Module 1.0 Indications for PFT

3,148 views
2,918 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
3,148
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
95
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Module 1.0 Indications for PFT

  1. 1. Indications for PFT RET 2414 Pulmonary Function Testing Module 1.0
  2. 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. 3. Pulmonary Function Testing  Purpose for PFT Identify and quantify pulmonary impairments
  4. 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. 5. Airway Function Tests  Spirometry  Vital Capacity (VC)
  6. 6. Airway Function Tests  Spirometry  Forced Vital Capacity (FVC)
  7. 7. Airway Function Tests  Spirometry  Flow – Volume Loop (FVL)  AKA; MEFV Curve
  8. 8. Airway Function Tests  Spirometry  Flow – Volume Loop (FVL)  AKA; MEFV Curve
  9. 9. Airway Function Tests  FVC and/or FVL  Pre/Post Bronchodilator  Pre/Post Bronchochallenge  Methacholine  Histamine  Exercise
  10. 10. Airway Function Tests  Spirometry  Maximum Voluntary Ventilation (MVV)
  11. 11. Airway Function Tests  Maximal Inspiratory (MIP)  Expiratory Pressure (MEP)  Airway Resistance (Raw)  Compliance (CL)
  12. 12. 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)
  13. 13. 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
  14. 14. Indications for Spirometry BOX 1-2  Assess risk for surgical procedures  Evaluate disability or impairment  Epidemiologic or clinical research involving lung health or disease
  15. 15. Lung Volumes  Includes the VC and its subdivisions, along with the FRC
  16. 16. Lung Volumes  Functional Residual Capacity (FRC)  Nitrogen Washout
  17. 17. Lung Volumes  FRC  Helium Dilution
  18. 18. Lung Volumes  FRC  Thoracic Gas Volumes
  19. 19. Ventilation  Minute Ventilation  Alveolar Ventilation  Dead Space
  20. 20. Distribution of Ventilation  Multiple – Breath N2  He Equilibration  Single – Breath Techniques
  21. 21. 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
  22. 22. 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)
  23. 23. Diffusing Capacity (DLco)
  24. 24. Diffusing Capacity (DLco)  Single – Breath (Breath Hold)  Steady – State  Other Techniques
  25. 25. Indications for Diffusing Capacity Box 1-4  Evaluate or follow the progress of parenchymal lung disease  Evaluate pulmonary involvement in systemic disease  Evaluate obstructive lung disease
  26. 26.  Evaluate cardiovascular diseases  Quantify disability associated with interstitial lung disease  Evaluate pulmonary hemorrhage, polycythemia, or left-to-right shunts Indications for Diffusing Capacity Box 1-4
  27. 27. Blood Gases and Gas Exchange
  28. 28. Blood Gases and Gas Exchange  Blood Gas Analysis and Oximetry  Shunt Study
  29. 29. Blood Gases and Gas Exchange  Pulse Oximetry and Capnography
  30. 30. Indications for Blood Gas Analysis Box 1-5  Evaluate the adequacy of lung function  Determine the need for supplemental oxygen  Monitor ventilatory support
  31. 31. Indications for Blood Gas Analysis Box 1-5  Document the severity or progression of know pulmonary disease  Provide data to correct or corroborate other pulmonary function measurement
  32. 32. Cardiopulmonary Exercise Test
  33. 33. Indications for Exercise Testing Box 1-6  Determine the level of cardiorespiratory fitness  Document or diagnose exercise limitations as a result of fatigue, dyspnea, or pain,  Cardiovascular / Pulmonary Disease
  34. 34. Indications for Exercise Testing Box 1-6  Evaluate adequacy of arterial oxygenation oxyhemoglobin saturation  Assess preoperative risk  Lung resection or reduction
  35. 35. Indications for Exercise Testing Box 1-6  Assess disability  Occupational lung disease  Evaluate therapeutic interventions such as heart or lung transplant
  36. 36. Patterns of Impaired Pulmonary Function Sometimes, patients display patterns during testing that are consistent with a specific diagnosis
