Presentation is loading. Please wait.

Presentation is loading. Please wait.

ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE.

Similar presentations


Presentation on theme: "ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE."— Presentation transcript:

1 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT PLETHYSMOGRAPHY 1

2 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 2 STANDARD PF PLETHYSMOGRAPH o SpirometrySpirometry o Diffusion CapacityDiffusion Capacity o Lung Volumes Lung Volumes o MIP/MEP MIP/MEP Thoracic Gas Volume Airways Resistance

3 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 3 MYTHS o Plethysmography is too difficult for the patient. o Plethysmography is too expensive o Plethysmography is too complex and useful only as a research tool. o My it will be torture for my patients

4 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 4

5 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 5

6 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 6 WHAT DOES IT MEASURE? o Flow (Volume) o Mouth Pressure o Box Pressure

7 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 7 How does it measure? Mouth Pressure Xducer Pneumotachometer (Flow) Box Pressure Transducer

8 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 8 HOW DOES IT WORK? o As the patient pants against the closed shutter, pressure change is measured in the box and at the mouth

9 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 9 ASSUMPTIONS o Mouth Pressure (P m ) is equal to alveolar pressure (P alv ) o Abdominal gas does not effect the measurement

10 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 10 HOW DOES IT WORK? In a fluid or gas filled circuit, pressure applied at any point is felt equally throughout the circuit This assumption must be true for results to be valid Pascal’s Principle P1 P2 P3

11 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT WHY CALCULATE LUNG VOLUMES o A restrictive ventilatory defect is characterized by a reduction in TLC o below the 5th percentile of the predicted value o Below the lower limits of normal 11

12 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 12 ERS/ATS: The presence of a restrictive ventilatory defect may be suspected when VC is reduced. A reduced VC by itself does not prove a restrictive ventilatory defect. Why Determine Lung Volumes

13 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 13 ERS/ATS: A reduced FVC is associated with a low TLC only 50% of the time or less. Why Determine Lung Volumes

14 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 14 Thoracic Gas Volume (TGV) also called FRCpleth – the volume of air in the lungs at the end of a normal exhalation We are after Total Lung Capacity (TLC); however, TLC is not measured directly. Lung Volumes

15 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 15 TLC = TGV (FRC) + Inspiratory Capacity (IC) TLC = Residual Volume (RV) + VC RV = TGV - ERV Lung Volumes

16 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 16 Lung Volumes

17 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 17 DETERMINATION OF FRC o Multiple breath gas dilution o Nitrogen Washout o Helium Dilution o TGV via Body Plethysmography o Imaging Techniques (radiology) o Planimetry o CT/MRI

18 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 18 DETERMINATION OF FRC o ACCP Scientific Section Recommendation: o In patients with airway obstruction the dilution method underestimates the thoracic gas volume to the extent that depends on the severity of the obstruction. The plethysmographic method measures the total compressible gas including that of poorly ventilated areas. Murray, Crapo, et al,1982

19 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 19 DETERMINATION OF FRC o Dilution methods measure only communicating airways and therefore can significantly underestimate true lung volume.

20 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 20 FRC by Dilution = 2L FRC by Plethysmography = 2L

21 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 21 Obstructed airway FRC by Dilution = 1 LFRC by Plethysmography = 2L

22 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 22 DETERMINATION OF TLC VIA SINGLE BREATH o Single breath inert gas dilution (DLco) o Helium, Neon, Methane o Alveolar Volume (VA) approximates TLC o Single breath techniques further underestimate lung volume due to reduced time for equilibration.

