Pulmonary Function Tests Other tests of lung function:1. Lung mechanics -Resistance -Compliance 2. Distribution of Ventilation (N2 delta) 3. Maximal Respiratory.

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Presentation transcript:

Pulmonary Function Tests Other tests of lung function:1. Lung mechanics -Resistance -Compliance 2. Distribution of Ventilation (N2 delta) 3. Maximal Respiratory Pressures (MIP, MEP)

V/Q ratio

V/Q mismatch (3-compartment model)

Lung volumes and capacities

How to measure FRC (RV,TLC) ? Nitrogen washout method Inert gas dilution technique Plethysmography

Resistance

Volume dependence of airway resistance (Raw) S Raw (cmH 2 O/L/sec) Lung Volume (liters) TLC RV

Compliance

Ventilatory Mechanics: Healthy P cw P RS PLPL % VC Pressure (cmH 2 O)

Ventilatory Mechanics: Healthy % VC Pressure (cmH 2 O)  resistive WOB ΔP ΔVΔP ΔV S Raw  as lung volume  because the airways distend as the lungs inflate, and bigger airways have lower resistance (*Poiseuilles’ Law*). The opposite is also true, of course! S Raw (cmH 2 O/L/sec) Lung Volume (liters) TLC RV ΔP ΔV  elastic WOB ΔP ΔV elastic and resistive work of breathing is minimized when tidal breathing occurs within the compliant portion of the respiratory systems P-V curve

VTVT IC Begin Exercise IC Ventilatory Mechanics: Healthy

TLC RVRV Volume (liters) Pressure (cmH 2 0) EELV Ventilatory Mechanics: Healthy  EILV  IRV  IC VTVT  EELV

IRV Dynamic hyperinflation during exercise

Diffusion capacity (DLCO, DLCO/VA, Tco, Kco)

Mechanism of hypoxaemia

Hypoxaemia, hypercapnia in clinical cases

acute chronic Respiratory and metabolic shifts acute chronic

Exercise tests in lung diseases 1.Exercise-induced asthma (EIA) - FEV1 2.Interstitial lung disease (ILD) - SAT 3.Exercise tolerance in rehabilitation (COPD) - cardiopulmonary exercise (CPX). Important variables: - work rate (watts), SpO2, ABG - VO2, VCO2, RQ, VE - lactate threshold (LT) - breathing reserve (1-VEmax/MVV) - heart rate reserve (1-HRmax/220-age)

Mechanism of exercise-induced hypoxaemia

Noninvasive determination of lactate threshold by the V-slope method

Exercise training 1. Endurance –leg, arm -Wmax % min, 3x/weeek 2. Strength -max. weight 80% - 8 repetitions, 3 series - 3x/week 3. Respiratory muscle - selected cases (reduced breathing reserve) - Müller manouver, >PImax 30%

Respiration during exercise ( Wasserman K, 1999 )