  37. 37. Obstructive Airway Diseases Simple definition: “Airflow into and out of the lungs is reduced”
  38. 38. Obstructive Airway Diseases  Chronic Obstructive Pulmonary Disease (COPD) Long-standing airway obstruction caused by:  Cystic Fibrosis  Bronchitis  Asthma  Bronchiectasis  Emphysema “CBABE”
  39. 39. Obstructive Airway Diseases  COPD Characterized by:  Dyspnea at rest or with exertion  Productive cough
  40. 40. Obstructive Airway Diseases  Emphysema “air trapping”  Primarily caused by cigarette smoking!  Genetic defect; absence of α-antitrypsin  Chronic exposure to environmental pollutants
  41. 41. Obstructive Airway Diseases  Emphysema  Dyspnea at rest or with exertion  Productive cough  Under weight  Barrel-chested  Use of accessory muscles
  42. 42. Obstructive Airway Diseases  Emphysema  Purse-lip breathing  Breath sounds are distant or absent  Chest X-Ray  Flattened diaphragms  Increased air spaces
  43. 43. Obstructive Airway Diseases  Emphysema  Airway obstruction  Spirometry  FEV1 is reduced  Air trapping  Lung Volumes  Hyperinflation of FRC
  44. 44. Obstructive Airway Diseases  Emphysema (cont)  Gas exchange abnormalities  Diffusing Capacity (DLco)  Reduced  Blood Gases  Hypoxemia/Hypercapnia  Possible O2 Desaturation with Exertion  Exercise Testing
  45. 45. 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.”
  46. 46. Obstructive Airway Diseases  Chronic Bronchitis  Primarily caused by cigarette smoking!  Chronic exposure to environmental pollutants
  47. 47. 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
  48. 48. Obstructive Airway Diseases  Chronic Bronchitis (cont)  Airway obstruction  Spirometry  FEV1 is reduced  May have preserved DLco  DLco to differentiate from emphysema
  49. 49. Obstructive Airway Diseases  Chronic Bronchitis (cont)  Gas exchange abnormalities  Blood Gases  Hypoxemia, Hypercapnia in advanced cases  Polycythemia  Cyanosis
  50. 50. Obstructive Airway Diseases  Bronchiectasis Pathologic dilatation of the bronchi, resulting from destruction of the bronchial wall by severe, repeated infections.
  51. 51. 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.
  52. 52. Obstructive Airway Diseases  Bronchiectasis  Dyspnea  Very productive cough  Purulent, foul smelling sputum  Hemoptysis is common
  53. 53. Obstructive Airway Diseases  Bronchiectasis  Frequent pulmonary infections  Right-sided heart failure when advanced  Appear chronically ill - under weight  Chest X-Ray / CT Scan  Airway Dilation
  54. 54. Obstructive Airway Diseases  Bronchiectasis (cont)  Airway obstruction  Spirometry  FEV1 is reduced  Lung Volumes  Hyperinflation  Gas exchange abnormalities  Blood Gases  Hypoxemia, Hypercapnia in advanced cases
  55. 55. Obstructive Airway Diseases  Asthma (Hypereactive Airway Disease) Reversible airway obstruction. Obstruction is characterized by inflammation of the mucosal lining of the airways, bronchospasm, and increased airway secretions.
  56. 56. Obstructive Airway Diseases  Asthma (Hypereactive Airway Disease)  Triggers; agents or events that cause an asthmatic episode  Allergic agents  Pollens, animal dander, house dust mites, molds  Nonallergic agents  Viral infections, exercise, cold air, air pollutants, drugs, food additives, emotional upset  Occupational exposure  Toluene 2,4-diisocyanate (TDI), cotton or wood dusts, grain, metal salts, insecticides
  57. 57. Obstructive Airway Diseases  Asthma (cont)  Airway obstruction  During Attacks  Peak Flow (PEF) is reduced, also used to track response to bronchodilators  Blood Gases  Hypoxemia  During Diagnosis  Airway Resistance (Raw)  Spirometry, Pre/Post Bronchodilator  Bronchial Provocation if airways appear normal
  58. 58. Obstructive Airway Diseases  Cystic Fibrosis An inherited disease that primarily affects the mucus-producing apparatus of the lungs and pancreas.
