SlideShare a Scribd company logo
1 of 44
Download to read offline
Pulmonary Function Testing:
The Basics
Dene W. Daugherty, DO
Department of Surgery
Pulmonary Function Testing
Tidal Volume (TV)
Pulmonary Function Testing
Inspiratory Reserve Volume (IRV)
Pulmonary Function Testing
Expiratory Reserve Volume (ERV)
Pulmonary Function Testing
Vital Capacity (VC)
Pulmonary Function Testing
Total Lung Capacity (TLC)
Objectives
 Identify the components
 Describe the indications
 Interpretation of results
 Recognize common patterns
 Clinical applications
The Purpose of PFT’s
To provide a quantifiable,
reproducible measurement of lung
function
Description
 Spirometry
 Flow Volume Loop
 Bronchodilator response
 Lung volumes
 Diffusion capacity (DLCO)
 Bronchoprovocation testing
 Maximum respiratory pressures
 Simple and complex cardiopulmonary exercise
testing
Indications — Diagnostic
 Evaluation of signs and symptoms
- SOB, exertional dyspnea, chronic cough
 Screening at-risk populations
 Evaluation of occupational symptoms
 Monitoring pulmonary drug toxicity
 Abnormal study
- CXR, EKG, ABG, hemoglobin
 Preoperative assessment
Indications — Prognostic
■ Assess severity
■ Follow response to therapy
■ Determine further treatment goals
■ Referral for surgery
■ Disability
Spirometry
 Simple, office-based
 Measures flow, volumes
 Volume vs. Time
 Can determine:
- Forced expiratory volume in one second (FEV1)
- Forced vital capacity (FVC)
- FEV1/FVC
- Forced expiratory flow 25%-75% (FEF25-75)
Lung Volumes
Spirometry
Obstructive Pattern
■ Decreased FEV1
■ Decreased FVC
■ Decreased FEV1/FVC
- <70% predicted
■ FEV1 used to follow severity in COPD
Obstructive Lung Disease
 Asthma
 COPD
- chronic bronchitis
- emphysema
 Bronchiectasis
 Bronchiolitis
 Upper airway obstruction
Restrictive Pattern
 Decreased FEV1
 Decreased FVC
 FEV1/FVC normal or increased
Restrictive Lung Disease
 Pleural
 Parenchymal
 Chest wall
 Neuromuscular
Spirometry Patterns
Bronchodilator Response
 Degree to which FEV1 improves with inhaled
bronchodilator
 Documents reversible airflow obstruction
 Considered a significant response if:
- FEV1 increases by 12% and >200ml
 Request if obstructive pattern on spirometry
Flow Volume Loop
 “Spirogram”
 Measures forced inspiratory and
expiratory flow rate
 Augments spirometry results
 Indications: evaluation of upper airway
obstruction (stridor, unexplained dyspnea)
Flow Volume Loop
Upper Airway Obstruction
 Variable intrathoracic obstruction
 Variable extrathoracic obstruction
 Fixed obstruction
Upper Airway Obstruction
Lung Volumes
 Measurement:
- helium
- nitrogen washout
- body plethsmography
 Indications:
- Diagnose restrictive component
- Differentiate chronic bronchitis from
emphysema
Lung Volumes – Patterns
 Obstructive
- TLC > 120% predicted
- RV > 120% predicted
 Restrictive
- TLC < 80% predicted
- RV < 80% predicted
Diffusing Capacity
 Diffusing capacity of lungs for Carbon Monoxide
 Measures ability of lungs to transport inhaled gas
from alveoli to pulmonary capillaries
 Depends on:
- alveolar—capillary membrane
- hemoglobin concentration
- cardiac output
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
DLCO — Indications
 Differentiate asthma from emphysema
 Evaluation and severity of restrictive lung
disease
 Early stages of pulmonary hypertension
 Pre-operative assessment: < 60% correlates to
poor prognosis following lung resection
 Not done for routine evaluation or follow-up, it’s
expensive
Bronchoprovocation
 Useful for diagnosis of asthma in the
setting of normal pulmonary function tests
 Common agents:
- Methacholine and Histamine
 Diagnostic if ≥20% decrease in FEV1
Quick Reference Obstructive Disease Algorithm
↓
SYMPTOMS
PFTs
OBSTRUCTION?