23 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 23 PLETHYSMOGRAPHY VS. DILUTION o Decreases test time – o One N2 washout or helium dilution can take up to 7-8 minutes. If you have to repeat, this takes an additional 7-8 minutes after waiting for gas to clear lungs o Plethysmography can perform several efforts in 3 minutes

24 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 24 CLINICAL INDICATIONS o To distinguish between restrictive and obstructive disease patterns, particularly in the presence of a reduced VC o To diagnose restrictive disease patterns o To provide an index of gas trapping (plethysmography vs gas dilution) o Assess response to therapeutic intervention AARC Clinical Practice Guideline

25 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 25 TGV - HOW DOES IT WORK? Boyle’s Law P 1 V 1 = P 2 V 2 V` P` P V

26 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 26 TGV - HOW DOES IT WORK? P 1 V 1 = P 2 V 2 P 1 = barometric Pressure* V 1 = thoracic gas volume P 2 = P 1 + delta P V 2 = V 1 - delta V Solving for P 1 V 1 = P B (  V /  P)

27 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT TESTING SEQUENCE(1 ST CHOICE) o Measure ERV after the acquisition of the FRC measurement followed by slow IVC maneuvers that are linked o FRC reported – mean of technically acceptable FRC measurements (CV 5% = difference between highest and lowest values divided by the mean ≤.05) linked to technically acceptable ERV and IC measurements used for calculating RV and TLC o Acceptable IC’s CV 5% +/- 3% (obstructed) 27

28 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT TESTING SEQUENCE 1 ST CHOICE 28

29 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT TESTING SEQUENCE 2 ND CHOICE o Perform IC immediately after the FRC measurement to TLC o This method might work better for those who have severe COPD o TLC = FRC + IC 29

30 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 30 Airways Resistance (Raw)

31 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 31 AIRWAYS RESISTANCE (RAW) Airways Resistance can be thought of as how much work (driving pressure) the patient has to do simply to breath.

32 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 32 Increased Raw is the primary finding in Obstructive Airways Disease May be caused by bronchospasm, compression or consolidative filling Airway Resistance (Raw)

33 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 33 AIRWAYS RESISTANCE (RAW) o Airways Resistance - Pressure cmH2O/L/sec o Conductance (Gaw) – Flow L/sec/cmH20 o Gaw is the reciprocal of Raw 1/Raw

34 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 34 AIRWAYS RESISTANCE (RAW) o Airways Resistance - Pressure cmH2O/L/sec o sRaw (Raw relative to lung volume) Raw x Vpant o Conductance (Gaw) – Flow L/sec/cmH20 o sGaw (Gaw relative to lung volume) Gaw/Vpant

35 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 35 AIRWAYS RESISTANCE (RAW) COPD patient - Raw sRaw sGaw Compensatory Hyperinflation

36 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 36 AIRWAY RESISTANCE Effort independent assessment of airway caliber ! If pressure is constant which will conduct more flow?

37 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 37 POISEUILLE’S LAW (P driving )(pi)(radius 4 ) Flow = (8)(Length)(viscosity) Flow rate is proportional to the 4 th power of a pipe’s radius.

38 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 38 POISEUILLE’S LAW You need 16 tubes to pass as much fluid as one tube twice their diameter.

39 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT AIRWAY RESISTANCE o Since resistance is related most strongly to total cross sectional area rather than length, the majority of resistance in normal lungs resides in the larger airways P1 P2 P3B P3A P3A1 P3A2 P3B2 P3B1

40 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT AIRWAYS RESISTANCE o In summary, what proportion of the total airways resistance is in the larger airways? o What proportion of the airways resistance is in the smaller airways? o 80% Larger o 20% Smaller 40

41 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 41 PLETH TEST MANEUVER o Door closed for ~1 min to allow for equilibration o Patient sitting up straight, nose clips o Hands supporting their cheeks o Elbows at their side

42 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 42 TGV TEST MANEUVER o Normal tidal breathing until stable respiratory pattern is achieved o At end expiration the shutter is closed o Patient is asked to “pant” against the closed shutter for 2 to 3 seconds. o After shutter reopens, perform an SVC

43 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 43 THORACIC GAS VOLUME – “PANTING” o Pant Volume:~50cc o Frequency:0.5 – 1.0 Hz (30 to 60 bpm, although up to 90 is acceptable) o Emphasize this is NOT an MVV or MIP/MEP

44 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 44 THORACIC GAS VOLUME – “PANTING” Tidal Breathing Shutter Closure

45 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 45 HOW DOES IT WORK? Mouth Pressure vs Box Pressure Mouth Pressur e Box Pressure (pleth volume)

