Pulmonary function tests & Lung volumes & capacities Prof. Omer Abdel Aziz.

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Presentation transcript:

Pulmonary function tests & Lung volumes & capacities Prof. Omer Abdel Aziz

Problem (2) Amal 20 years old, came early in the morning to the out patient with shortness of breath and cough. She had common cold for the last three days. On chest examination the doctor heard wheezes, a sign of bronchoconsriction.

1. Explain her symptoms in relation to the bronchial tone. The doctor referred her for lung function tests. The technician measured her height and performed spirometry which showed: PEFR: 300 L/m, FEV1: 1.5 L, FVC: 2.5 L (70% of predicted) 2. Why has he measured her height? 3. Comment on the spirometry values.

He gave her salbutamol inhaler and after 10 min repeated the spirometry which showed: FEV1 2 L, PEFR 400 L/min. 4. How does this drug act? 5. What do you call this test? 6. What is your interpretation of the results?

ABG showed: pH=7.47, PaO2=90 mmHg, PaCO2=37mmHg. 7. According to these results she has two mild conditions. What are they? 8. Which type of each? 9. What is your diagnosis? 10. How would you treat her?

Objectives Definitions of lung volumes Definitions of lung capacities Pulmonary function tests.

Q Respiratory muscles do not fatigue due to ……. Ventilation at the base of the lungs is …… than the apex because………

Lung volumes & capacities Differ according to 1. Age 2. Sex 3. Height 4. Ethnicity Measured by spirometers & vitalographs.

Lung volumes Tidal volume: is the amount of air that moves into the lung with each normal inspiration.(about 500 ml in adults) Inspiratory reserve volume: amount of air inspired by a max. insp. after a normal insp.

Expiratory reserve volume: amount of air expired by a max. exp. after a normal exp. Residual volume: amount of air left in the lungs after max. exp. Respiratory minute volume: (Pulmonary ventilation) amount of air inspired per min.

Capacities Vital capacity: amount of air expired by a max exp. after a max. insp. Inspiratory capacity: amount of air inspired by a max. insp. after a normal exp. Expiratory capacity: max exp. after normal insp. Total lung capacity: amount of air present in lungs after max. insp.

Pulmonary function tests Function: 1. Diagnosis. 2. Follow up. 3. Compensation. 4. Preoperative assessment.

PFT 1. Spirometry: pocket, microlab, computerized. - FEV1: forced expiratory volume in the first second. - FVC : forced vital capicity. - Peak expiratory flow rate PEFR. - Maximum expiratory flow loop. 2. Peak flow meter: PEFR. 3. Blood gases. 4. Transfer factor. 5. Static lung volumes.

PFT in asthma diagnosis 1. FEV1 / FVC <70% (obstructive LD- asthma, chronic bronchitis). If both are low the ratio will be normal (Restrictive LD- fibrosis). Peak flow meter: I. Spontaneous variability 20%. II. Reversibility 15% III.Provocation: a. Exercise 20% b. Histamine challenge. c. Hypertonic saline.

Quiz A patient with nocturnal cough showed the following findings in PFT: FEV1 2L, FVC=4L, FEV1 after salbutamol inhaler=2.5L, his diagnosis is: 1. Chronic bronchitis. 2. Emphysema. 3. Obstructive lung disease. 4. Asthma. 5. Restrictive lung disease.

Summary Lung volumes and capacities are important parameters for assessing lung funtion. Pulmonary function tests are used for diagnosis, followup, occupational compensation and presurgical assessment. For asthma diagnosis reversibility test, provocation tests and spontaneous variations are used.

Research Bashir AA & Musa OA (2005): Normal spirometric values in Sudan. Int. J. TB & LD 1:9:161 Bashir AA & Musa OA (2005): Lung function and airways responsiveness during pregnancy. Int. J. TB & LD, 11:9:1:160. Musa OA, Elsayed NM & Abdel Magid HH (2007): Provocation by hypertonic saline for asthma diagnosis in Sudan. WAM 134.

Thanks