YES NO
TREAT
BRONCHOPROVOCATION
Obstruction
TREAT
No Obstruction
Other Diagnosis
↓
↓
↓ ↓
↓
↓ ↓
Interpretation
 What is the clinical concern?
 What is “normal” or “baseline”?
 Did the test or equipment meet American
Thoracic Society (ATS) criteria?
 Don’t forget to look at the flow volume loop.
Obstructive Pattern — Evaluation
 Spirometry
 FEV1, FVC: decreased
 FEV1/FVC: decreased (<70% predicted)
 FV Loop “scooped”
 Lung Volumes
 TLC, RV: increased
 Responds to Bronchodilator
Restrictive Pattern – Evaluation
 Spirometry
 FVC, FEV1: decreased
 FEV1/FVC: normal or increased
 FV Loop “witch’s hat” pattern
 DLCO decreased
 Lung Volumes
 TLC, RV: decreased
 Muscle pressures may be helpful
PFT Patterns
 Emphysema
 FEV1/FVC <70%
 “Scooped” FV curve
 TLC increased
 Increased compliance
 DLCO decreased
 Chronic Bronchitis
 FEV1/FVC <70%
 “Scooped” FV curve
 TLC normal
 Normal compliance
 DLCO usually normal
PFT Patterns
 Asthma
 FEV1/FVC normal or decreased
 DLCO normal or increased
PFTs may be normal  bronchoprovocation test
Question
Which of the following is used to follow disease severity in
COPD patients?
a. Total lung capacity (TLC)
b. Degree of responsiveness to bronchodilators
c. Forced vital capacity (FVC)
d. Forced expiratory volume in 1 second (FEV1)
e. Diffusing capacity (DLCO)
Answer
Which of the following is used to follow disease severity in
COPD patients?
a. Total lung capacity (TLC)
b. Degree of responsiveness to bronchodilators
c. Forced vital capacity (FVC)
d. Forced expiratory volume in 1 second (FEV1)
e. Diffusing capacity (DLCO)
Question
A 36yo F, non-smoker, presents to your office for follow-up of
‘recurrent bronchitis.’ You suspect asthma and decide to
order spirometry. Which of the following would you
include in your prescription for testing?
a. Diffusing Capacity (DLCO)
b. If no obstruction present, perform trial of bronchodilator
c. If no obstruction present, perform methacholine challenge
d. Flow volume loop
e. b and c
Answer
A 36yo F, non-smoker, presents to your office for follow-up of
‘recurrent bronchitis.’ You suspect asthma and decide to
order spirometry. Which of the following would you
include in your prescription for testing?
a. Diffusing Capacity (DLCO)
b. If no obstruction present, add trial of bronchodilator
c. If no obstruction present, perform methacholine challenge
d. Flow volume loop
e. b and c
Question
A 68yo M is admitted to the ICU with acute respiratory
distress. A CXR obtained in the ED demonstrates
bilateral pulmonary infiltrates, and his DLCO is
elevated. What is the most likely diagnosis?
a. Pulmonary edema
b. Aspiration pneumonitis
c. Pulmonary emboli
d. Alveolar hemorrhage
e. Interstitial lung disease
Answer
A 68yo M is admitted to the ICU with acute respiratory
distress. A CXR obtained in the ED demonstrates
bilateral pulmonary infiltrates, and his DLCO is
elevated. What is the most likely diagnosis?
a. Pulmonary edema
b. Aspiration pneumonitis
c. Pulmonary emboli
d. Alveolar hemorrhage
e. Interstitial lung disease
References
1. Aboussouan LS, Stoller JK: Flow volume loops. UpToDate, 2006.
2. Bahhady IJ, Unterborn J: Pulmonary function tests: an update. Consultant.
2003.
3. Barreiro, TJ, Perillo I: An approach to interpreting spirometry. Am Fam
Physician. 2004 Mar 1;69(5):1107-14.
4. Chesnutt MS, Prendergast TJ. Current Medical Diagnosis and Treatment.
New York: Appleton and Lange, 2006.
5. Enright PL: Diffusing capacity for carbon monoxide. UpToDate, 2007.
6. Enright PL: Overview of pulmonary function testing in adults. UpToDate,
2007.
7. Irvin CG: Bronchoprovocation testing. UpToDate, 2006.
8. West JB. Respiratory Physiology: The Essentials. Lippincot Williams &
Wilkins, 2000.
Pulmonary Function Testing