46 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 46 HOW DOES IT WORK? Mouth Pressur e Box Pressure (pleth volume)  V /  P is the relationship between mouth pressure and box pressure, and can be expressed as the tangent of the angle

47 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 47 LINE OF “BEST FIT”

48 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 48 IMPORTANCE OF “PINNED” SVC o Trying to measure TLC o TGV efforts can be variable o Performing an SVC with the TGV maneuver produces more repeatable TLC values

49 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 49 IMPORTANCE OF “PINNED” SVC TGVICTLC L L L

50 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT AIRWAY RESISTANCE TEST o Open Shutter Phase o Pant with shutter open to determine airway resistance o Closed Shutter Phase o Pant with shutter closed to measure lung volume – VPant (can be used to measure TGV)

51 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT AIRWAY RESISTANCE TEST o Patient performance criteria o Small breaths (~50) o Consistent, gentle efforts efforts/sec (60 – 90 efforts/min) o Emphasize this is NOT an MVV o Provide continuous feedback on performance

52 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 52 AIRWAYS RESISTANCE – “QUIET BREATHING” o Volume:~50cc o Frequency:0.5 cycle/sec (30 BPM) o Glottis opens and closes with each breath, causing Raw to increase o Most Raw predicted numbers are based on panting efforts

53 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 53 Airway Resistance Test

54 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT AIRWAY RESISTANCE Raw = Slope (pressure/volume) Slope (flow/volume)

55 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT AIRWAY RESISTANCE o In the Lung: o Flow = Pressure/ Resistance or o Resistance = Pressure/ Flow Slope of the line is Flow / Box Pressure FLOWFLOW BOX PRESSURE

56 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT RESISTANCE o What pressure (cmH20/L/S) does it take to create a certain flow? o What pressure does it take to create a standardized flow of.5 L/S? o R=Pressure/Flow 56

57 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT LINE OF “BEST FIT” o In the Lung: o Flow = Pressure/ Resistance or o Resistance = Pressure/ Flow FLOWFLOW BOX PRESSURE Zero Flow0.5 L/sec

58 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT Airway Resistance a) Normal, b) Increased large airway Raw, c) COPD, d) Upper airway obstruction

59 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT Airway Resistance Airway Collapse Patterns may be better represented by separating Inspiratory and Expiratory Raw.

60 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT Airway Resistance

61 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 61 AIRWAYS RESISTANCE AND AIRWAY REACTIVITY o Airways resistance measures significant changes in airway caliber during bronchodilator and bronchoprovocation trials which might not be reflected in spirometry. o Airways resistance explains patient’s “perceived” response in the absence of spirometric changes.

62 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT BRONCHODILATORS WITH SPIROMETRY o Masking the response of bronchodilators o Lung memory and the broncho-dilatory effect of deep inhalations o Possible closure of intra-thoracic airways during forced exhalation Blast it out!!!! PREPOST

63 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 63 AIRWAYS RESISTANCE AND AIRWAY REACTIVITY o From National Jewish Medical Center in Denver: o Subjects often report subjective benefit from bronchodilators without demonsting improvement in spirometry

64 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 64 DETERMINATION OF AIRFLOW OBSTRUCTION o Flows determined by spirometry inherently incorporate driving pressure and therefore: o are effort dependent o are insensitive to early obstructive changes especially in a young, motivated subject o reflect true obstruction only after significant compromise of airway radius, well beyond the development of symptoms o Can overcome obstruction with more force

65 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 65 DETERMINATION OF AIRFLOW OBSTRUCTION o Determination of Airways Resistance and Conductance: o is effort independent o can identify early obstructive changes throughout the tracheobronchial tree o will identify obstructive changes, which increase work of breathing, and cause dyspnea, that might otherwise not be identified using spirometry

66 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 66 Airflow & Artificial Resistance

67 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 67 DETERMINATION OF AIRFLOW OBSTRUCTION SpirometryPredBaseline+1.5 cm/H2O/L/s % Change FVC FEV FEV1/FVC FEFmax FEF

