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Pulmonary Function Testing

Pulmonary function tests (PFTs) measure lung function and capacity. Common PFTs include spirometry, lung volume measurement, diffusion capacity for carbon monoxide (DLCO), and maximal respiratory pressures. Spirometry measures breath volume and flow. Lung volume measurement uses helium dilution or plethysmography to assess volumes like functional residual capacity. DLCO estimates how efficiently oxygen transfers to blood. Maximal respiratory pressures test breathing muscle strength. Together, PFTs evaluate lung function and diagnose conditions like asthma, COPD, and interstitial lung disease.

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0% found this document useful (0 votes)
57 views10 pages

Pulmonary Function Testing

Pulmonary function tests (PFTs) measure lung function and capacity. Common PFTs include spirometry, lung volume measurement, diffusion capacity for carbon monoxide (DLCO), and maximal respiratory pressures. Spirometry measures breath volume and flow. Lung volume measurement uses helium dilution or plethysmography to assess volumes like functional residual capacity. DLCO estimates how efficiently oxygen transfers to blood. Maximal respiratory pressures test breathing muscle strength. Together, PFTs evaluate lung function and diagnose conditions like asthma, COPD, and interstitial lung disease.

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Samman Aftab
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© © All Rights Reserved
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MEDICINE-I

Assignment#2

Name: Samman Aftab

SAP ID: 3272

Semester-VII (B)

Submitted to Dr. Wardah Farhat


Pulmonary Function Tests (PFTs)

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.

 Types of Pulmonary Function Tests;


1. Spirometry
2. Lung Volume Measurement by Helium Dilution or Body Plethysmography
3. Diffusion lung capacity for CO (DLCO)
4. Maximal Respiratory Pressures (Maximal Inspiratory Pressure (Pi max)&Maximal
Expiratory Pressure (Pe max)) / Respiratory Muscle Function Test
5. Maximum Voluntary Ventilation (MVV)
6. Arterial Blood Gases (ABG)
7. Exhaled Nitric Oxide Test
8. Pulse Oximetry
9. Bronchoprovocation Test
10. Cardiopulmonary Exercise Testing (CPET)

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:

Values that are measured with lung plethysmography include:

 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

3. Diffusion lung capacity for CO (DLCO)


 Definition: A diffusing capacity test is used to estimate how efficiently oxygen is transferred
from the air sacs of the lungs (alveoli) to the bloodstream.
 Method: Because the diffusing capacity of oxygen is difficult to measure directly, a person
inhales a small amount of carbon monoxide, holds the breath for 10 s, and then exhales into
a carbon monoxide detector. The exhaled gas is analyzed to measure the amount of CO
transferred into the capillary blood during the maneuver
 Uses: DLCO is helpful primarily in distinguishing between types of obstructive lung disease.
For example, the diffusing capacity will generally be normal or increased in asthma, while it
will be decreased in emphysema.
LUNG CAPACITY
Values that are measured with DLCO include;
 Functional Residual Capacity (FRC): the volume of air remaining in the lungs at the end
of a normal tidal expiration. Value=3 L
 Inspiratory Capacity (IC): The volume of air that is inhaled into the lung during a
maximal forced inspiration effort that begins at the end of a normal tidal expiration
(VT+IRV=3L).
 Vital Capacity (VC): The volume of air that is expelled from the lung during a maximal
forced expiration effort starting after a maximal forced inspiration (4.5L).
 Total Lung Capacity (TLC): The volume of air that is inhaled into the lung after a maximal
inspiration effort (5-6 L).

4. Maximal Respiratory Pressures (Pi max) & Pe max):


 Definition: This test measures how much pressure the breathing muscles can generate
when the client breathes in or out. The purpose of the test is to measure the strength of the
respiratory muscles.
 Method: Maximal inspiratory and expiratory pressures (MIP/MEPs) are measured by having
the patient perform maximal inspiratory and expiratory efforts against a closed valve and
measuring the static pressures that are generated. The lung specialist may also ask client to
do a spirometry test lying down, to see if this makes lung capacity fall by more than 30%
when moving from an upright position to lying down, which can be a sign of muscle
weakness.
 Values:

Gender Pi max Pe max


Male –124 ± 44 cm H2O 233 ± 84 cm H2O
Female – 87 ± 32 cm H2O 152 ± 54 cm H2O
 Uses
 Used to track respiratory muscle weakness that may suggest neuromuscular conditions.
 A useful approach in targeting specific muscles and their functionality corresponding to
MEP and/or MIP findings.
 Unexplained decrease in VC & MVV
 Weaning (Pimax > -30)
5. Maximal Voluntary Ventilation (MVV):
 It is used to measure the ventilatory reserve.
 The subject breaths as hard and fast as possible
for 10-15 sec, and then adjust it to 1 min.
 MVV = FEV-1 times 35-40
 Decreases in;
•Poor effort
•Neuromuscular diseases
•Obstructive & restrictive lung diseases
•Heart diseases
•Obesity

6. Arterial Blood Gases


 Definition: This test is used to check how well the lungs are able to move oxygen into the
blood and remove carbon dioxide from the blood. An ABG test uses blood drawn from an
artery, where the oxygen and carbon dioxide levels can be measured before they enter
body tissues.
 Method/procedure A sample of blood from an artery is usually taken from the radial artery.
An arterial blood gas (ABG) test measures the acidity (pH) and the levels of oxygen and
carbon dioxide in the blood from an artery.
 Normal values

 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.