More Related Content

What's hot

Clinical Symptoms of Respiratory System
Clinical Symptoms of Respiratory SystemClinical Symptoms of Respiratory System
Clinical Symptoms of Respiratory SystemSaswat Subhankar
 
Simple Interpretation of Pulmonary Function tests
Simple Interpretation of Pulmonary Function testsSimple Interpretation of Pulmonary Function tests
Simple Interpretation of Pulmonary Function testsGamal Agmy
 
Pulmonary function tests for PGs
Pulmonary function tests for PGsPulmonary function tests for PGs
Pulmonary function tests for PGsSwapnil Jaiswal
 
interstitial lung diseases
interstitial lung diseasesinterstitial lung diseases
interstitial lung diseasesikramdr01
 
Pulmonary Flow Volume Loops.. Dr.Padmesh
Pulmonary Flow Volume Loops.. Dr.PadmeshPulmonary Flow Volume Loops.. Dr.Padmesh
Pulmonary Flow Volume Loops.. Dr.PadmeshDr Padmesh Vadakepat
 
Obstructive Lung Diseases
Obstructive Lung DiseasesObstructive Lung Diseases
Obstructive Lung Diseasesautumnpianist
 
Obesity Hypoventilation Syndrome
Obesity Hypoventilation Syndrome Obesity Hypoventilation Syndrome
Obesity Hypoventilation Syndrome Ade Wijaya
 
Allergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku Joseph
Allergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku JosephAllergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku Joseph
Allergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku JosephDr.Tinku Joseph
 
Cheyne stokes breathing
Cheyne stokes breathingCheyne stokes breathing
Cheyne stokes breathingAyesha Bukhari
 
Jugular Venous Pressure (JVP) Jugular Venous Pulse
Jugular Venous Pressure (JVP) Jugular Venous PulseJugular Venous Pressure (JVP) Jugular Venous Pulse
Jugular Venous Pressure (JVP) Jugular Venous PulseArun Vasireddy
 
pulmonary Function Test Interpreation
pulmonary Function Test Interpreation pulmonary Function Test Interpreation
pulmonary Function Test Interpreation Sarfraz Saleemi
 
Idiopathic interstitial pneumonias
Idiopathic interstitial pneumoniasIdiopathic interstitial pneumonias
Idiopathic interstitial pneumoniasArvind Ghongane
 
pulmonary Function Test
pulmonary Function Testpulmonary Function Test
pulmonary Function TestRekha Marbate
 

What's hot (20)

Pulmonary function tests
Pulmonary function testsPulmonary function tests
Pulmonary function tests
 
Clinical Symptoms of Respiratory System
Clinical Symptoms of Respiratory SystemClinical Symptoms of Respiratory System
Clinical Symptoms of Respiratory System
 
Simple Interpretation of Pulmonary Function tests
Simple Interpretation of Pulmonary Function testsSimple Interpretation of Pulmonary Function tests
Simple Interpretation of Pulmonary Function tests
 
Flow volume loop
Flow volume loopFlow volume loop
Flow volume loop
 
Pulmonary function tests for PGs
Pulmonary function tests for PGsPulmonary function tests for PGs
Pulmonary function tests for PGs
 
interstitial lung diseases
interstitial lung diseasesinterstitial lung diseases
interstitial lung diseases
 
Pulmonary Flow Volume Loops.. Dr.Padmesh
Pulmonary Flow Volume Loops.. Dr.PadmeshPulmonary Flow Volume Loops.. Dr.Padmesh
Pulmonary Flow Volume Loops.. Dr.Padmesh
 
SARCOIDOSIS
SARCOIDOSISSARCOIDOSIS
SARCOIDOSIS
 
Obstructive Lung Diseases
Obstructive Lung DiseasesObstructive Lung Diseases
Obstructive Lung Diseases
 
Obesity Hypoventilation Syndrome
Obesity Hypoventilation Syndrome Obesity Hypoventilation Syndrome
Obesity Hypoventilation Syndrome
 
Asthma biomarkers: FENO
Asthma biomarkers: FENOAsthma biomarkers: FENO
Asthma biomarkers: FENO
 
PULMONARY EOSINOPHILIAS
PULMONARY EOSINOPHILIASPULMONARY EOSINOPHILIAS
PULMONARY EOSINOPHILIAS
 
Allergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku Joseph
Allergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku JosephAllergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku Joseph
Allergic Broncho Pulmonary Aspergillosis (ABPA) by Dr.Tinku Joseph
 
Hypersensitivity pneumonitis
Hypersensitivity pneumonitisHypersensitivity pneumonitis
Hypersensitivity pneumonitis
 
Cheyne stokes breathing
Cheyne stokes breathingCheyne stokes breathing
Cheyne stokes breathing
 
Jugular Venous Pressure (JVP) Jugular Venous Pulse
Jugular Venous Pressure (JVP) Jugular Venous PulseJugular Venous Pressure (JVP) Jugular Venous Pulse
Jugular Venous Pressure (JVP) Jugular Venous Pulse
 
pulmonary Function Test Interpreation
pulmonary Function Test Interpreation pulmonary Function Test Interpreation
pulmonary Function Test Interpreation
 
Idiopathic interstitial pneumonias
Idiopathic interstitial pneumoniasIdiopathic interstitial pneumonias
Idiopathic interstitial pneumonias
 
pulmonary Function Test
pulmonary Function Testpulmonary Function Test
pulmonary Function Test
 
Diffusing Capacity Tests
Diffusing Capacity TestsDiffusing Capacity Tests
Diffusing Capacity Tests
 

Viewers also liked

pulmonary function test’s
 pulmonary function test’s pulmonary function test’s
pulmonary function test’sLokender Yadav
 
Laxman lung diffusion-capacity
Laxman lung diffusion-capacityLaxman lung diffusion-capacity
Laxman lung diffusion-capacitysonilaxman
 
14. pulmonary-function-tests
14. pulmonary-function-tests14. pulmonary-function-tests
14. pulmonary-function-testsSuhail Khan
 
Pulmonary Function Test.ppt
Pulmonary Function Test.pptPulmonary Function Test.ppt
Pulmonary Function Test.pptShama
 
Acute Respiratory Distress-Syndrome_0
Acute Respiratory Distress-Syndrome_0Acute Respiratory Distress-Syndrome_0
Acute Respiratory Distress-Syndrome_0MAGED ABULMAGD
 
Acute Respiratory Distress-Syndrome_0
Acute Respiratory Distress-Syndrome_0Acute Respiratory Distress-Syndrome_0
Acute Respiratory Distress-Syndrome_0MAGED ABULMAGD
 
Pft lecture for residents mine
Pft lecture for residents minePft lecture for residents mine
Pft lecture for residents minekatejohnpunag
 
Functional assessment-in-pulmonary-medicine
Functional assessment-in-pulmonary-medicineFunctional assessment-in-pulmonary-medicine
Functional assessment-in-pulmonary-medicineAmmedicine Medicine
 
Bedside assessment of pulmonary function by prof. mridul panditrao
Bedside assessment of pulmonary function by prof. mridul panditraoBedside assessment of pulmonary function by prof. mridul panditrao
Bedside assessment of pulmonary function by prof. mridul panditraoProf. Mridul Panditrao
 
Pruebas de función pulmonar
Pruebas de función pulmonarPruebas de función pulmonar
Pruebas de función pulmonarSandru Acevedo MD
 
Tracheostomy:When to perform and How to manage?
Tracheostomy:When to perform and How to manage?Tracheostomy:When to perform and How to manage?
Tracheostomy:When to perform and How to manage?Gamal Agmy
 
Orthotic overview
Orthotic overviewOrthotic overview
Orthotic overviewMd. Rana
 
Bed side pulmonary function tests 7
Bed side pulmonary function tests 7Bed side pulmonary function tests 7
Bed side pulmonary function tests 7dr_sekharr
 
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease Ashraf ElAdawy
 
Ventilatory support
Ventilatory supportVentilatory support
Ventilatory supportHusni Ajaj
 

Viewers also liked (20)

pulmonary function test’s
 pulmonary function test’s pulmonary function test’s
pulmonary function test’s
 
Laxman lung diffusion-capacity
Laxman lung diffusion-capacityLaxman lung diffusion-capacity
Laxman lung diffusion-capacity
 
14. pulmonary-function-tests
14. pulmonary-function-tests14. pulmonary-function-tests
14. pulmonary-function-tests
 
Pulmonary Function Test.ppt
Pulmonary Function Test.pptPulmonary Function Test.ppt
Pulmonary Function Test.ppt
 
Acute Respiratory Distress-Syndrome_0
Acute Respiratory Distress-Syndrome_0Acute Respiratory Distress-Syndrome_0
Acute Respiratory Distress-Syndrome_0
 
Acute Respiratory Distress-Syndrome_0
Acute Respiratory Distress-Syndrome_0Acute Respiratory Distress-Syndrome_0
Acute Respiratory Distress-Syndrome_0
 
Pft lecture for residents mine
Pft lecture for residents minePft lecture for residents mine
Pft lecture for residents mine
 
Functional assessment-in-pulmonary-medicine
Functional assessment-in-pulmonary-medicineFunctional assessment-in-pulmonary-medicine
Functional assessment-in-pulmonary-medicine
 
ECI COPD Course Lecture 3
ECI COPD Course Lecture 3ECI COPD Course Lecture 3
ECI COPD Course Lecture 3
 
Bedside assessment of pulmonary function by prof. mridul panditrao
Bedside assessment of pulmonary function by prof. mridul panditraoBedside assessment of pulmonary function by prof. mridul panditrao
Bedside assessment of pulmonary function by prof. mridul panditrao
 
Pruebas de función pulmonar
Pruebas de función pulmonarPruebas de función pulmonar
Pruebas de función pulmonar
 
Tracheostomy:When to perform and How to manage?
Tracheostomy:When to perform and How to manage?Tracheostomy:When to perform and How to manage?
Tracheostomy:When to perform and How to manage?
 
Orthotic overview
Orthotic overviewOrthotic overview
Orthotic overview
 
Bed side pulmonary function tests 7
Bed side pulmonary function tests 7Bed side pulmonary function tests 7
Bed side pulmonary function tests 7
 
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease
 
Tracheostomy Tube
Tracheostomy Tube Tracheostomy Tube
Tracheostomy Tube
 
Copd n comorbidities
Copd n comorbiditiesCopd n comorbidities
Copd n comorbidities
 
Oxygen Therapy
Oxygen TherapyOxygen Therapy
Oxygen Therapy
 
Respiratory Failure
Respiratory FailureRespiratory Failure
Respiratory Failure
 
Ventilatory support
Ventilatory supportVentilatory support
Ventilatory support
 

Similar to Pulmonary Function Testing

Similar to Pulmonary Function Testing (20)

Pulmonary function testing
Pulmonary function testingPulmonary function testing
Pulmonary function testing
 
Pulmonary function testing
Pulmonary function testingPulmonary function testing
Pulmonary function testing
 
Bài Giảng Hô Hấp Ký
Bài Giảng Hô Hấp KýBài Giảng Hô Hấp Ký
Bài Giảng Hô Hấp Ký
 
Common pulmonary functions and interpretation
Common pulmonary functions and interpretationCommon pulmonary functions and interpretation
Common pulmonary functions and interpretation
 
Pulmonary function exam
Pulmonary function examPulmonary function exam
Pulmonary function exam
 
Pulmonary Function Tests Nonotes
Pulmonary Function Tests NonotesPulmonary Function Tests Nonotes
Pulmonary Function Tests Nonotes
 
Pulmonary function test
Pulmonary function testPulmonary function test
Pulmonary function test
 
Pulmonary function test
Pulmonary function testPulmonary function test
Pulmonary function test
 
Pulmonary function testing
Pulmonary function testingPulmonary function testing
Pulmonary function testing
 
Pulmonary Function Test's
Pulmonary Function Test's Pulmonary Function Test's
Pulmonary Function Test's
 
INTERPRETATION OF PFTs.pdf
INTERPRETATION OF PFTs.pdfINTERPRETATION OF PFTs.pdf
INTERPRETATION OF PFTs.pdf
 
INVESTIGATION IN RESPIRATORY SYSTEM
INVESTIGATION IN RESPIRATORY SYSTEMINVESTIGATION IN RESPIRATORY SYSTEM
INVESTIGATION IN RESPIRATORY SYSTEM
 
Pulmonary function test
Pulmonary function testPulmonary function test
Pulmonary function test
 
Pft
PftPft
Pft
 
Diagnosis of COPD
Diagnosis of COPDDiagnosis of COPD
Diagnosis of COPD
 
Interpretation of Clinical Lab Data [PFTs] for Newbies.pdf
Interpretation of Clinical Lab Data [PFTs] for Newbies.pdfInterpretation of Clinical Lab Data [PFTs] for Newbies.pdf
Interpretation of Clinical Lab Data [PFTs] for Newbies.pdf
 
Pulmonary function tests
Pulmonary function testsPulmonary function tests
Pulmonary function tests
 
Updates in Diagnosis of COPD
Updates in Diagnosis of COPDUpdates in Diagnosis of COPD
Updates in Diagnosis of COPD
 
Pulmonary Function Testing 2023.pdf
Pulmonary Function Testing 2023.pdfPulmonary Function Testing 2023.pdf
Pulmonary Function Testing 2023.pdf
 
Spirometry
 Spirometry Spirometry
Spirometry
 

More from Dene W. Daugherty

More from Dene W. Daugherty (11)

Surgical Wound Classification
Surgical Wound ClassificationSurgical Wound Classification
Surgical Wound Classification
 
Venous Disease: Peripheral and Embolic
Venous Disease: Peripheral and EmbolicVenous Disease: Peripheral and Embolic
Venous Disease: Peripheral and Embolic
 
Lung Cancer: Diagnosis, Staging, and Treatment
Lung Cancer: Diagnosis, Staging, and TreatmentLung Cancer: Diagnosis, Staging, and Treatment
Lung Cancer: Diagnosis, Staging, and Treatment
 
Hiatal Hernias
Hiatal HerniasHiatal Hernias
Hiatal Hernias
 
Gastric Neoplasms
Gastric NeoplasmsGastric Neoplasms
Gastric Neoplasms
 
Esophagus
EsophagusEsophagus
Esophagus
 
Chest Tube In-Service
Chest Tube In-ServiceChest Tube In-Service
Chest Tube In-Service
 
Acid Base Disturbances
Acid Base DisturbancesAcid Base Disturbances
Acid Base Disturbances
 
Abdominal Comparment Syndrome
Abdominal Comparment SyndromeAbdominal Comparment Syndrome
Abdominal Comparment Syndrome
 
Ballistics in Trauma
Ballistics in TraumaBallistics in Trauma
Ballistics in Trauma
 
Surgical Sutures and Suturing Techniques
Surgical Sutures and Suturing TechniquesSurgical Sutures and Suturing Techniques
Surgical Sutures and Suturing Techniques
 

Recently uploaded

High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 

Recently uploaded (20)

High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 

Pulmonary Function Testing

  • 1. Pulmonary Function Testing: The Basics Dene W. Daugherty, DO Department of Surgery
  • 6. Pulmonary Function Testing Total Lung Capacity (TLC)
  • 7. Objectives  Identify the components  Describe the indications  Interpretation of results  Recognize common patterns  Clinical applications
  • 8. The Purpose of PFT’s To provide a quantifiable, reproducible measurement of lung function
  • 9. Description  Spirometry  Flow Volume Loop  Bronchodilator response  Lung volumes  Diffusion capacity (DLCO)  Bronchoprovocation testing  Maximum respiratory pressures  Simple and complex cardiopulmonary exercise testing
  • 10. Indications — Diagnostic  Evaluation of signs and symptoms - SOB, exertional dyspnea, chronic cough  Screening at-risk populations  Evaluation of occupational symptoms  Monitoring pulmonary drug toxicity  Abnormal study - CXR, EKG, ABG, hemoglobin  Preoperative assessment
  • 11. Indications — Prognostic ■ Assess severity ■ Follow response to therapy ■ Determine further treatment goals ■ Referral for surgery ■ Disability
  • 12. Spirometry  Simple, office-based  Measures flow, volumes  Volume vs. Time  Can determine: - Forced expiratory volume in one second (FEV1) - Forced vital capacity (FVC) - FEV1/FVC - Forced expiratory flow 25%-75% (FEF25-75)
  • 15. Obstructive Pattern ■ Decreased FEV1 ■ Decreased FVC ■ Decreased FEV1/FVC - <70% predicted ■ FEV1 used to follow severity in COPD
  • 16. Obstructive Lung Disease  Asthma  COPD - chronic bronchitis - emphysema  Bronchiectasis  Bronchiolitis  Upper airway obstruction
  • 17. Restrictive Pattern  Decreased FEV1  Decreased FVC  FEV1/FVC normal or increased
  • 18. Restrictive Lung Disease  Pleural  Parenchymal  Chest wall  Neuromuscular
  • 20. Bronchodilator Response  Degree to which FEV1 improves with inhaled bronchodilator  Documents reversible airflow obstruction  Considered a significant response if: - FEV1 increases by 12% and >200ml  Request if obstructive pattern on spirometry
  • 21. Flow Volume Loop  “Spirogram”  Measures forced inspiratory and expiratory flow rate  Augments spirometry results  Indications: evaluation of upper airway obstruction (stridor, unexplained dyspnea)
  • 23. Upper Airway Obstruction  Variable intrathoracic obstruction  Variable extrathoracic obstruction  Fixed obstruction
  • 25. Lung Volumes  Measurement: - helium - nitrogen washout - body plethsmography  Indications: - Diagnose restrictive component - Differentiate chronic bronchitis from emphysema
  • 26. Lung Volumes – Patterns  Obstructive - TLC > 120% predicted - RV > 120% predicted  Restrictive - TLC < 80% predicted - RV < 80% predicted
  • 27. Diffusing Capacity  Diffusing capacity of lungs for Carbon Monoxide  Measures ability of lungs to transport inhaled gas from alveoli to pulmonary capillaries  Depends on: - alveolar—capillary membrane - hemoglobin concentration - cardiac output
  • 28. 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
  • 29. DLCO — Indications  Differentiate asthma from emphysema  Evaluation and severity of restrictive lung disease  Early stages of pulmonary hypertension  Pre-operative assessment: < 60% correlates to poor prognosis following lung resection  Not done for routine evaluation or follow-up, it’s expensive
