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Pulmonary Function Test

Pulmonary Function Test. By : Dr.L.GHOFRANIHA. Main questions about each case : Is there any abnormal pattern in spirometry What ‘s your estimate of the degree of limitation? What are differential diagnosis. Summary of spirometry interpretation.

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Pulmonary Function Test

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  1. Pulmonary Function Test By : Dr.L.GHOFRANIHA

  2. Main questions about each case : Is there any abnormal pattern in spirometry What ‘s your estimate of the degree of limitation? What are differential diagnosis Summary of spirometry interpretation

  3. Step 1.Look at the Flow-Volume loop Step 2.Look at the FEV1 (Nl ≥ 80% predicted). Step 3.Look at FVC (Nl ≥ 80%). Step 4.Look atFEV1/FVCratio(Nl≥ 75%). Step 5.Look at FEF25-75%(wide normal range) Interpretation of Spirometry

  4. Acceptability Criteria 1 - good start of test : sharp take off 2- Meet end-of-test criteria 3- free from artifacts: Cough or glottis closure during the first second of exhalation Variable effort , submaximal effort Leak Obstructed mouthpiece Have a satisfactory exhalation 6 s of exhalation

  5. After 3 acceptable spirograms been obtained • Are the two largest FVC within 150ml of each other? • Are the two largest FEV1 within 150ml of each other? If both of these criteria are met, the test session may be concluded. If both of these criteria are not met, continue testing until Both of the criteria are met with analysis of additional acceptable spirograms; OR a total of eight tests have been performed Reproducibility Criteria

  6. goldcopd.com

  7. Variable Effort

  8. Early Glottic Closure

  9. Cough

  10. Spirometry Interpretation: Obstructive vs. Restrictive Defect • Obstructive Disorders • FVC nl or↓ • FEV1 ↓ • FEF25-75% ↓ • FEV1/FVC ↓ • TLC nl or ↑ • Restrictive Disorders • FVC ↓ • FEV1 ↓ • FEF 25-75% nl to ↓ • FEV1/FVC nl to ↑ • TLC ↓

  11. Flow-Volume Loops

  12. Diffusing Capacity • Decreased DLCO(<80% predicted) • Obstructive lung disease • Parenchymal disease • Pulmonary vascular disease • Anemia • Increased DLCO (>120-140% predicted) • Asthma (or normal) • Pulmonary hemorrhage • Polycythemia • Left to right shunt

  13. case 1 65 year-old man No pulmonary complaints PFT as part of a routine health screening test Lifelong non-smoker Prior history of asbestose exposure

  14. His flow volume loops is as follows: :

  15. Case 2 54 year – old man With dyspnea &cough Non-smoker,with no occupational exposures. His flow volume loop is as follows:

  16. Case 2 interpretation Flow volume loop: PEFR Scooped out appearance Decreased FEV1 ,FVC & FEV1/FVC moderate airflow obstruction BD response Dx: obstructive disease

  17. Case 3 60 year-old man With progressive dyspnea on exertion 40 pack-year smoker Retired following as a building contractor His flow volume loop is as follows:

  18. The units for DLCO are ml/min/mmHg

  19. Case 3 interpretation Redused FEV1,FVC&FEV1/FVC very severe obstruction Significant BD response Increased RV air trapping

  20. Case 4 25 year-old man With dyspnea and wheezing Non smoker History of motor vehicle accident , hospitalization and tracheostomy 2 years ago His flow volume loops is as follows:

  21. Case 4 interpretation Flow volume loop: Flattened inspiratory &expiratory limb Decreased FEV1 , FEV1/FVC moderate obstruction Dx: Fixed UAWO

  22. Case 5 41 year-old woman With dyspnea on mild exertion History of 10 pack-year smoking and IV drug abusment (heroin and Ritalin) Her flow volume loop is as follows:

  23. Case 5 interpretation Flow volume loop : PEFR Scooped out pattern Decreased FEV1 ,FVC ,FEV1/FVC very severe obstruction Increased RV air trapping No BD response DDx: Alpha 1 AT Dficiency, Ritalin lung

  24. Case 6 30 year-old woman Dyspnea on exertion from 2 month ago Non-smoker ,No PMH She has a cat and parrot at home. • Her flow volume loop is as follows:

  25. Case 6 interpretation Decreased FEV1 ,FVC + NL FEV1/FVC Rstrictive pattern Decreased TLC severe restriction Decreased DLCO

  26. Pulmonary Function Tests Pre- and Post-Treatment CT Scan Images Dx :Hypersensitivity puemonitis

  27. Case 7 73 year-old man Progressive dyspnea on exertion,dry cough over the past one year. No fever ,hemoptysis and sputum production Life-long non-smoker

  28. Case 7 interpretation Flow volume loop : tall, narrow , short expiratory phase Decreased FEV1,FVC + NL FEV1/FVC +decreased TLC restrictive pattern Severe Restriction Decresed DLCO

  29. PA and Lateral Chest X-Ray Chest CT Images Dx :IPF

  30. Case 8 64 year-old woman With dysnea and orthopnea Non-smoker Her spirometry is repeated with her in the upright and supine positions:

  31. Case 8 interpretation Decreased FEV1 ,FVC ,FEV1/FVC + Decreased TLC Mixed restrictive ,obstructive pattern DDx : CHF Diaphragmatic weakness(reduced more than 20% in FEV1&FVC in supine position)

  32. Case 9 35 year-old man With dyspnea ,fever,chills and night sweat from 2 month ago Non smoker,no occupational or habit exposure His flow volume loop is as follows:

  33. case 9 inetrpretation : Flow volume loop : 2 component in expiratory limb faster emptying of one lung Decreased FEV1 ,FVC, FEV1/FVC + Mixed Res . obs. Pattern Decreased TLC Severe Obs . & modrate Res.

  34. Chest X—Ray Chest CT Dx : large mass and collapse

  35. Case 10 53 year old woman With increasing dyspnea on exertion. No cough,fevers ,hemoptysis,weight loss or sweat. Occasional chest pain with syncope or palpitation.

  36. DLCO is measured in ml/min/mmHg

  37. Case 10 inetrpretation FEV1 ,FVC ,FEV1/FVC ,TLC NL No limitation Isolated decreased DLCO Dx : CTEPHN

  38. Case 11 36 year –old woman Worsreningdyspnea on exertion and exercise limitation. Life-long non-smoker No PMH. DLCO is measured in ml/min/mmHg

  39. Case 11 interpretation Decreased FEV1 ,FVC ,NL FEV1/FVC Res. Pattern Decreased TLC Modreate RVD DLCO ~ NL Probably extrinsic process Further evaluation: 17% drop in supine FVC MIP = -35 MEP= 50 Dx = muscle weakness( Limb Girdle Dystropy)

  40. Case 12 44 year-old woman with cirrhosis Increasing dysnea . worse in upright position and walking.improves in supine position. 8% reduction in O2Sat from supine to sitting position DLCO is measured in ml/min/mmHg

  41. Case 12 interpration: Decreased FEV1/FVC + NL FEVI &FVC Mild OVD No BD response Decreased DLCO probably due to pulmonary vascular disease Platypnea +Orthodeoxia vascular intrapulmonary shunt hepatopulmonarysyndrom

  42. THANK YOU FOR YOUR ATTENTION

  43. Acceptability Criteria 1 - good start of test : sharp take off 2- Meet end-of-test criteria 3- free from artifacts: Cough or glottis closure during the first second of exhalation Variable effort , submaximal effort Leak Obstructed mouthpiece Have a satisfactory exhalation 6 s of exhalation

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