68 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 68 SpirometryPredBaseline+1.5 cm/H2O/L/s % Change FVC FEV FEV1/FVC FEFmax FEF Airway Mechanics Raw Gaw sGaw

69 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 69 SpirometryPredBaseline+1.5 cm/H2O/L /s % Change+4.0% Change FVC FEV FEV1/FVC FEFmax FEF

70 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 70 SpirometryPredBaseline+1.5 cm/H2O/L /s % Change+4.0% Change FVC FEV FEV1/FVC FEFmax FEF Airway Mechanics Raw Gaw sGaw

71 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 71 Case Study

72 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 72 Young AsthmaticAge: 16 Height: 75 inWeight: 268Sex: M SpirometryPredictedActual Pre% Predicted FVC FEV FEV1/FVC8667 FEF25-75% FEFmax

73 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 73 Young AsthmaticAge: 16 Height: 75 inWeight: 268Sex: M SpirometryPredictedActual Pre% Predicted FVC FEV FEV1/FVC8667 FEF25-75% FEFmax Airway Mechanics Raw Gaw sGaw

74 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 74 Young AsthmaticAge: 16 Height: 75 inWeight: 268Sex: M SpirometryPredictedActual Pre% PredictedActual Post% Change FVC FEV FEV1/FVC FEF25-75% FEFmax

75 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 75 SpirometryPredictedActual Pre% PredictedActual Post% Change FVC FEV FEV1/FVC FEF25-75% FEFmax Airway Mechanics Raw Gaw sGaw

76 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 76

77 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 77

78 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 78

79 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 79 AIRWAYS RESISTANCE AND AIRWAY REACTIVITY o What is a clinically significant response? o Raw and SRaw: 40% o SGaw : 35-40% Current ATS/ERS Standards use 12% and 200 ml for FVC and/or FEV1 for bronchodilator response

80 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 80 IMPLICATIONS o Without Airways Resistance: o Patient may not have been correctly diagnosed with reversible airway obstruction. o Prescription of inhaler may not have been clinically justified.

81 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 81 AIRWAY RESISTANCE o Spirometry alone: o May not accurately determine the presence or absence of obstruction o May not adequately evaluate airway response to stimuli

82 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 82 AIRWAYS RESISTANCE AND AIRWAY REACTIVITY “We conclude that spirometry alone fails to identify reversibility in approximately 15 percent of patients, and most of these patients can be identified by additional plethysmographic measurements…” Smith HR, Irvin CG, Cherniak RM. The Utility of Spirometry in the Diagnosis of Reversible Airway Obstruction. Chest 1992; 101:1577

83 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 83 ASTHMA MANAGEMENT o The use of airways resistance to diagnose and monitor the asthmatic can improve the patient’s quality of life and reduce the associated cost of care.

84 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT PLETHYSMOGRAPHY: THE BENEFITS o Rapid, accurate functional measurement o Multiple measurements < 5 min o Quantifies Non-Ventilated Lung o TGV-FRC o Non-Ventilated lung contributes to Hypoxemia (Resting/Exercise) Dyspnea

85 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 85 PLETHYSMOGRAPHY: THE BENEFITS o Enhances diagnosis and treatment of obstructive disorders o More accurate Lung Volumes compared to lung dilution methods o Differential Diagnosis o Restriction/Hyperinflation is based on TLC

86 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 86 PLETHYSMOGRAPHY: THE BENEFITS o More sensitive in diagnosis of airways disease o Earlier detection of airways disease o More accurate evaluation of airway reactivity (bronchodilation and bronchoprovocation) o Enhanced evaluation of upper airway lesions

87 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 87 AARC Clincal Practice Guidelines ATS/ERS Guidelines education.org/pages/default.aspx?id=2 477

88 ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT 88 Thank You Patrick G Burns Director of Marketing MGC Diagnostics


Download ppt "ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE IMPROVEMENTS PROVIDE UNMATCHED SERVICE AND SUPPORT ANTICIPATE AND SOLVE UNMET NEEDS RELENTLESSLY MAKE."

Similar presentations


Ads by Google