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Comprehensive Guide to Spirometry and Lung Function Testing

Explore the history of spirometry, from John Hutchinson in 1846 to modern ventilation tests. Learn about lung volumes, diseases like asthma and COPD, pulmonary function metrics, exercise tests, and diagnostic methods. Master the essentials of spirometry technique and interpretation in health and disease.

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Comprehensive Guide to Spirometry and Lung Function Testing

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  1. The inventor of spirometer: John Hutchinson (1846)

  2. Ventilation and V/Q ratio

  3. Branching of the airways

  4. Static lung volumes IC

  5. Slow (SVC) and forced (FVC) vital capacity in health and disease

  6. Elastic forces and airway diameter

  7. Antropometric data determine reference values • Age • Height • Sex • Race

  8. Spirogram and flow-volume loop

  9. Asthma - reversible airway obstruction spirogram F-V loop FVC: 2.4 (73 ref%) – 3.1 (92 ref%) FEV1: 1.0 (36 ref%) – 1.5 (52 ref%) FEV1/FVC: 42% - 49%

  10. COPD = postbronchodilator FEV1/FVC<70% (irreversible airway obstruction

  11. Lung fibrosis FVC: 75 ref% TLC: 63 ref% FEV1: 78 ref% RV: 57 ref% FEV1/FVC: 87% DLCO: 34 ref%

  12. Heart failure FVC: 55 ref% FEV1: 49 ref% FEV1/FVC: 74%

  13. Typical spirograms and flow-volume loops

  14. Etiology of obstructive and restrictive ventilatory disorders

  15. Pathophysiology of the variable lesion of the major (proximal) airways

  16. Typical F-V loops in cases of lesions of the major airways

  17. Flow-volume loops A:normal, B:obstructive, C:restrictive

  18. Inhalative provocation test (metacholin, histamin)

  19. Asthma – reversible obtruction healthy asthmatic

  20. COPD

  21. COPD (emphysema!!!)

  22. Lung fibrosis

  23. Use of spacer with MDI

  24. How to measure FRC (RV,TLC) ? • Nitrogen washout method • Inert gas dilution technique • Plethysmography

  25. Resistance

  26. RV 4 3 2 SRaw (cmH2O/L/sec) 1 TLC 0 2 4 6 8 Lung Volume (liters) Volume dependence of airway resistance (Raw)

  27. Compliance

  28. Diffusion capacity (DLCO, DLCO/VA, Tco, Kco)

  29. Arterial Blood Gas

  30. Respiratory and metabolic shifts chronic acute acute chronic

  31. Exercise tests in lung diseases Exercise-induced asthma (EIA) - FEV1 Interstitial lung disease (ILD)- SAT Exercise tolerance in rehabilitation (COPD) - cardiopulmonary exercise (CPX). Important variables: - work rate (watts), SpO2, ABG - VO2, VCO2, RQ, VE - lactate threshold (LT) - breathing reserve (1-VEmax/MVV) - heart rate reserve (1-HRmax/220-age)

  32. Mechanism of exercise-induced Hypoxaemia (decreased contact time)

  33. Noninvasive determination of lactate threshold by the V(entilatory)-slope method

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