Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
A technique used to measure air flow in and out of the lungs.
A recording of lung volumes and capacities defined by the respiratory process. These recordings may be static (untimed) or dynamic (timed).
Assesses the integrated mechanical functions of lungs, chest wall and respiratory muscles.
The gold standard for diagnosis, assessment and monitoring of COPD.
Better than PEFR (which is effort dependent) for demonstrating airway obstruction in BA.
The most commonly used PFT
Pulmonary function testing is the process of having the patient perform specific inspiratory and expiratory maneuvers while breathing in and out of tubing attached to the equipment that measure a variety of variables
Application of PEP devices in Cardiorespiratory physiotherapy.
It includes types of PEP devices and their uses in physiotherapy..
It stands for positive expiratory pressure.
It includes spirometry, flutter, rc cornet, acapella, etc.
useful in various cardiorespiratory disorders like COPD, asthma , cystic fibrosis, respiratory failure etc.
A technique used to measure air flow in and out of the lungs.
A recording of lung volumes and capacities defined by the respiratory process. These recordings may be static (untimed) or dynamic (timed).
Assesses the integrated mechanical functions of lungs, chest wall and respiratory muscles.
The gold standard for diagnosis, assessment and monitoring of COPD.
Better than PEFR (which is effort dependent) for demonstrating airway obstruction in BA.
The most commonly used PFT
Pulmonary function testing is the process of having the patient perform specific inspiratory and expiratory maneuvers while breathing in and out of tubing attached to the equipment that measure a variety of variables
Pulmonary function tests (PFT) are series of tests that measure lung function and aid in the management of patients with respiratory disease.
They are performed using standardized equipment and can be used for diagnosis, prognostication, management and follow-up of patients with pulmonary pathology.
Although PFT may not identify the exact pathology, it broadly classifies respiratory disorders as either obstructive or restrictive. In this session , the role of PFT in the measurement of lung mechanics and diagnosis of various diseases will be discussed in detail.
PULMONARY FUNCTION TESTS - LAB DATA INTERPRETATIONLincyAsha
PULMONARY FUNCTION TESTS
LAB DATA INTERPRETATION
CLINICAL PHARMACY PRACTICE
M.PHARMACY
PHARMACY PRACTICE
1ST YEAR
Pulmonary function tests are a series of tests performed to examine a patient’s respiratory system and identify the severity of pulmonary impairment.
These tests are performed to measure a patient’s lung volume, capacity, flow rate and gas exchange.
This allows medical professionals to obtain an accurate diagnosis and determine the best course of medical intervention for the patient.
In general there are two types of lung disorders that these tests can be used to assess
Obstructive lung diseases
Restrictive lung diseases
1.OBSTRUCTIVE LUNG DISEASES
It include conditions that make it difficult to exhale air out of the lungs
This results in shortness of breath that occurs from narrowing and constriction of the airways and causes the patient to have decreased flow rates. Eg. COPD, Asthma
2.RESTRICTIVE LUNG DISEASES
It include conditions that make it difficult to fully fill the lungs with air during inhalation.
When the lungs aren’t fully able to expand it causes the patient to have decreased lung volumes. Eg. Pulmonary fibrosis, interstitial lung disease
Pulmonary function tests would be indicated for the following:
On healthy patients as part of a routine physical exam
Evaluate signs and symptoms of lung disease
Diagnosis of certain medical conditions
Measure current stage of disease and evaluate its progress
Assess how a patient is responding to different treatments
Determine patient’s condition before surgery to assess the risk of respiratory complications
Screen people who are at risk of pulmonary disease
Determine how much a patient’s airways have narrowed due to disorders
In certain types of work environments to assess the health of employees.
Additionally PFTs may be indicated for the following
Chronic lung conditions
Restrictive airway problems
Asthma
COPD
Shortness of breath
Impairment or disability
Early morning wheezing
Chest muscle weakness
Lung cancer
Respiratory infections
STATIC LUNG VOLUMES
Lung volume is the amount of air breathed by an individual under a specific condition.
1.Tidal Volume (TV)
It is the volume of air inspired or expired during normal breathing at rest.
2.Inspiratory Reserve Volume (IRV)
It is the volume of air inspired with maximum effort over and above the normal tidal volume.
3.Expiratory Reserve Volume (ERV)
It is the volume of air expired forcefully after a normal respiration.
4.Residual Volume (RV)
It is the volume of air remaining in the lungs after a forceful expiration
STATIC LUNG CAPACITIES
1.Inspiratory capacity (IC)
It is the amount of air a person can inspire forcefully after a normal respiration.
IC = TV+IRV
2.Functional Residual Capacity (FRC)
It is the amount of air that remains in the lungs at the end of normal respiration.
FRC = ERV+RV
3.Vital Capacity (VC)
It is the maximum volume of air exhaled forcefully from the lungs after a maximum inspiration.
