2. The inventor of spirometer: John Hutchinson (1846)

3. Ventilation and V/Q ratio

4. Branching of the
airways

5. Static lung volumes IC

6. Slow (SVC) and forced (FVC) vital capacity in
health and disease

7. Elastic forces and airway diameter

8. Antropometric data determine reference values
Age
Height
Sex
Race

9. Spirogram and flow-volume loop

10. Asthma - reversible airway obstruction
spirogram
F-V loop
FVC: 2.4 (73 ref%) – 3.1 (92 ref%)
FEV1: 1.0 (36 ref%) – 1.5 (52 ref%)
FEV1/FVC: 42% - 49%

11. COPD = postbronchodilator FEV1/FVC<70% (irreversible airway obstruction

12. Lung fibrosis FVC: 75 ref% TLC: 63 ref% FEV1: 78 ref% RV: 57 ref%
FEV1/FVC: 87% DLCO: 34 ref%

13. Heart failure
FVC: 55 ref%
FEV1: 49 ref%
FEV1/FVC: 74%

14. Typical spirograms and
flow-volume loops

15. Etiology of obstructive and restrictive ventilatory
disorders

16. Pathophysiology of the variable lesion of the
major (proximal) airways

17. Typical F-V loops in cases of lesions of
the major airways

20. Flow-volume loops
A:normal, B:obstructive, C:restrictive

21. Inhalative provocation test with metacholin

22. Asthma – reversible obtruction
healthy
asthmatic

23. COPD

24. COPD
(emphysema!!!)

25. Lung fibrosis

26. Use of spacer with MDI

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

32. Resistance

33. Volume dependence of airway resistance (Raw)
SRaw (cmH2O/L/sec) 1 2 4 6 8 3
Lung Volume (liters)
TLC RV

34. Compliance

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

39. Arterial
Blood
Gas

40. Respiratory and metabolic shifts
chronic
acute
acute
chronic

41. Exercise tests in lung diseases
Exercise-induced asthma (EIA) - FEV1
Interstitial lung disease (ILD) - SAT
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)

42. Mechanism of
exercise-induced
Hypoxaemia
(decreased
contact time)

45. Noninvasive determination of lactate threshold by the
V(entilatory)-slope method