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Indications for PFT

Indications for PFT. RET 2414 Pulmonary Function Testing Module 1.0. Indications For PFT. Learning Objectives Categorize PFTs according to specific purposes Identify at least one indication for spirometry, lung volumes, and diffusing capacity

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Indications for PFT

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  1. Indications for PFT RET 2414 Pulmonary Function Testing Module 1.0

  2. Indications For PFT • Learning Objectives • Categorize PFTs according to specific purposes • Identify at least one indication for spirometry, lung volumes, and diffusing capacity • List one obstructive and one restrictive pulmonary disorder • Name at least two disease in which air trapping may occur • Relate pulmonary history to indications for performing pulmonary function tests

  3. Pulmonary Function Testing • Purpose for PFT Identify and quantify pulmonary impairments

  4. Pulmonary Function Testing • Tests can be divided into categories • Airway Function • Lung Volumes and Gas Distribution • Diffusing Capacity • Blood Gas and Exchange Tests • Cardiopulmonary Exercise Tests

  5. Airway Function Tests • Spirometry (meaning the measuring of breath) is the most common of the Pulmonary Function Tests (PFTs). It measures lung function, specifically the direct measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled.

  6. Airway Function Tests • Spirometry • Vital Capacity (VC)

  7. Airway Function Tests • Spirometry • Forced Vital Capacity (FVC)

  8. Airway Function Tests • Spirometry • Flow – Volume Loop (FVL) • AKA; MEFV Curve

  9. Airway Function Tests • Spirometry • Flow – Volume Loop (FVL) • AKA; MEFV Curve

  10. Airway Function Tests • FVC and/or FVL • Pre/Post Bronchodilator • Pre/Post Bronchochallenge • Methacholine • Histamine • Exercise

  11. Airway Function Tests • Spirometry • Maximum Voluntary Ventilation (MVV)

  12. Airway Function Tests • Maximal Inspiratory (MIP) • Expiratory Pressure (MEP) • Airway Resistance (Raw) • Compliance (CL)

  13. Indications for Spirometry • Detect the presence of lung disease Spirometry is recommended as the “Gold Standard” for diagnosis of obstructive lung disease by: • National Lung Health Education Program (NLHEP) • National Heart, Lung and Blood Institute (NHLBI) • World Health Organization (WHO)

  14. Indications for Spirometry BOX 1-2 • Diagnose the presence or absence of lung disease • Quantify the extent of known disease on lung function • Measure the effects of occupational or environmental exposure • Determine beneficial or negative effects of therapy

  15. Indications for Spirometry BOX 1-2 • Assess risk for surgical procedures • Evaluate disability or impairment • Epidemiologic or clinical research involving lung health or disease

  16. Lung Volumes • Determination of lung volume • Includes the VC (spirometry) and its subdivisions, along with the FRC (indirect spirometry) – from these TLC and other lung volumes can be determined

  17. Lung Volumes • Functional Residual Capacity (FRC) • Nitrogen Washout • Helium Dilution • Thoracic Gas Volumes

  18. Indications for Lung Volume Tests Box 1-3 • Diagnose or assess the severity of restrictive lung disease • Differentiate between obstructive and restrictive disease patterns • Assess the response to therapy • Make preoperative assessment of patients with compromised lung function

  19. Indications for Lung Volume Tests Box 1-3 • Determine or evaluate disability • Assess gas trapping by comparison of plethysmographic lung volumes with gas dilution lung volumes • Standardize other lung functions (i.e., specific conductance)

  20. Ventilation • Minute Ventilation • Alveolar Ventilation • Dead Space

  21. Distribution of Ventilation • Multiple – Breath N2 • He Equilibration • Single – Breath Techniques

  22. Diffusing Capacity (DLco)

  23. Diffusing Capacity (DLco) • Single – Breath (Breath Hold) • Steady – State • Other Techniques

  24. Indications for Diffusing CapacityBox 1-4 • Evaluate or follow the progress of parenchymal lung disease • Evaluate pulmonary involvement in systemic disease • Evaluate obstructive lung disease

  25. Indications for Diffusing CapacityBox 1-4 • Evaluate cardiovascular diseases • Quantify disability associated with interstitial lung disease • Evaluate pulmonary hemorrhage, polycythemia, or left-to-right shunts

