Pulmonary Function Testing
Pulmonary Function Testing
Assignment#2
Semester-VII (B)
Definition: Pulmonary function tests measures the function of lung capacity and volume and
chest wall mechanics to determine whether or not the patient has a lung problem. The term
encompasses a wide variety of objective methods to assess lung function.
1. SPIROMETRY
Definition: Spirometry (meaning the measuring of breath) is the most common of the PFTs,
measuring lung function, specifically the amount (vol.) and/or speed (flow) of air that can be
inhaled and exhaled.
Method:
Value:
Uses:
2. Lung Volume Measurement by helium dilution or body plethysmography
a. The helium dilution technique is the way of measuring the functional residual capacity
(FRC) of the lungs (the volume left in the lungs after normal expiration).
Method: This technique is a closed-circuit system where a spirometer is filled with a
mixture of helium and oxygen. The amount of He in the spirometer is known at the
beginning of the test (concentration × volume = amount). The patient is then asked to
breathe (normal breaths) in the mixture starting from FRC (functional residual capacity),
which is the gas volume in the lung after a normal breath out. The spirometer measures
helium concentration. The helium spreads into the lungs of the patient, and settles at a new
concentration. Because there is no leakage of substances in the system, the amount of
helium remains constant during the test, and then FRC is calculated.
Uses: May be used as an alternative to quantitative CT scans to assess end-expiratory lung
volumes (EELV) among patients who are on mechanical ventilation with diagnosis of
ALI/ARDS. It offers the advantages of lower cost, decreased transportation of critically ill
patients, and reduced radiation exposure.
b. Plethysmography is a test used to measure the volume of air in the lungs
both when the patient takes a deep breath and after complete exhalation.
Method: During plethysmography, the patient is advised to breathe into a
tube that is connected to a computer to measure their lung volume.
In some cases, patients may be advised to breathe in nitrogen or helium gas
and breathe it out. The volume of air is indicative of the lung volume.
Uses: This type of pulmonary test is particularly useful in the diagnosis of
pulmonary fibrosis of a weak chest wall.
LUNG VOLUMES:
Tidal Volume (VT): The volume of air entering the nose or mouth per breath.
Value=500ml
Residual Volume (RV): The volume of air left in the lungs after a maximal forced
expiration. Value=1.5L
Expiratory Reserve Volume (ERV): The volume of
air that is expelled from the lung during a maximal
forced expiration that starts at the end of normal
tidal expiration. Value=1.5L
Inspiratory Reserve Volume (IRV): The volume of air that is inhaled into the lung during
a maximal forced inspiration starting at the end of a normal tidal inspiration. Value=2.5L
Uses
An arterial blood gas (ABG) test is done to:
• Check for severe breathing problems and lung diseases, such as asthma, cystic fibrosis, or
COPD.
• See how well treatment for lung diseases is working.
• Find out if one needs extra oxygen or help with breathing (mechanical ventilation).
• Find out if one is receiving the right amount of oxygen when you are using oxygen in the
hospital.
• Measure the acid-base level in the blood of people who have heart failure, kidney failure,
uncontrolled diabetes, sleep disorders, severe infections, or after a drug overdose.
8. Bronchoprovocation Test
Definition: A bronchial provocation test evaluates the sensitivity of your lungs. It’s often
used to diagnose or rule out asthma as a cause of your symptoms.
When the physician assessing a patient is concerned that they might have asthma, first
spirometry is performed. • If no obstruction is identified further testing is sometimes
required. A medication called methacholine is used to ‘provoke' airway response. • When
the airways of people with asthma are exposed to this medication, it will stimulate a
response, which can be measured. •
• If there is a positive response, asthma can be clearly identified and treated appropriately.
• In most cases, methacholine challenge testing involves repeated FEV1 efforts at increasing
levels of the drug. The sooner the patient reacts by a 20% reduction in their FEV1 compared
to room air (normal) conditions the more likely their prevalence to asthma
Method: CPET also measures how much oxygen person’s body can use during exercise.
Before the test, a nurse or technician will place monitors on the body including:
EKG leads to measure HR
a blood pressure cuff
a pulse oximeter to measure oxygen saturation in the blood
a mouthpiece attached with a tube to a flow meter to measure how deeply and quickly
one breathes and how much oxygen and carbon dioxide flow in and out of the lungs
The test lasts about 10-12 min. You begin by walking or pedaling slowly for a few minutes.
After that, the treadmill will move faster or the resistance will increase on the stationary
bicycle until you need to stop. Before stopping entirely, however, you will continue walking
or pedaling at a slow rate to cool down.
Uses: It may be useful in patients who complain of excessive breathlessness and in whom
investigations such as echocardiogram and pulmonary functions tests are normal.
Spirometry
Definition: A physiological test for assessing lung function by measuring the volume of air that
the patient is able to expel from the lungs after a maximal inspiration.
There are two key measurements obtained during a spirometry test, of which include the peak
expiratory flow (PEF) and forced expiratory volume in 1 second (FEV1). PEF is the fastest rate
that air is exhaled from the lungs, whereas FEV1 indicates the maximum volume of air that can
be inhaled in 1 second.
Measurements that are made include
Method: The spirometry test involves the use of a specialized machine called a spirometer that
is able to detect the flow rate and volume of air that moves through a tube into the machine.
The patient takes the maximum inspiration, followed by forced expiration and continues
expiration as long as possible in the spirometer.
The spirometer measures the 1 second expiratory volume (FEV1) and forced vital capacity
(FVC). In normal healthy person;
FEV1 is about 4 liters,
FVC is 5 liters
FEV1/FVC ratio 75% to 80%
Peak Expiratory flow (PEF); Measured by maximal forced expiration through a peak flow meter.
PEF = FEV1 x 60
Most spirometers display the following graphs, called spirograms: