1. Respiratory function tests

2. Lung anatomy and physiology
Lungs consist 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. Mechanics of Breathing
Inspiration
Active process
Expiration
Quiet breathing: passive
Can become active , with forced expiration

5. The goals of respiration:
Provide O2 to tissue and remove Co2 through:
Pulmonary ventilation: outflow and inflow of air between outside and alveoli.
Diffusion of O2 and Co2 between alveoli and blood.
Transport to and from tissue

6. Lung Volumes
IRV IC VC
TLC TV
ERV
FRC RV RV

7. Tidal Volume (TV)
Volume of air inspired or expired during normal quiet breathing
About 500ml
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
=3000ml
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.
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

15. CLINICAL SIGNIFICANCE
VC depends on sex, age and height.
VC < 80% is abnormal.
As in cases of restrictive ventilation disorder
RV/TLC% (residual air rate)
normal : < 35%
emphysema: > 40 %
old person can be 50%.
FRC ↑ : emphysema
FRC ↓ : interstitial pulmonary fibrosis

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

17. Why to use Respiratory function test?
Detect disease
Evaluate extent and monitor course of disease
Evaluate treatment
Assess risk for surgical procedures

18. Investigation tools used for studying respiratory function
Arterial blood gases
Blood PH
Pulse oximeter
Peak flow meter measuring peaked expiratory flow rate.
Spirometry

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

20. Peak expiratory flow rate (PEFR) using the peak flow meter

21. Peak flow meter is a small device that measures the fastest rate of air that you can blow out of your lungs, it can detect airway narrowing, commonly used in asthma, Even by the patient himself to know
when he needs 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 )

22. PEAKED EXPIRATORY FLOW
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.
Why the Test is Performed?
The test is commonly used to diagnose and monitor lung diseases such as:
Asthma
Chronic obstructive pulmonary disease (Less accurate)

23. Normal Results
Normal values vary based on a person's age, sex, and size. Peak flow measurements are most useful when a person compares the number on a given day to his or her "personal best."
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

24. 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. 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

28. 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)

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

30. 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 75-80% of their FVC in the first second; thus the FEV1/FVC can be utilized to characterize lung disease

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

32. 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

33. Obstructive Lung Disease — Differential Diagnosis
Asthma
COPD
- chronic bronchitis
Bronchiectasis
Bronchiolitis
Upper airway obstruction

34. Restrictive lung disease:
Pneumoconiosis
Chest wall deformity
Pleural adhesion and pleural effusion
Interstitial lung fibrosis
Combined restrictive and obstructive in cases of cystic fibrosis

35. Flow-Volume Loop
Illustrates maximum expiratory and inspiratory flow-volume curves
Useful to help characterize disease states (e.g. obstructive vs. restrictive)

37. Spirometer pattern

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

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

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

41. Restrictive Disease Rapid upstroke as in normal spirometry
Plateau volume is low

42. 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