1. Led by Graham Atherton Supported by Georgina Powell, Marie Kirwan & Debbie Kennedy NAC Centre Manager Chris Harris Talks given by Nigel Clayton Lung function facility North West Lung Centre UHSM, Manchester National aspergillosis centre UHSM Manchester Support Meeting for Aspergillosis Patients Fungal Research Trust

2. Welcome to Wythenshawe Hospital

4. The lungs contain more than 300 million air sacs called alveoli.

5. If your lungs could be opened up and laid flat they would cover the area of a tennis court.

6. Children whose parents smoke are 1.5 times more likely to suffer from asthma.

7. Lung disease kills 30,000 people a year in the UK.

8. Smoking is the single largest preventable cause of death and illness in the UK.

10. How we do it

11. What does it all mean?Nigel Clayton Respiratory Physiologist Wythenshawe Hospital

12. What is Aspergillus? Aspergillus is a fungus whose spores are present in the air we breathe It does not normally cause illness However an individual with a weakened immune status may be susceptible to aspergillus infection

13. What is Aspergillosis? Aspergillosis describes a number of diseases involving both infection by and growth of the aspergillus fungi, as well as allergic responses against aspergillus. Aspergillosis can occur in a variety of body organs, in both humans and animals. Infections can effect any area of the body, but by far the most common are the lungs and sinuses. Aspergillosis includes allergic bronchopulmonary aspergillosis (ABPA), aspergilloma and invasive pulmonary aspergillosis (IPA) Incidence rate of 1-2 per 100,000 per year.

14. Diagnosis Depending on patient history a number of tests may be requested from the following list: A blood test - Specific IgE (allergy) test A skin test to measure sensitivity to Aspergillus allergens X-rays or CT scan of the chest Culture and analysis of a sputum (mucus) sample Culture of tissue fluids e.g. lung fluid called bronchoalveolar lavage (BAL) A bronchoscopy – where a flexible tube is passed down into the lungs to sample or biopsy a tissue mass (if present) in a lung cavity Lung Function Tests

15. The Respiratory System Main function to supply the body with O2 and remove CO2 Respiration is actually 4 distinct processes: Ventilation – Movement of air into & out of the lungs External Respiration – Gas exchange between blood and air-filled chambers of the lungs Transport of Gases – Cardio-vascular circulation Internal Respiration – Gas exchange between systemic blood and the tissue cells

17. Begins at the transition from terminal bronchioles to respiratory bronchioles – which contain scattered alveoli.

19. Lung Function Tests measure How much air you can take into your lungs. This amount is compared to that of other people your age, height, and sex. This allows your doctor to see whether you're in the normal range. How much air you can blow out of your lungs and how fast you can do it. How well your lungs deliver oxygen to your blood. How strong your breathing muscles are.

20. What is the purpose of a lung function test? To detect the general type and severity of a lung disorder rather than defining the specific cause of problems Useful for assessing change in lung function over time (improvement / deterioration)

21. Lung Function tests most often used Spirometry. This test measures how much air you can breathe in and out. It also measures how fast you can blow air out. Lung volume measurement. This test, in addition to spirometry, measures how much air you have left in your lungs after you breathe out completely. Lung diffusing capacity. This test measures how well oxygen passes from your lungs to your bloodstream.

22. Tests to Measure Oxygen Level Pulse oximetry and arterialised blood gases are two tests used to measure the oxygen level in the blood. They're also called blood oxygen tests. Pulse oximetry measures blood oxygen levels using an infrared light. If the pulse oximeter oxygen level is less than 95% the physiologist will often take a sample of blood from the earlobe. A more accurate check can be made of the oxygen level and carbon dioxide level (waste gas).

23. Measuring Oxygen Saturation Pulse oximetry measures blood oxygen levels using an infrared light. Heart rate may also be monitored.

24. Arterialised Blood Gas Test Measures the oxygen and carbon dioxide levels in arterial blood

26. Spirometry FEV1 / VC ratio = 4.2 x 100 = 88% 4.8 5 4 3 Volume (L) 2 FVC 4.8 FEV1 4.2 1 0 1 6 2 3 4 5 Time(s)

27. Spirometry

28. Practical Spirometry measurement showing: Volume against time Flow against volume

29. Cross-Sections of Bronchioles Normal Mucus Bronchospasm Inflamation

31. Question: How much faster will container A empty compared to container B ? A B 2 cm 1 cm

32. Volumes and Capacities

35. Practical Lung volume measurement using oxygen breathing to washout and measure the volume of air in the lungs

37. Obstruction Severe FEV1 29% predicted Marked scooping on FV loop Hyperinflation increased FRC, RV and RV/TLC% Ventilation / perfusion mismatch Reduced DLCO Reduced KCO Hyperinflation confirmed by body box data Low PO2, normal PCO2

38. Thank you