  • 30. Bronchoprovocation  Useful for diagnosis of asthma in the setting of normal pulmonary function tests  Common agents: - Methacholine and Histamine  Diagnostic if ≥20% decrease in FEV1
  • 31. Quick Reference Obstructive Disease Algorithm ↓ SYMPTOMS PFTs OBSTRUCTION? YES NO TREAT BRONCHOPROVOCATION Obstruction TREAT No Obstruction Other Diagnosis ↓ ↓ ↓ ↓ ↓ ↓ ↓
  • 32. Interpretation  What is the clinical concern?  What is “normal” or “baseline”?  Did the test or equipment meet American Thoracic Society (ATS) criteria?  Don’t forget to look at the flow volume loop.
  • 33. Obstructive Pattern — Evaluation  Spirometry  FEV1, FVC: decreased  FEV1/FVC: decreased (<70% predicted)  FV Loop “scooped”  Lung Volumes  TLC, RV: increased  Responds to Bronchodilator
  • 34. Restrictive Pattern – Evaluation  Spirometry  FVC, FEV1: decreased  FEV1/FVC: normal or increased  FV Loop “witch’s hat” pattern  DLCO decreased  Lung Volumes  TLC, RV: decreased  Muscle pressures may be helpful
  • 35. PFT Patterns  Emphysema  FEV1/FVC <70%  “Scooped” FV curve  TLC increased  Increased compliance  DLCO decreased  Chronic Bronchitis  FEV1/FVC <70%  “Scooped” FV curve  TLC normal  Normal compliance  DLCO usually normal
  • 36. PFT Patterns  Asthma  FEV1/FVC normal or decreased  DLCO normal or increased PFTs may be normal  bronchoprovocation test
  • 37. Question Which of the following is used to follow disease severity in COPD patients? a. Total lung capacity (TLC) b. Degree of responsiveness to bronchodilators c. Forced vital capacity (FVC) d. Forced expiratory volume in 1 second (FEV1) e. Diffusing capacity (DLCO)
  • 38. Answer Which of the following is used to follow disease severity in COPD patients? a. Total lung capacity (TLC) b. Degree of responsiveness to bronchodilators c. Forced vital capacity (FVC) d. Forced expiratory volume in 1 second (FEV1) e. Diffusing capacity (DLCO)
  • 39. Question A 36yo F, non-smoker, presents to your office for follow-up of ‘recurrent bronchitis.’ You suspect asthma and decide to order spirometry. Which of the following would you include in your prescription for testing? a. Diffusing Capacity (DLCO) b. If no obstruction present, perform trial of bronchodilator c. If no obstruction present, perform methacholine challenge d. Flow volume loop e. b and c
  • 40. Answer A 36yo F, non-smoker, presents to your office for follow-up of ‘recurrent bronchitis.’ You suspect asthma and decide to order spirometry. Which of the following would you include in your prescription for testing? a. Diffusing Capacity (DLCO) b. If no obstruction present, add trial of bronchodilator c. If no obstruction present, perform methacholine challenge d. Flow volume loop e. b and c
  • 41. Question A 68yo M is admitted to the ICU with acute respiratory distress. A CXR obtained in the ED demonstrates bilateral pulmonary infiltrates, and his DLCO is elevated. What is the most likely diagnosis? a. Pulmonary edema b. Aspiration pneumonitis c. Pulmonary emboli d. Alveolar hemorrhage e. Interstitial lung disease
  • 42. Answer A 68yo M is admitted to the ICU with acute respiratory distress. A CXR obtained in the ED demonstrates bilateral pulmonary infiltrates, and his DLCO is elevated. What is the most likely diagnosis? a. Pulmonary edema b. Aspiration pneumonitis c. Pulmonary emboli d. Alveolar hemorrhage e. Interstitial lung disease
  • 43. References 1. Aboussouan LS, Stoller JK: Flow volume loops. UpToDate, 2006. 2. Bahhady IJ, Unterborn J: Pulmonary function tests: an update. Consultant. 2003. 3. Barreiro, TJ, Perillo I: An approach to interpreting spirometry. Am Fam Physician. 2004 Mar 1;69(5):1107-14. 4. Chesnutt MS, Prendergast TJ. Current Medical Diagnosis and Treatment. New York: Appleton and Lange, 2006. 5. Enright PL: Diffusing capacity for carbon monoxide. UpToDate, 2007. 6. Enright PL: Overview of pulmonary function testing in adults. UpToDate, 2007. 7. Irvin CG: Bronchoprovocation testing. UpToDate, 2006. 8. West JB. Respiratory Physiology: The Essentials. Lippincot Williams & Wilkins, 2000.