4.Total Lung Capacity
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
2. INTRODUCTION
• Pulmonary function tests or lung function tests are useful in assessing
the functional status of the respiratory system both in physiological
and pathological conditions.
• MEASURE:
(1) Dynamic flow rates of gases through the airways,
(2) Lung volumes and capacities, and
(3) The ability of the lungs to diffuse gases
• Identify the presence and type of pulmonary impairments and the degree of
pulmonary disease present.
3. INDICATIONS
• To identify and quantify changes in pulmonary function
• To evaluate need and quantify therapeutic effectiveness
• To perform epidemiologic surveillance for pulmonary disease
• To assess patients for risk for postoperative pulmonary complications
• To determine pulmonary disability
4. Contraindications
• acute, unstable cardiopulmonary problems, such as
• hemoptysis,
• pneumothorax,
• myocardial infarction,
• pulmonary embolism, and
• patients with acute chest or abdominal pain should not be tested.
• Patients who have nausea and who have recently vomited
• Recent cataract removal surgery
6. LUNG VOLUMES
• TIDAL VOLUME: Tidal volume (TV) is the volume of air breathed in
and out of lungs in a single normal quiet respiration. Tidal volume
signifies the normal depth of breathing.
• Normal value: 500ml
• INSPIRATORY RESERVE VOLUME: Inspiratory reserve volume (IRV) is
an additional volume of air that can be inspired forcefully after the
end of normal inspiration.
• Normal value: 3,300 ml
7. • EXPIRATORY RESERVE VOLUME: Expiratory reserve volume is the
additional volume of air that can be expired out forcefully, after
normal expiration.
• Normal value: 1000 ml
• RESIDUAL VOLUME: Residual volume (RV) is the volume of air
remaining in lungs even after forced expiration. Normally, lungs
cannot be emptied completely even by forceful expiration. Some
quantity of air always remains in the lungs even after the forced
expiration.
• Normal value: 1200ml
8. LUNG CAPACITIES
• INSPIRATORY CAPACITY: Inspiratory capacity (IC) is the maximum
volume of air that is inspired after normal expiration. It includes tidal
volume and inspiratory reserve volume.
• IC = TV + IRV
500 + 3,300 = 3,800 mL
• VITAL CAPACITY: Vital capacity (VC) is the maximum volume of air that
can be expelled out forcefully after a deep inspiration. VC includes
inspiratory reserve volume, tidal volume and expiratory reserve
volume.
• VC = IRV + TV + ERV
• = 3,300 + 500 + 1,000 = 4,800 mL
9. • FUNCTIONAL RESIDUAL CAPACITY: Functional residual capacity (FRC)
is the volume of air remaining in lungs after normal expiration.
Functional residual capacity includes expiratory reserve volume and
residual volume.
• FRC = ERV + RV = 1,000 + 1,200 = 2,200 mL
• TOTAL LUNG CAPACITY:
• Total lung capacity (TLC) is the volume of air present in lungs after a deep
inspiration. It includes all the volumes.
• TLC = IRV + TV + ERV + RV
• = 3,300 + 500 + 1,000 + 1,200 = 6,000 mL
13. SPIROMETRY
• SPIROMETRY: Measures of breathing
• Spiro means breathing
• Metry means measurement
• Spirometry is a method of assessing lung function by measuring the
total volumes of air the patient can expel from the lungs after a
maximal inhalation.
• It measure how much and how quickly air can be expelled following
deep breath
• Spirometry is an effort-dependent test that requires careful patient
instruction, understanding, coordination, and cooperation
14.
15. • Measures:
• Forced vital capacity (FVC)
• Forced expiratory volume in one second. (FEV1)
• FEF25-75 - Forced Expiratory Flow between 25% to 75% of forced vital capacity
• peak expiratory flow rate (PEFR)
• Fev1/FVC
16. Forced vital capacity
• Volume of air that can be maximally and forcibly expelled from the
lung after a deep inhalation.
• Depends on:
• Lung elasticity
• Size of airways
• Resistance to flow along these airways
17.
18. Fev1/FVC
• Expressed as percentage
• In normal adult, the ratio ranges from 75%-85%.
• Childrens may have higher flow.
• Obstructive condition: Decreased
• Restrictive condition: Normal or Increase
19. PEFR
• Maximum rate at which air can be expired after a deep inspiration.
• Normal values: 400L/min
• Measured by peak flow meter
• Pefr reduced in obstructive disease more than restrictive disease.