  59. 59. Obstructive Airway Diseases  Cystic Fibrosis  Airway obstruction  Spirometry  FEV1 used to monitor the progression of the disease  Pulmonary function studies are routinely used to assess lung function following transplantation
  60. 60. Obstructive Airway Diseases  Upper or Large Airway Obstruction (Upper: nose, mouth, pharynx) (Large: Trachea, mainstem bronchi)  Increased work of breathing  Spirometry  Flow-Volume Loop
  61. 61. Restrictive Lung Disease Characterized by:  Reduction in lung volumes  (Vital Capacity (VC) and Total Lung Capacity (TLC) are both reduced below the lower limits of normal.
  62. 62. Restrictive Lung Disease Any process that interferes with the bellows action of the lungs or chest wall can cause restriction.
  63. 63. Restrictive Lung Disease  Idiopathic Pulmonary Fibrosis Characterized by alveolar wall inflammation resulting in fibrosis. Vascular changes are usually associated with pulmonary hypertension.
  64. 64. Restrictive Lung Disease  Idiopathic Pulmonary Fibrosis  IPF often follows  Treatment with bleomycin, cyclophosphamide, methotrexate or amiodarone  Autoimmune diseases  Rheumatoid arthritis, systemic lupus erythematousus (SLE), scleroderma
  65. 65. Restrictive Lung Disease  Idiopathic Pulmonary Fibrosis  Increasing exertional dyspnea  Pulmonary hypertension  Vascular changes  Chest X-Ray  Infiltrates are visible  Honeycombing pattern when advanced
  66. 66. Restrictive Lung Disease  Idiopathic Pulmonary Fibrosis  Spirometry  Reduced VC  Lung Volumes  Reduced TLC
  67. 67. Restrictive Lung Disease  Idiopathic Pulmonary Fibrosis  Gas exchange abnormalities  Reduced DLco  Blood Gases  Hypoxemia; worsens with exertion  Lung compliance  Reduced
  68. 68. Restrictive Lung Disease  Pneumoconiosis Lung impairment caused by inhalation of dusts.  Silicosis – Silica dust  Asbestosis – Asbestos fibers  Coal Worker’s Pneumoconiosis – Coal dust
  69. 69. Restrictive Lung Disease  Pneumoconiosis (cont)  Spirometry  Reduced VC  Lung Volumes  Reduced TLC  Gas exchange abnormalities  Decreased Diffusing Capacity (DLco)  Blood Gases  Hypoxemia
  70. 70. Restrictive Lung Disease  Sarcoidosis Granulomatous disease that affects multiple organ systems. The granuloma found in sarcoidosis is composed of macrophages, epithelioid cells, and other inflammatory cells.
  71. 71. Restrictive Lung Disease  Sarcoidosis  Fatigue  Muscle weakness  Fever  Weight loss  Dyspnea and cough  Chest X-Ray  Enlargement of hilar and mediastinal lymph nodes  Interstitial infiltrates
  72. 72. Restrictive Lung Disease  Sarcoidosis  Spirometry  Reduced VC  Normal Flow Rates  Lung Volumes  Reduced TLC  Gas exchange abnormalities  Decreased Diffusing Capacity (DLco) when advanced  Blood Gases  Normal or hypoxemia
  73. 73. Diseases of Chest Wall and Pleura Disorders involving the chest wall or pleura of the lungs result in restrictive patterns on pulmonary function testing.
  74. 74. Diseases of Chest Wall and Pleura  Kyphoscoliosis Abnormal curvature of the spine both anteriorly (kyphosis) and lateraly (scoliosis).
