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Visit us at drsarma

Visit us at www.drsarma.in. Dr. R.V.S.N.Sarma., M.D., M.Sc., Consultant Physician & Chest Specialist E mail: sarma.rvsn@gmail.com 3760 9226 or 2766 0593 93805 21221 or 98940 60593. Pulmonary Function Tests Ventilatory Function – Spirometry. Clinical Applications. LUNG FUNCTION TESTS.

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Visit us at drsarma

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  1. Visit us at www.drsarma.in Dr. R.V.S.N.Sarma., M.D., M.Sc., Consultant Physician & Chest Specialist E mail: sarma.rvsn@gmail.com 3760 9226 or 2766 0593 93805 21221 or 98940 60593

  2. Pulmonary Function TestsVentilatory Function – Spirometry ClinicalApplications

  3. LUNG FUNCTION TESTS • Tests of Ventilation • Tests of Diffusion • Tests of Perfusion • Tests for V-P Mismatch

  4. LUNG FUNCTION TESTS • Tests of Ventilation • Tests of Diffusion • Tests of Perfusion • Tests for V-P Mismatch

  5. Function of Ventilation • Air Exit – Airways, Bronchomotor tone, Secretions, Thoracic muscles etc • Air Entry – Expansion of lungs – Functioning lung volume, its elastic nature, Lung compliance • ‘Air Out’ Problem – Obstructive Diseases • ‘Air In’ problem – Restrictive Diseases • Both Air Out and In - Combined

  6. Spirometry Objectives • To detect Obstructive Airway Diseases • To quantify the severity of obstruction. • To assess response to IBD. • To identify Restrictive Lung Diseases. • To identify flow-volume loop patterns • To understand the clinical relevance.

  7. PEAK FLOW METER Diagnosis of ASTHMA or COPD can be confirmed by demonstrating the presence of airway obstruction using Spirometry.

  8. PEFR - Pros and Cons • Advantages • With in 1 to 2 minutes, • Inexpensive (meter costs less than Rs.1000) • Simple, useful for frequent follow up use • Disadvantages • Very much effort dependent • Insensitive to small changes • Small airways cannot be assessed • Large inter & intra subject variation;↓accurate

  9. SPIROMETRY

  10. SPIROMETRY

  11. SPIROMETRY

  12. SPIROMETRY

  13. Spirometry - Pros and Cons • Advantages • Evaluates smaller as well as larger airways • Relatively easy to use and maintain • Reversibility can be tested with IBD and steroids • Diagnostic as well as management assessments • Disadvantages • Costs about 50,000 + computer and printer • Takes time to perform – 10 to 15 minutes • Requires training – at least one day course

  14. Spirometry Maneuver In single breath test • A few normal tidal respirations • Then deeeeep inspiration • Momentary breath holding • Very forced and fast expiration • As hard and as fast as he/she can blow out • Then deep, quick and full inspiration • Repeat at least 3 times – take the best

  15. Reproducibility of Spirometry • Adequate explanation to the patient • Demonstrating the steps one by one • Encouraging the patient to give best effort • Taking at least 3 and usually 5 attempts • Selecting the best effort • Cough and severe dyspnoea may interfere • Not like ECG – Results depend on effort

  16. Spirometry Results • FVC Forced Vital Capacity • FEV1 Forced Expiratory Volume in the first second • FEV1/FVC Ratio of the above two • PEFR Peak Expiratory Flow Rate • FET Forced Expiratory Time

  17. Normal Flow-Volume Volume-Time Test Values

  18. Spirometry Results • FVC Forced Vital Capacity • FEV1 Forced Expiratory Volume in the first second • FEV1/FVC Ratio of the above two • PEFR Peak Expiratory Flow Rate • FET Forced Expiratory Time

  19. Spirometry Normal Values • There are no fixed ‘Normal’ values • Dependent on age, sex, height, weight, ethnicity • Observed value expressed as % of predicted value • FVC Normal if > 80% of predicted • FEV1 Normal if > 80% of predicted • FEV1/FVC At least 75% • PEFR Normal if > 80% of predicted • FET Less than 4 seconds

  20. The Four Square Game FEV1 NORMAL 80% FEV1 < 80% of Pd. 80% FVC < 80% Pred. FVC NORMAL

  21. The Four Square Game FEV1 NORMAL Normal Lungs FEV1÷FCV is N 80% FEV1 < 80% of Pd. 80% FVC < 80% Pred. FVC NORMAL

  22. The Four Square Game FEV1 NORMAL 80% Obstructive Disease FEV1÷FCV is Low FEV1 < 80% of Pd. 80% FVC < 80% Pred. FVC NORMAL

  23. The Four Square Game FEV1 NORMAL Restrictive Disease FEV1÷FCV is High 80% FEV1 < 80% of Pd. 80% FVC < 80% Pred. FVC NORMAL

