1. Respiratory Function Tests RFTs

2. Review Of Anatomy & physiology
Lungs comprised of
Airways
Alveoli

3. Airways Conducting zone: no gas exchange occurs (Anatomic dead space)
Transitional zone: alveoli appear, but are not great in number
Respiratory zone: contain the alveolar sacs

4. The Alveoli There are approximately 300 million alveoli in each lung.
Their total surface area is m2

5. Mechanics of Breathing
Inspiration
Active process caused mainly by contraction of diaphragm . Accessory muscles may used during exercise and distress
Expiration
Quiet breathing is a passive process but can become active , with forced expiration

6. Lung Volumes 4 Volumes 4 Capacities Sum of 2 or more lung volumes IRVTV
ERV RV IC
FRC VC
TLC
4 Volumes
4 Capacities
Sum of 2 or more lung volumes

7. Tidal Volume (TV)
Volume of air inspired or expired during normal quiet breathing
TV = 500 ml
IRV IC VC
TLC TV
ERV
FRC RV RV

8. The Inspiratory Reserve Volume IRV
The extra volume of air that can be inspired over and above the normal tidal volume , when person inspires with full force
IRV= 3000 ml
IRV IC VC
TLC TV
ERV
FRC RV RV

9. Expiratory Reserve Volume (ERV)
The extra volume of air that can be exhaled over normal tidal volume when person expires forcefully
ERV= 1100ml
IRV IC VC
TLC TV
ERV
FRC RV RV

10. Residual Volume (RV)
Volume of air remaining in the lungs at the end of maximum expiration.
RV =1200 ml
IRV IC VC
TLC TV
ERV
FRC RV RV

11. Vital Capacity (VC)
The maximum amount of air a person can expel from the lungs after filling the lungs to their maximum extent and then expires to the maximum extent. Also called Forced vital capacity FVC
VC=4600ml
VC=IRV+TV+ERV
IRV IC VC
TLC TV
ERV
FRC RV RV

12. Inspiratory Capacity (IC)
The amount of air a person can breathe in beginning at the normal expiratory level and distending the lung to the maximum amount.
IC = IRV + TV
IC= 3500ml
IRV IC VC
TLC TV
ERV
FRC RV RV

13. Functional Residual Capacity (FRC)
Volume of air remaining in the lungs at the end of a normal expiration
FRC = ERV + RV
FRC= 2300 ml
IRV IC VC
TLC TV
ERV
FRC RV RV

14. Total Lung Capacity (TLC)
Volume of air in the lungs after a maximum inspiration
TLC = IRV + TV + ERV + RV
=5800ml
IRV IC VC
TLC TV
ERV
FRC RV RV

16. Factors affecting lung volume
Age
Sex
Height
Weight
Race
Disease

17. CLINICAL SIGNIFICANCE
VC% < 80% is abnormal
RV/TLC% (residual air rate)
normal : < 35%
emphysema: > 40 %
old person can be 50%.
FRC ↑ : emphysema
FRC ↓ : interstitial pulmonary fibrosis

18. Value of Respiratory function tests
Evaluates 1 or more major aspects of the respiratory system
Lung volumes
Airway function
Gas exchange

19. Indications Detect disease
Evaluate extent and monitor course of disease
Evaluate treatment
Measure effects of exposures
Assess risk for surgical procedures

20. PFTs Arterial blood gases Blood PH Pulse oximeter
Peak flow meter measuring peaked expiratory flow rate.
Spirometry

21. Peak flow meter measuring peaked expiratory flow rate PEFR
This is extremely simple and cheap test
It describes maximal airflow rate in a given time.
It measures the airflow through the bronchi and thus the degree of obstruction in the airways.
Is best for monitoring the progression of disease

22. Cont…..
it can detect airway narrowing, commonly used in asthma, Even by the patient himself to know when he need an emergency interference.
the effectiveness of a person's asthma management and treatment plan.
when to stop or add medication, as directed by physician.
what triggers the asthma attack (such as exercise-induced asthma )

24. To perform this test
Loosen any tight clothing that might restrict your breathing.
Sit up straight or stand while performing the tests
Breathe in as deeply as possible.
Mouthpiece is placed in mouth with lip sealed to prevent escape of air
Blow into the instrument's mouthpiece as hard and fast as possible.
Do this three times, and record the highest flow rate.