  75. 75. Diseases of Chest Wall and Pleura  Kyphoscoliosis  Spirometry  Reduced VC  Lung Volumes  Reduced TLC  Gas exchange abnormalities  Decreased Diffusing Capacity (DLco)  Blood Gases (Hypoxemia / Hypercapnia)
  76. 76. Diseases of Chest Wall and Pleura  Obesity Increased mass of the thorax and abdomen interferes with the bellows action of the chest wall, as well as excursion of the diaphragm.
  77. 77. Diseases of Chest Wall and Pleura  Obesity Spirometry  Reduced VC  Normal Flow Rates Lung Volumes  Reduced TLC
  78. 78. Diseases of Chest Wall and Pleura  Obesity  Gas exchange abnormalities  Decreased Diffusing Capacity (DLco)  Blood Gases  Hypoxemia / Hypercapnia  Polycythemia  Pulmonary Hypertension  Cor pulmonale
  79. 79. Diseases of Chest Wall and Pleura  Pleurisy and Pleural Effusion Pleurisy is characterized by deposition of a fibrous exudate on the pleural surface – often associated with pneumonia or cancer. May precede the development of pleural effusion.
  80. 80. Diseases of Chest Wall and Pleura  Pleurisy and Pleural Effusion Plural effusion is an abnormal accumulation of fluid in the pleural space.
  81. 81. Diseases of Chest Wall and Pleura  Pleurisy and Pleural Effusion Spirometry  Reduced VC because of volume loss  Difficulty performing because of pain Lung Volumes  Reduced TLC because of volume loss
  82. 82. Diseases of Chest Wall and Pleura  Pleurisy and Pleural Effusion  Gas exchange abnormalities  DLco – Difficulty performing due to pain  Blood Gases  Large effusions may cause changes
  83. 83. Neuromuscular Disorders Disease that affect the spinal cord, peripheral nerves, neuromuscular junctions, and the respiratory muscles can all cause a restrictive pattern of pulmonary function.
  84. 84. Neuromuscular Disorders  Diaphragmatic paralysis  Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s disease)  Guillain – Barre’ syndrome  Myasthenia gravis
  85. 85. Neuromuscular Disorders  Spirometry  Reduced VC  Lung Volumes  Reduced TLC
  86. 86. Neuromuscular Disorders  Gas exchange abnormalities  Blood Gases  Hypoxemia if involvement is severe  Respiratory alkalosis from hyperventilation  Inspiratory Pressures  MIP - Reduced
  87. 87. Congestive Heart Failure Often caused by left ventricular failure, but may also be associated with cardiomyopathy, congenital heart defects, or left-to-right shunts. In each case, fluid backs up in the lungs.
  88. 88. Congestive Heart Failure  Spirometry  Reduced VC  Lung Volumes  Reduced TLC
  89. 89. Congestive Heart Failure  Gas exchange abnormalities  DLco is reduced  Blood Gases  Hypoxemia  Lung Compliance  Reduced
  90. 90. Lung Transplantation Lung transplantation has been used for patients with CF, primary pulmonary hypertension, and COPD.
  91. 91. Lung Transplantation Pulmonary function testing is used to both assess potential transplant candidates and follow them postoperatively.
  92. 92. Preliminaries to Patient Testing  Patient Preparation  Withholding Medications  Bronchodilator held 4-6 hours prior to test  Smoking Cessation  Should be ceased 24 hours prior to test  Eating should be limited
  93. 93. Preliminaries to Patient Testing  Physical Measurements  Age  Height (arm span if unable to stand)  Weight  Gender  Race or Ethnic Origin
  94. 94. Preliminaries to Patient Testing  Physical Assessment  Breathing Patterns  Breath Sounds  Respiratory Symptoms
  95. 95. Preliminaries to Patient Testing  Pulmonary History  Age, gender, height, weight, race  Current Dx. or reason for test  Family History (immediate family: mother, father, brother, or sister)  Tuberculosis  Emphysema  Chronic Bronchitis  Asthma  Hay fever or allergies  Cancer  Other lung disorders
  96. 96. Preliminaries to Patient Testing  Pulmonary History  Personal History  Tuberculosis  Emphysema  Chronic Bronchitis  Asthma  Recurrent lung infection  Pneumonia or pleurisy  Allergies or hay fever  Chest injury  Chest surgery
  97. 97. Preliminaries to Patient Testing  Occupation  What was your occupation?  How long did you work there?  Have you ever worked in …  Mine, quarry, foundry?  Near gases or fumes?  Dusty environment?