20. Before the test- avoid
• Alcohol – 4hours
• Large meal -2 hours
• Smoking – 1hr
• Vigorous exercise- 30 minutes
• Wear loose, comfortable clothing
• Avoid use of bronchodilators
21. Prior to test
• Gain verbal consent
• Check for contraindication
• Gain accurate height and weight
• Patient should sit comfortable and upright
• Technique in detail should be explained
22. Spirometry maneuver
• A few normal tidal respiration
• Then deep inspiration
• Breath holding,
• Very forced and fast expiration as hard as patient can
• Then deep, quick and full inspiration.
• Repeat atleast 3 times.
• Take the best readings.
23. Forced vital capacity
• Possible causes of a decrease in FVC:
• 1. The problem may be with the lung itself. There may have been a
resectional surgical procedure or areas of collapse. Various other
conditions can render the lung less expandable, such as fibrosis,
congestive heart failure, and thickened pleura. Obstructive lung
diseases may reduce the FVC by limiting deflation of the lung.
• 2. The problem may be in the pleural cavity, such as an enlarged
heart, pleural fluid, or a tumor encroaching on the lung.
24. • 3. Another possibility is restriction of the chest wall. The lung cannot
inflate and deflate normally if the motion of the chest wall (which
includes its abdominal components) is restricted.
• 4. Inflation and deflation of the system require normal function of the
respiratory muscles, primarily the diaphragm, the intercostal muscles,
and the abdominal muscles.
25.
26. FEV1
• Fev1 is the volume of air exhaled in the first second of the FVC test.
• Normal value depends on patient age, size, sex and race.
• When flow rates are slowed by airway obstruction, as in emphysema,
the FEV1 is decreased by an amount that reflects the severity of the
disease.
• The FVC may also be reduced, although usually to a lesser degree.
27. FEV1 /FVC
• The FEV1 /FVC ratio is generally expressed as a percentage.
• The amount exhaled during the first second is a fairly constant
fraction of the FVC, irrespective of lung size.
• In the normal adult, the ratio ranges from 75% to 85%, but it
decreases somewhat with aging.
• Children have high flows for their size, and thus, their ratios are
higher, up to 90%.
28. • Significance:
• It aids in quickly identifying persons with airway obstruction
• The ratio is valuable for identifying the cause of a low FEV
• In pulmonary restriction, the FEV1 and FVC are decreased
proportionally; hence, the ratio is in the normal range, as in the case
of fibrosis.
29. • How to determine whether airway obstruction or a restrictive:
• A low FEV1 with a normal ratio usually indicates a restrictive process
• A low FEV1 and a decreased ratio signify a predominantly obstructive process.
30.
31.
32. MAXIMAL VOLUNTARY VENTILATION
• The test for maximal voluntary ventilation (MVV) is an athletic event.
• The subject is instructed to breathe as hard and fast as possible for 10
to 15 seconds.
• The result is extrapolated to 60 seconds and reported in liters per
minute.
• A low MVV can occur in obstructive disease, in restrictive disease, in
neuromuscular disease, in heart disease, in a patient who does not
try or who does not understand, or in a frail patient
33.
34. MAXIMAL INSPIRATORY FLOW
• With spirometer systems that measure both expiratory and
inspiratory flows, the maximal inspiratory flow (MIF) can be
measured.
• The subject exhales maximally (the FVC test) and then immediately
inhales as rapidly and completely as possible, producing an
inspiratory curve.
• The combined expiratory and inspiratory FV curves form the FV loop.
• Increased airway resistance decreases both maximal expiratory flow
and MIF
35.
36.
37.
38. Reversibility
• Based on the initial results of baseline spirometry, additional testing
of pulmonary mechanics is often desirable.
• If the baseline test indicates airway obstruction, determining the
reversibility of the obstruction is indicated.
• RTs also use the concept of reversibility when evaluating routine
therapy by performing spirometry before and after therapy.
• In the laboratory, the FVC maneuver is often repeated after the
patient has received a bronchodilator administered by small volume
nebulizer or metered dose inhaler.
39. • Reversibility of the airway obstruction indicates effective therapy.
• Although improvement in other measurements of pulmonary
function is sometimes used, reversibility is defined as a 15% or
greater improvement in FEV1 and at least a 200-ml increase in FEV1.
• % Improvement = PostFEV1 – PreFEV1/ PreFEV1 * 100
40. Bronchoprovocation
• When the patient’s history suggests episodic symptoms of
hyperreactive airways and airway obstruction, such as seasonal or
exercise-induced wheezing, and the results of baseline spirometry are
normal, performing a bronchial provocation may be indicated.
• Bronchial provocation testing uses an agent to stimulate a
hyperreactive airway response and to create airway obstruction.
• The procedure usually begins with the patient inhaling a normal
saline aerosol and then repeating the FVC maneuver.
• Some very sensitive patients exhibit hyperreactive airways with saline
alone; a positive response to saline is defined as a decrease in FEV1 of
10% or greater.
