bronchitis, asthma
 pulmonary parenchimal disease –
 upper airway disease – pharyngeal,
tracheal and laryngeal tumors,
foreign bodies, stenosis
Mixed-defect ventilatory
 pulmonary congestion
Major division of lung volumes
 In the mornig of the investigation is contraindicaite to
smoke, use bronchodilatator.
 The pacient sit to the stool.
 Place nose clips on the nose, and instruct the patient to
breathe normally through a mounthpiece ( is a filter for
bacterial or viral)
 Ask the pacient to take a maximal inspirations and then
forcibly and completely exhale into the spirometer
 have the pacient repeat this maneuver a minimum of
three times.
 If the result is not normaly , you moust admistrate
bronchodilators with a handheld nebuliser and repeat
spirometry is indicate.

 Spirometry is a patient effort –

dependent test

 The pain and altered mental status

is a contraindications for spirometry
Identifying errors in spirometry
Hesitation Premature finish


Poor effort Premature finish and restart

Interpreting the results
Obstructive Restrictive Mixed

FEV1/FVC% Decreased increased Decreased

Or normal

FVC Decreased Decreased Decreased

Or normal

FEV1 Decreased Decreased Decreased

Or normal
the Normal flow volume curve
Severe Airflow Obstruction
Severe Restrictive Defect
subpleural bleb - emphysema
subpleural bleb - emphysema

 Asymptomatic and normal PEF between


 Symptoms < 1 time a week

 FEV1 –normal ( > 80 %)

 Metode – inhalator administration
• etacolina- for bronchobstructionM
• Ventolin - for bronhodilatation
 pletysmograph
• It is a closed chamber with a fixed
volume in which the subject breathes
the gas in the plethysmograph.
• Measurement the TLC, RV, RAW( airway
resistence), TLco ( diffusion)
Pulmonary diffusing capacity
 Requires the use of a gas that is
more soluble in blood than in lung
tissue –carbon monoxide
 The diffusing capacity is measure for
the carbon monoxide and is
converted to oxigen by multiplying
by 1.23.
 Is necessary to adjustment with
Lung Diffusing
Lung Volume Terminology

Inspiratory reserve Inspiratory

volume capacity

Total Tidal volume

Expiratory reserve Vital
volume capacity

Residual volume