  26. Blood Gases and Gas Exchange

  27. Blood Gases and Gas Exchange • Blood Gas Analysis and Oximetry • Shunt Study

  28. Blood Gases and Gas Exchange • Pulse Oximetry and Capnography

  29. Indications for Blood Gas AnalysisBox 1-5 • Evaluate the adequacy of lung function • Determine the need for supplemental oxygen • Monitor ventilatory support

  30. Indications for Blood Gas AnalysisBox 1-5 • Document the severity or progression of know pulmonary disease • Provide data to correct or corroborate other pulmonary function measurement

  31. Cardiopulmonary Exercise Test

  32. Indications for Exercise TestingBox 1-6 • Determine the level of cardiorespiratory fitness • Document or diagnose exercise limitations as a result of fatigue, dyspnea, or pain, • Cardiovascular / Pulmonary Disease

  33. Indications for Exercise TestingBox 1-6 • Evaluate adequacy of arterial oxygenation oxyhemoglobin saturation • Assess preoperative risk • Lung resection or reduction

  34. Indications for Exercise TestingBox 1-6 • Assess disability • Occupational lung disease • Evaluate therapeutic interventions such as heart or lung transplant

  35. Patterns of Impaired Pulmonary Function Sometimes, patients display patterns during pulmonary function testing that are consistent with a specific diagnosis

  36. Obstructive Airway Diseases Simple definition: “Airflow into and out of the lungs is reduced”

  37. Obstructive Airway Diseases • Chronic Obstructive Pulmonary Disease (COPD) Long-standing airway obstruction caused by: • Cystic Fibrosis • Bronchitis • Asthma • Bronchiectasis • Emphysema “CBABE”

  38. Obstructive Airway Diseases • COPD Characterized by: • Dyspnea at rest or with exertion • Productive cough

  39. Obstructive Airway Diseases • Emphysema“air trapping” • Primarily caused by cigarette smoking! • Genetic defect; absence of α-antitrypsin • Chronic exposure to environmental pollutants

  40. Obstructive Airway Diseases • Emphysema • Dyspnea at rest or with exertion • Productive cough • Under weight • Barrel-chested • Use of accessory muscles

  41. Obstructive Airway Diseases • Emphysema • Purse-lip breathing • Breath sounds are distant or absent • Chest X-Ray • Flattened diaphragms • Increased air spaces

  42. Obstructive Airway Diseases • Emphysema • Airway obstruction • Spirometry • FEV1 is reduced • Air trapping • Lung Volumes • Hyperinflation of FRC

  43. Obstructive Airway Diseases • Emphysema (cont) • Gas exchange abnormalities • Diffusing Capacity (DLco) • Reduced • Blood Gases • Hypoxemia/Hypercapnia • Possible O2 Desaturation with Exertion • Exercise Testing

  44. Obstructive Airway Diseases • Chronic Bronchitis “Excessive mucus production, with a productive cough on most days, for at least 3 months for 2 years or more.”

  45. Obstructive Airway Diseases • Chronic Bronchitis • Primarily caused by cigarette smoking! • Chronic exposure to environmental pollutants

  46. Obstructive Airway Diseases • Chronic Bronchitis • Chronic cough – “smoker’s cough” • Dyspnea, particularly with exertion • Chest X-Ray • Congested airways • Enlarged heart w/prominent pulmonary vessels • Diaphragms normal or flattened • Edema of lower extremities

  47. Obstructive Airway Diseases • Chronic Bronchitis (cont) • Airway obstruction • Spirometry • FEV1 is reduced • Dlco • Usually reduced • May have a preserved (normal) Dlco, which is helpful to distinguish it from emphysema

  48. Obstructive Airway Diseases • Chronic Bronchitis (cont) • Gas exchange abnormalities • Blood Gases • Hypoxemia, Hypercapnia in advanced cases • Polycythemia • Cyanosis

  49. Obstructive Airway Diseases • Bronchiectasis Pathologic dilatation of the bronchi, resulting from destruction of the bronchial wall by severe, repeated infections.

  50. Obstructive Airway Diseases • Bronchiectasis Common in Cystic Fibrosis (CF), as well as following bronchial obstruction by a tumor or foreign body. When entire bronchial tree is involved, it is assumed that the disease is inherited.

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