Editor's Notes

  1. The 6min walk test is great to evaluate physical function and can be used to assess therapeutic response in COPD and idiopathic pulmonary fibrosis (IPF) patients. If oxygen sats fall by &amp;gt;4% (ending below 93%), this indicates significant desaturation, and need confirmatory ABGs. Maximum respiratory pressures are used to identify a neuromuscular cause of restrictive lung disease. Simple and complex cardiopulmonary exercise testing will not be addressed in this lecture.
  2. Preop assessment is rarely to tell surgeon not to operate, but to prepare for pulmonary complications such as pneumonia, prolonged mechanical ventilation, etc. Also for screening: this includes all current and former smokers &amp;gt;45yoa, known COPD or asthma pts, also those scheduled for thoracic or upper abdominal surgery. If mod-severe obstruction identified and surgery can be delayed, can start prophylactic program of pulmonary hygiene, stop smoking, give inhaled bronchodilators or steroids, etc.
  3. Image source: http://en.wikipedia.org/wiki/Main_Page
  4. Image source: http://www.nationalasthma.org.au/html/management/spiro_book/index.asp
  5. Image source: http://www.spirxpert.com/index.html FEV1 is decreased out of proportion to FVC, which causes the ratio to decrease as well.
  6. This is not a complete list, just some of the most common diseases that should be on your differential for obstructive lung disease.
  7. Image source: http://www.spirxpert.com/index.html FEV1 decreases in proportion to decrease in FVC, so ratio remains normal or even slightly increased
  8. Restrictive lung disease is made up of intrinsic lung disease (causes inflammation and scarring (interstitial lung diseases) or fill the airspaces w/ debris, inflammation (exudate); extrinsic causes are chest wall or pleural diseases that mechanically compress the lung and prevent expansion. Neuromuscular causes decreases ability of respiratory muscles to inflate and deflate the lungs.
  9. Lack of observed response to bronchodilator does not preclude use, b/c patients may have symptomatic benefit. Can give 6-8wk trial of bronchodilator and/or inhaled corticosteroids (ICS) and reassess clinically, can also obtain FEV1 at that time. HOLD MDI THE MORNING PRIOR TO TESTING.
  10. Have patient breath out at max effort, then breath in quickly at max effort, creates a loop w/ differing patterns. Upper airway = pharynx, larynx, trachea.
  11. Image source: http://www.nationalasthma.org.au/html/management/spiro_book/index.asp Vocal cord dysfunction: variable extrathoracic obstruction. Tracheal stenosis: fixed obstruction (hx frequent intubations). Rapid rise to peak flow rate, followed by fall in flow as pt exhales toward residual volume. Inspiratory curve is symmetrical.
  12. Example of someone grabbing trachea—causes problems w/ inspiration and expiration = fixed obstruction Vocal cord dysfunction: variable extrathoracic obstruction. Endobronchial carcinoma: variable intrathoracic obstruction. (Rare to diagnose this on flow volume loop).
  13. FVC is decreased in both obstructive and restrictive disease, so usually need to obtain lung volumes to see if restrictive component present (increased TLC).
  14. Measure of gas exchange at alveolar-capillary membrane. Changes in DLCO are one of the earliest signs of interstitial lung disease (ILD).
  15. Pulmonary vascular disease = pulmonary emboli, pulmonary HTN. Low DLCO is also a major predictor of desaturation during exercise.
  16. So you have restrictive disease by spirometry and lung volumes. You get a DLCO and see it is normal. Thinking back to your differential diagnosis of restrictive lung disease (what are the four things on your differential?), what can you probably rule out? Answer = Interstitial lung disease. This is where you would order max respiratory pressures, to evaluate for NM disease. Max inspiratory pressures are recorded as patientt is breathing through a blocked tube, also done for expiration. Should be decreased in NM disease.
  17. Can always send patient home and tell them to come back when having symptoms, but this delays diagnosis. Another alternative is measure peak flow variability at home. If suspected asthma but has not responded to therapy, think of obtaining flow volume loop to see if there is vocal cord dysfunction = variable extrathoracic obstruction.
  18. Now we’re going to put it all together…
  19. Don’t need a DLCO, but if were decreased would make you think emphysema, if normal then chronic bronchitis.
  20. IF restrictive pattern, you’re going to want to get DLCO b/c it tells you whether the restriction is due to parenchymal disease (which will change your management), or NM, pleural or CW disease
  21. Remember that DLCO should be normal in chronic bronchitis because it affects the more proximal airways which is not where your gas exchange takes place.
  22. In COPD patients, the FEV1 is used to classify severity of obstructive lung disease, and followed to assess progression.
  23. This is kind of tricky b/c technically the recommendation is if no obstruction, then no bronchodilator (can omit this since costs an extra $40-50). Flow volume loops will usually come w/ your testing but you need to ask if you want the full max inspiratory and expiratory curves.
  24. Intrinsic lung diseases that cause inflammation or scarring of the lung tissue OR that fill the airspaces w/ exudate or debris (pneumonitis or pneumonia) can cause decreased lung volumes and DLCO but NOT increased DLCO. This only comes from blood in the alveoli, polycythemia, L to R shunt or possibly asthma. So if you see bilateral pulmonary infiltrates on CXR and you get a DLCO that is elevated, then there is only one answer alveolar hemorrhage.