PULMONARY FUNCTION TESTS

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Pulmonary Function Testing

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Presentation transcript:

PULMONARY FUNCTION TESTS Effort dependent tests - Forced expiratory volumes/flow rates Effort independent tests - Relaxed vital capacity - Helium static lung volume Gas diffusion tests - CO transfer factor - Arterial blood gases (resting) - SaO2 during exercise

DYNAMIC LUNG VOLUMES (SPIROMETRY) Volume (L) vs Time (s) curve - Forced expiratory manoeuvre: from TLC to RV Forced expiratory volume in 1 s : FEV1 (L) Forced vital capacity : FVC (L) Forced expiratory ratio : FER (FEV1/FVC%)

EXPIRATORY FLOW RATES Flow -volume curve: dv/dt (flow-rate) from volume time curve - Flow rate (L/s) plotted against forced expiratory volume (L) - from TLC to RV

EXPIRATORY FLOW RATES Shape of expiratory flow-volume curve: Volume dependent expiratory airway closure - asthma, chronic bronchitis Pressure dependent expiratory airway closure - emphysema

EXPIRATORY FLOW RATES From flow-volume curve: Peak expiratory flow rate (PEFR) - expressed in L/min (L/s x 60) - also measurable with simple linear peak flow meter Forced expiratory flow rate (FEFR) at a % of FVC - FEFR 50%, FEFR 75%

Obstructive Restrictive PEFR  Normal FEV1    FVC Normal(Asthma)  (COPD) FEV1/FVC ratio < 75% > 75% FEV1 response > 15% (Asthma) to 2-agonist <15% (COPD) No response

BRONCHIAL CHALLENGE TESTING Exercise Methacholine/Histamine - marker of airway hyperreactivity - concentration to produce 20%  FEV1 Allergens/Chemicals - early and late responses - diagnosis of occupational asthma

EXERCISE TESTING FEV1 or PEF post exercise - Asthma SaO2 during exercise in interstitial lung disease - to monitor treatment response Differentiate cardiac vs respiratory dyspnoea - heart rate vs oxygen uptake vs ventilatory rate

STATIC LUNG VOLUMES Effort independent test Helium dilution / N2 washout : functional residual capacity (RV = FRC - ERV) (TLC = VC + RV) TLC in hyperinflation (Emphysema) TLC in restrictive lung disease Gas trapping in COPD: (RV/TLC%) (RVC - FVC/RVC%) TLC adds little to RVC and FVC

TRANSFER FACTOR (DIFFUSION CAPACITY) CO diffusion across alveolar-capillary barrier TLCO - total lung transfer for CO TLCO: Anaemia, Emphysema, Int lung disease, Pulmonary oedema, Pulmonary emboli To monitor treatment response in In lung disease

SUMMARY OF LUNG FUNCTION PATTERNS Parameter Obstructive Restrictive PEFR  Normal FEV1   FVC Normal in asthma  Reduced in COPD FEV1/FVC% <75% >75% Gas transfer (TLCO)  in Emphysema Normal in Asthma FEV1 response to  2-agonist > 15% in asthma No response < 15% in COPD 