7. Exhaled Nitric Oxide Test


 Definition: Fractional exhaled nitric oxide tests measure how much nitric oxide is in the air
that you exhale. For this test, client will breathe out into a tube that is connected to the
portable device. It requires steady but not intense breathing.
 Measurement procedure: Patients should refrain from smoking and the ingestion of food or
beverages for 1 hour before FENO measurement. Upper and lower respiratory tract viral
infections may lead to increased levels of FENO, and measurement should be deferred until
recovery, if possible.
 Clinical instruments for the measurement of exhaled nitric oxide typically require that the
patient inhale fully through the device so that ambient nitric oxide can be scrubbed. The
patient then exhales into the device, which affords greater than 5 cm water resistance to
assist with velum closure, thereby preventing or minimizing nasal contribution to the
exhaled gas sample .The measuring device provides auditory and visual feedback to assist
with maintaining a constant exhaled flow. An elevated level of nitric oxide in the breath
suggests inflammation in airways and possibly allergic asthma. The appropriate treatment is
usually corticosteroids to reduce the inflammation.
 Values:
 Uses:

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.

The test can take one of three forms:


a) Irritant challenge. The person is exposed to an asthma trigger, such as smoke or a
chemical to see if the airways react.
b) Exercise challenge. You exercise on a treadmill or stationary bicycle to see if physical
exertion makes the airways react.
c) Methacholine challenge. You inhale increasing doses of the chemical methacholine,
which causes the airways to constrict with low doses among people with asthma and
with high doses in people without asthma. If there is no reaction at low doses, your
doctor will look for another cause of your symptoms.

 Method: Provocative material is given by inhalation & bronchospasm provoked in the


laboratory. 3 types of provocative materials are used:
1. Nonspecific pharmacologic- Histamine, Methacholine.
2. Nonspecific irritant- Sulphur dioxide, smoke, citric acid.
3. Specific-Individual allergen.
Values:
Uses:

• 20% fall in FEV1 from basal values – positive response.


• Histamine solution by nebulization - 8mg/ml. 2.
9. Pulse Oximetry
 Definition: Pulse oximetry is a tool to look at the oxygen levels in people. Oxygen saturation
tells us how much of the hemoglobin is loaded with oxygen in the blood stream. Most
people will be between 92% and 99% saturated. This test is not nearly as accurate as doing
an arterial blood gas, but will often be more than enough for
evaluation of a patient's oxygen level.
Pulse Oximetry measures % oxygenation of Hb (oxyhemoglobin)
 Method: Measured via electrodes placed on skin- fingertips,
ear lobes.Measures absorption of light passing through
tissue, then calculates O2 saturation of arterial blood.
 Normal value = 97%
 Uses

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

10. Cardiopulmonary Exercise Test (CPET)

 Definition: A cardiopulmonary exercise test (CPET) is a specialized exercise stress test to


gauge one’s ability to exercise and to diagnose what may be restricting their activity levels.
It is usually performed on a treadmill or stationary bicycle in a doctor’s office or PFT lab.

 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

 Forced vital capacity (FVC)


 Forced expiratory volume in the first second (FEV-1)
 The ratio of the two volumes (FEV1/FVC)
 Vital Capacity (VC)
 Peak Expiratory Flow (PEF)
 Flow Volume Loop

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:

 a volume-time curve, showing volume

(liters) along the Y-axis and time (seconds)


along the X-axis
 a flow-volume loop, which graphically depicts the rate of airflow on the Y-axis and the total
volume inspired or expired on the X-axis.
Procedure:

• Subject position: Upright sitting


• Instruments: Nose clip, computerized spirometer device with mouthpiece.
• Procedure: The patient should breathe normally into the spirometer through a tight- fitting
mouthpiece
Instructions: Step 1: Breath in deeply and hold
Step 2: Nose clip applied to avoid
expiration
Step 3: Hold mouth-piece tightly
in mouth and expired forcefully
as fast and long as possible.
Step 4: Once further expiration
end, remove mouthpiece.

 Repeat minimum of three times to check for


reproducibility.

Spirometry in obstructive lung disease Spirometry in restrictive lung disease


It is a reliable method of differentiating between obstructive airways disorders (e.g. COPD,
asthma) and restrictive disease where the size of the lungs is reduced e.g. fibrotic lung disease-
Spirometry is the most effective way of deterring the severity of COPD
A major advantage of spirometry is that it enables you to detect COPD before symptoms
become apparent - Early identification and persuading patients to stop smoking may mean
minimal disease progression and long term improvement in quality of life

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