  24. The Four Square Game FEV1 NORMAL 80% Combined Obs+Res FEV1÷FCV is N or L FEV1 < 80% of Pd. 80% FVC < 80% Pred. FVC NORMAL

  25. The Four Square Game FEV1 NORMAL Restrictive Disease FEV1÷FCV is High Normal Lungs FEV1÷FCV is N 80% Combined Obs+Res FEV1÷FCV is N or L Obstructive Disease FEV1÷FCV is Low FEV1 < 80% of Pd. 80% FVC < 80% Pred. FVC NORMAL

  26. The Four Square Game FEV1 NORMAL Air Entry Problem Lungs ↓ expansion Normal Air Entry & Exit 80% Air Exit Problem Airways choked Both Air Entry & Air Exit Problem FEV1 < 80% of Pd. 80% FVC < 80% Pred. FVC NORMAL

  27. The Four Square Game FEV1 NORMAL Restrictive Disease FEV1÷FCV is High Normal Lungs FEV1÷FCV is N 80% Combined Obs+Res FEV1÷FCV is N or L Obstructive Disease FEV1÷FCV is Low FEV1 < 80% of Pd. 80% FVC < 80% Pred. FVC NORMAL

  28. Millers Prediction Quadrants 100% Air Entry is reduced Restrictive Disease FEV1÷FCV is High Air In and Out N Normal Lungs FEV1÷FCV is N FEV1 NORMAL 90% 90% 100% 60% 70% 80% Both Air In & Out ↓↓ Combined Obs+Res FEV1÷FCV is N or L Air Exit is chocked Obstructive Disease FEV1÷FCV is Low FEV1 < 80% of Pd. 70% 60% FVC < 80% Pred. FVC NORMAL

  29. Algorithm for Diagnosis FVC FVC > 80% FVC < 80% FEV1 > 80% FEV1 < 80% FEV1 > 80% FEV1 < 80% Normal PFT Obstructive Restrictive Combined IBD Reversible Irreversible Extra-pulmonary Pulmonary

  30. Normal Airways and Lungs • FVC > 80% • FEV1 > 80% • FEV1÷FCV > 75% • PEFR > 80% • FET <4 sec • Air Entry Normal • Air Exit Normal FEV1 is LOW FVC is Normal FEV1 ÷ FVC is < 75%

  31. Normal Airways - PFT

  32. Normal PFT and CXR

  33. Obstructive Airways Disease • Bronchial Asthma – Reversible Airway obs. • Chronic bronchitis – Irreversible with IBD • Emphysema – Irreversible with IBD • Bronchiectasis – Airway rigidity • Cystic Fibrosis • Allergic bronchopulmonary Aspergillosis • Bronchiolitis

  34. Obstructive Airways Disease • FVC > 80% • FEV1 < 80% • FEV1÷FCV < 75% • PEFR < 80% • FET >4 sec • Air Entry Normal • Air Exit Problem FEV1 is LOW FVC is Normal FEV1 ÷ FVC is < 75%

  35. Obstructive Airways Disease - PFT FEV1 is LOW FVC is Normal FEV1 ÷ FVC is < 75%

  36. Obstructive V/s Normal

  37. Obstructive Airways Mild Bronchial Asthma

  38. Reversible Obstruction (IBD) Bronchial Asthma

  39. Bronchiectasis (Obstructive) UNILATERAL BRONCHOGRAM - BIL

  40. Obstructive Airways Severe Emphysema

  41. Obstructive Airways Severe -IBD Emphysema

  42. Obstructive Lung Diseases ABPA CYSTIC FIBROSIS

  43. Truncation of flow loop Expiratory – Intra Thoracic Inspiratory –Extra Thoracic Both – Fixed Obstruction Tumour Tracheal stenosis Tracheal FB Vocal Chord Dysfunction Upper Airway Obstruction

  44. Restrictive Lung Diseases • Sarcoidosis • Tuberculosis – (Fibrocaseous) • Interstitial Lung Disease - ILD • Idiopathic pulmonary fibrosis - IPF • Pneumoconiosis • Drug- or radiation-induced lung disease • Pneumonectomy

  45. Extrinsic Restrictive Diseases • Kyphosis, Scoliosis • Ankylosing Spondylitis • Massive Pleural effusion • Pregnancy, Obesity, Ascites • Rib fractures • Neuromuscular disorders

  46. FVC < 80% FEV1 > 80% FEV1÷FCV > 75% PEFR > 80% FET <4 sec Air Entry Problem Air Exit Normal Restrictive Lung Disease FEV1 is LOW FVC is Normal FEV1 ÷ FVC is < 75%

  47. Restrictive Lung Disease - PFT ILD or IPF FEV1 is LOW FVC is Normal FEV1 ÷ FVC is < 75%

  48. Restrictive V/s Normal ILD or IPF

  49. Restrictive Lung Disease - ILD ILD or IPF

  50. Restrictive Lung Disease - ILD HEPATIOD APPEARANCE

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