  98. 98. Preliminaries to Patient Testing  Smoking Habits  Have you ever smoked the following:  Cigarettes (how many per day?)  Cigars (how many per day?)  Pipe (how many bowls per day?)  How many years?  Do you still smoke?  Do you live with a smoker?
  99. 99. Preliminaries to Patient Testing  Cough  Do you ever cough?  In the morning?  At night?  Blood?  Phlegm? (when, color, volume)
  100. 100. Preliminaries to Patient Testing  Dyspnea  Do you get short of breath at the following times:  At rest?  On exertion?  At night?
  101. 101. Preliminaries to Patient Testing  Patient Disposition  Dyspneic  Wheezing  Coughing  Cyanotic  Apprehensive  Cooperative
  102. 102. Preliminaries to Patient Testing  Current Medications  Heart, lung, or blood pressure?  Last taken?
  103. 103. Test Performance  Patient Instruction  Many tests are effort dependent  Instruction & coaching very important  Demonstration a must
  104. 104. Test Performance  Patient Instruction  Encouragement during test  Suboptimal effort results in poor reproducibility  Documentation of effort important
  105. 105. Practice / Review Which of the following are indications for performing spirometry? I. Assess the risk of lung resection II. Determine the response to bronchodilator therapy III. Assess the severity of restrictive lung disease IV. Quantify the extent of COPD a. I and IV b. II and III c. I, II, and IV d. II, III, and IV
  106. 106. Practice / Review Which of the following symptoms is an indication for performing spirometry? A. Headache B. Shortness of breath C. Chest pain D. Daytime sleepiness
  107. 107. Practice / Review Which of the following tests would be indicated to assess the severity of a restrictive lung disease? A. Blood gas analysis B. Simple spirometry C. Lung volume determination D. Cardiopulmonary exercise test
  108. 108. Practice / Review Which of the following tests would be indicated in the evaluation of a patient exposed to dust including asbestos? A. Shunt study B. DLco C. Methacholine challenge D. Airway Resistance
  109. 109. Practice / Review A 17-year old female complains of chest tightness and cough after soccer practice. These symptoms are most consistent with which of the following? A. Emphysema B. Congestive heart failure C. Asthma D. Cystic fibrosis
  110. 110. Practice / Review Which of the following diseases often results in an obstructive pattern when simple spirometry is performed? A. Sarcoidosis B. Idiopathic pulmonary fibrosis C. Pleurisy D. Chronic bronchitis
  111. 111. Practice / Review  Lung volumes measured by closed – circuit He dilution may be expected to show a reduced FRC in which of the following? A. Emphysema B. Asthma C. Pulmonary fibrosis D. Upper airway obstruction
  112. 112. Practice / Review Which of the following should a pulmonary function technologist do before performing spirometry? a. Limit feedback to the patient to limit placebo effect b. Explain the physiologic basis of the test c. Demonstrate how to correctly perform the test maneuver d. Explain the exact number of efforts that will be required for the test
  113. 113. Practice / Review Pulmonary function testing is usually contraindicated in which of the following conditions? A. Untreated pneumothorax B. Congestive heart failure C. Cyanosis D. Tuberculosis
  114. 114. Practice / Review  In which of the following diseases is air-trapping likely to occur? A. Acute exacerbation of asthma B. Sarcoidosis C. Asbestosis D. Emphysema E. B & C F. A & D
  115. 115. Practice / Review Which of the following correctly describes appropriate physical measurements before pulmonary function testing? I. Actual body weight should be used to calculate predicted values II. Standing height should be measured when the patient is barefoot III. Arm span should be used instead of height for a patient with kyphosis IV. Age should be recorded to the nearest decade (10 years) a. I only b. II and III c. I, II, and IV d. I, II, III, and IV

×