25. Normal values vary based on a person's age, sex, and size
Normal person can empty their chest from full inspiration in 4 sec or less
Prolongation to more than 6 sec indicates airflow obstruction
A fall in peak flow can signal the onset of a lung disease flare, especially when it occurs with symptoms such as:
Shortness of breath
Increased cough
Wheezing

26. SPIROMETRY Simple, office-based Measures flow, volumes Volume vs. Time
Can determine:
- Forced expiratory volume in one second (FEV1)
- Forced vital capacity (FVC)
- FEV1/FVC

27. Old version
spirometer bell
kymograph pen
New version
portable

28. Indications of Spirometry: diagnostic and prognostic
Evaluation of signs and symptoms of pulmonary diseases like asthma and COPD
Screening at-risk populations male smokers >45 years
Monitoring pulmonary drug toxicity
Preoperative assessment
Assess severity of diseases
Follow up response to therapy
Determine further treatment goals
Referral for surgery
Disability

29. What information does a spirometer yield?
A spirometer can be used to measure the following:
FVC and its derivatives (such as FEV1, FEF 25-75%)
Forced Inspiratory vital capacity (FIVC)
Peak expiratory flow rate
Maximum voluntary ventilation (MVV)
Slow VC
IC, IRV, and ERV
Pre and post bronchodilator studies

30. Terminology Forced vital capacity (FVC):
Total volume of air that can be exhaled forcefully from TLC
The majority of FVC can be exhaled in <3 seconds in normal people, but often is much more prolonged in obstructive diseases
Measured in liters (L)

31. FVC Interpretation of % predicted: 80-120% Normal
70-79% Mild reduction
50%-69% Moderate reduction
<50% Severe reduction

32. FEV1 Forced expiratory volume in 1 second: (FEV1)
Volume of air forcefully expired from full inflation (TLC) in the first second
Measured in liters (L)
Normal people can exhale more than % of their FVC in the first second; thus the FEV1/FVC can be utilized to characterize lung disease

33. FEV1 Interpretation of % predicted: >75% Normal
60%-75% Mild obstruction
50-59% Moderate obstruction
<49% Severe obstruction

34. Technique Have patient seated comfortably Closed-circuit technique
Place nose clip on
Have patient breathe on mouthpiece
Have patient take a deep breath
Blow out the air as fast as possible and as hard and long as possible

35. ive Vs Restrictive Defect
Obstructive Disorders
Characterized by a limitation of expiratory airflow so that airways cannot empty as rapidly compared to normal (such as through narrowed airways from bronchospasm, inflammation, etc.)
Examples:
Asthma
Emphysema
Cystic Fibrosis
Restrictive Disorders
Characterized by reduced lung volumes/decreased lung compliance
Examples:
Interstitial Fibrosis
Scoliosis
Obesity
Lung Resection
Neuromuscular diseases
Cystic Fibrosis

36. Obstructive Disorders
Characterized by a limitation of expiratory airflow
Decreased: FEV1, FEV1/FVC ratio (<0.8)
Increased or Normal: TLC

37. Spirometry in Obstructive Disease
Slow rise in upstroke
May not reach plateau

38. Restrictive Lung Disease
Characterized by diminished lung volume
Decreased TLC, FVC
Normal FEV1
Normal or increased: FEV1/FVC ratio

39. Restrictive Disease Rapid upstroke as in normal Spirometry
Plateau volume is low

40. Bronchial Dilation Test
Method: to determine FEV1 and FEV1/FVC% before and after ß2-agonist inhalation
Result: improved rate = after-before ×100%
before
Positive: >15%
Reversible limitation: asthma