41. • The methacholine provocation protocol systematically exposes the patient
to increasing dosages of methacholine. Usually starting with a low dose of
0.03 mg/ml, patients inhale methacholine aerosol and then repeat the FVC
maneuver.
• A positive response to methacholine is defined as a decrease in FEV1 of
20% or greater.
• If a positive response does not occur, the methacholine dose is doubled to
0.06 mg/ml, and the FVC maneuver is repeated.
• The process of “double-dosing” and performing FVC maneuvers continues
until there is a positive response or until the full dose, 16 mg/ml, is given.
• If a positive response occurs, treatment with a fast-acting bronchodilator is
indicated, and sometimes administering O2 is helpful
42. Static lung volume
• The three most commonly used methods of measuring the FRC are
• Nitrogen washout,
• Inert gas dilution, and
• Plethysmography.
43. Helium Dilution
• The helium dilution technique for measuring lung volumes uses a closed,
rebreathing circuit.
• This technique is based on the assumptions that the patient has no He in
his or her lungs, and that an equilibration of He can occur between the
spirometer and the lungs.
• First, volume (V1) and concentration (C1) of He are measured at the
beginning of the test.
• Next, the valve is turned to connect the patient to the breathing circuit,
usually at the resting expiratory level of the FRC.
• The patient is connected to the He-air mixture, and the concentration of
He is diluted slowly by the patient’s lung volume.
44. • The patient is connected to the He-air mixture, and the concentration
of He is diluted slowly by the patient’s lung volume.
• Wearing nose clips, the patient breathes normally in the closed
circuit.
• Exhaled CO2 is absorbed with soda lime, and O2 is added at a rate
equal to the patient’s O2 consumption.
• A constant volume is maintained to ensure accurate He concentration
measurements.
• The patient rebreathes the gas in the system until equilibrium of He
concentration is established.
45. • In healthy patients and patients with a small FRC, equilibration occurs
in 2 to 5 minutes.
• Patients with obstructive lung disease may require 20 minutes to
equilibrate because of slow gas mixing in the lungs.
46.
47. Nitrogen Washout Method
• The nitrogen washout technique uses a nonrebreathing or open
circuit.
• The technique is based on the assumptions that the N concentration
in the lungs is 78% and in equilibrium with the atmosphere, that the
patient inhales 100% O2, and that the O2 replaces all of the N in the
lungs.
• Similar to the He dilution technique, the patient is connected to the
system at FRC.
• The patient’s exhaled gas is monitored, and its volume and N
percentage are measured.
48.
49. Plethysmography
• The principle of plethysmography is based on Boyle’s law, which
states that the product of the pressure (P) and volume (V) of a gas is
constant under constant temperature conditions.
• The whole-body plethysmograph consists of a sealed chamber in
which the patient sits.
• Pressure transducers (electronic manometers) measure pressure at
the mouth and in the chamber.
• The plethysmographic method measures essentially all the gas in the
lung, including that in poorly ventilated areas.
50.
51. Diffusing Capacity
• The third major category of pulmonary function testing is measuring
the ability of the lungs to transfer gases across the alveolar-capillary
membrane.
• Vgas = DL× − ( P1-p2 )
• Vgas = Amount of the gas transferred into the lungs
• P1 = Partial pressure of the gas in the alveolus
• P2 = Partial pressure of the gas in the pulmonary capillary
52. • Carbon monoxide (CO) is the gas normally used to measure the DL.
• The diffusing capacity of the lung for carbon monoxide (DLCO) is expressed
in ml/min/mm Hg under standard temperature and pressure and dry
conditions.
• CO is used as the transfer gas because CO is similar to O2 in important
ways.
• CO and O2 have similar molecular weights and solubility coefficients.
Similar to O2, CO also chemically combines with hemoglobin (Hb).
• CO has a very high affinity for Hb and diffuses rapidly into the pulmonary
blood, keeping the pulmonary capillary partial pressure of CO near zero.
53. An average normal value is 20 to 30 mL/min/mm Hg; that is, 20 to 30
mL CO is transferred per minute per mm Hg difference in the driving
pressure of CO, namely, the difference between the partial pressure of
CO in alveolar air and blood.
The normal values depend on age, sex , and size.
54. Causes of Increased Dlco
• 1. Supine position: Rarely is the Dlco measured while the subject is supine,
but this position produces a higher value because of increased perfusion
and blood volume of the upper lobes.
• 2. Exercise: It is difficult to hold one’s breath for 10 seconds during exercise.
When this is done just after exercise, however, Dlco is increased because of
increased pulmonary blood volumes.
• 3. Asthma: Some patients with asthma, especially when symptom-free,
have an increased Dlco, possibly because of more uniform distribution of
pulmonary blood flow.
• 4. Obesity: The Dlco can be increased in obese persons, especially those
who are massively obese. This increase is thought to be due to an
increased pulmonary blood volume.