1. 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)

2. V/Q ratio

3. V/Q mismatch (3-compartment model)

4. Lung volumes and capacities

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

10. Resistance

11. Volume dependence of airway resistance (Raw) S Raw (cmH 2 O/L/sec) 1 02 468 2 3 4 Lung Volume (liters) TLC RV

12. Compliance

15. Ventilatory Mechanics: Healthy P cw P RS PLPL 100 80 60 40 20 0 -60-40-200 604020 % VC Pressure (cmH 2 O)

16. Ventilatory Mechanics: Healthy 100 80 60 40 20 0 -60-40-200 604020 % 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) 1 02 468 2 3 4 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

17. VTVT IC Begin Exercise IC Ventilatory Mechanics: Healthy

18. TLC RVRV Volume (liters) 0 2 4 6 8 - 20 01020 Pressure (cmH 2 0) - 30 - 40 - 10 304050 EELV Ventilatory Mechanics: Healthy  EILV  IRV  IC VTVT  EELV

19. IRV Dynamic hyperinflation during exercise

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

30. Mechanism of hypoxaemia

31. Hypoxaemia, hypercapnia in clinical cases

32. acute chronic Respiratory and metabolic shifts acute chronic

33. 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)

34. Mechanism of exercise-induced hypoxaemia

37. Noninvasive determination of lactate threshold by the V-slope method

38. Exercise training 1. Endurance –leg, arm -Wmax. 60-90% -30-45 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%

39. Respiration during exercise ( Wasserman K, 1999 )