1. PULMONARY FUNCTION TESTING Pat Allan Pulmonary, CC, Sleep, NeuroCC, Int Pulmonary Medicine

2. Spirometry Lung volumes (plethysmography) Diffusion capacity COPD Asthma Vocal cord dysfunction Fixed airway obsruction Tracheomalacia Interstitial Lung disease Neuromuscular disease PULMONARY FUNCTION TESTING Methacholine Oscillimetry Exhaled nitric oxide Thoracic ultrasound

3. Requires a cooperative patient Meet American Thoracic Society standards Asthma COPD Vocal cord dysfunction SPIROMETRY

4. FEV must improve by 12%

5. Asthma and COPD What do they have in common? Airway obstruction – Lowers FEV1 – Leaves the total amount of air blown out unchanged (FVC) – FEV/FVC ration falls to < 70% – 12% improvement in FEV suggests asthma SPIROMETRY

6. SPIROMETRY IN COPD

7. SPIROMETRY Normal flow volume curve

8. Obstruction on a flow volume curve SPIROMETRY

9. Flow volume curve SPIROMETRY

10. Flow volume curve SPIROMETRY

12. Lung volumes (plethysmography) Diffusion capacity Interstitial Lung disease Neuromuscular disease Pulmonary hypertension LUNG VOLUMES & DIFFUSION CAPACITY

13. V 1 =V box P box /P 1

15. Low total lung volume lung volumes (restrictive lung disease) – Interstitial lung disease – Neuromuscular disease – Obesity Residual volume – ILD – normal – NM disease – increased – Obesity – decreased Inspiratory capacity – Low in neuromuscular disease LUNG VOLUMES

16. Measures carbon monoxide diffusion Low – Any pulmonary vascular disease pHTN, CHF, PE – Any parenchyaml destructive disease (COPD or ILD) High – Fresh hemoglobin in the alveoli DIFFUSION CAPACITY

19. IMPULSE OSCILLOMETRY

22. EXHALED NITRIC OXIDE

24. THIS OFFICIAL CLINICAL PRACTICE GUIDELINE OF THE AMERICAN THORACIC SOCIETY (ATS) WAS APPROVED BY THE ATS BOARD OF DIRECTORS, MAY 2011

28. DYSPNEA PFT/FVL/NO OSCILLOMETRY METHACHOLINE THORACIC US ECHO OR CT IMAGING