Pulmonary Function Test Part 1 PptDr Mona Allangawi
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Transcript of Pulmonary Function Test Part 1 PptDr Mona Allangawi
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PFT IPFT I 11
Pulmonary function testPulmonary function testPart IPart I
Dr.Mona AllangawiDr.Mona Allangawi
ConsultantConsultant Pulmonary/AllergyPulmonary/Allergy
Hamad General HospitalHamad General Hospital -- HMCHMC
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PFT IPFT I 22
Pulmonary function test :Pulmonary function test :Group of procedures that measure the function of theGroup of procedures that measure the function of the
lungslungs
1.1. SpirometrySpirometry
2.2. Lung volumesLung volumes
3.3. Gas transferGas transfer
4.4. Bronchial chalengeBronchial chalenge
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PFT IPFT I 33
IndicationsIndications
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PFT IPFT I 44
A.DiagnosticA.Diagnostic
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PFT IPFT I 55
Symptoms:Symptoms:dyspnea, wheezing, orthopnea, cough,dyspnea, wheezing, orthopnea, cough,phlegm production, chest painphlegm production, chest pain
Signs:Signs:
decreased breath sounds, overinflation,decreased breath sounds, overinflation,expiratory slowing, cyanosis, chest deformitory,expiratory slowing, cyanosis, chest deformitory,unexplained cracklesunexplained crackles
Abnormal laboratory tests:Abnormal laboratory tests:
hypoxemia, hypercapnia, polycythemia,hypoxemia, hypercapnia, polycythemia,abnormal chest radiographsabnormal chest radiographs
To measure the effect of disease on pulmonaryTo measure the effect of disease on pulmonaryfunctionfunction
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PFT IPFT I 66
To screen individuals at risk of having pulmonaryTo screen individuals at risk of having pulmonarydiseasesdiseases
1.1. SmokersSmokers
2.2. Individuals in occupations with exposures toIndividuals in occupations with exposures toinjurious substancesinjurious substances
To assess preoperative riskTo assess preoperative risk
To assess prognosis (lung transplant, etc.)To assess prognosis (lung transplant, etc.)
To assess health status before enrollment inTo assess health status before enrollment instrenuous physical activity programsstrenuous physical activity programs
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PFT IPFT I 77
B. MonitoringB. Monitoring
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PFT IPFT I 99
C. Disability/Impairment EvaluationsC. Disability/Impairment Evaluations
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PFT IPFT I 1010
To assess patients as part of a rehabilitationTo assess patients as part of a rehabilitationprogramprogram
MedicalMedical
IndustrialIndustrial
VocationalVocational
To assess risks as part of an insuranceTo assess risks as part of an insurance
evaluationevaluation
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PFT IPFT I 1111
ContraindicationsContraindications
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PFT IPFT I 1212
Hemoptysis of unknown originHemoptysis of unknown origin PneumothoraxPneumothorax
Unstable angina pectorisUnstable angina pectoris
Recent myocardial infarctionRecent myocardial infarction
Thoracic aneurysms
Thoracic aneurysms
Abdominal aneurysmsAbdominal aneurysms
Cerebral aneurysmsCerebral aneurysms
Recent eye surgery (increased intraocular pressureRecent eye surgery (increased intraocular pressureduring forced expiration)during forced expiration)
Recent abdominal or thoracic surgical proceduresRecent abdominal or thoracic surgical procedures
History of syncope associated with forced exhalationHistory of syncope associated with forced exhalation
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PFT IPFT I 1313
Pulmonary function test:Pulmonary function test:
1.1. SpirometrySpirometry
2.2. Lung volumesLung volumes
3.3. Gas transferGas transfer4.4. Bronchial chalengeBronchial chalenge
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PFT IPFT I 1414
What is a spirometry ??What is a spirometry ??SpirometrySpirometry isis aa measuremeasure ofof airflowairflow andand
lunglung volumesvolumes duringduring aa forcedforced expiratoryexpiratory
maneuvermaneuver fromfrom fullfull inspirationinspiration
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PFT IPFT I 1515
How to do it ??How to do it ??
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PFT IPFT I 1616
1.1. Stand or sit up straight (The patient places aStand or sit up straight (The patient places aclip over the nose )clip over the nose )
2.2. Inhale maximallyInhale maximally
3.3. Get a good seal around mouthpiece of theGet a good seal around mouthpiece of thespirometerspirometer
4.4. Blow out as hard as fast as possible andBlow out as hard as fast as possible andcount for at least 6 seconds.count for at least 6 seconds.
5.5. Record the best of three trialRecord the best of three trial
*pt should hold bronchodilator few hrs before the test*pt should hold bronchodilator few hrs before the test
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PFT IPFT I 1717
1. Volume Time Graph 2. Flow1. Volume Time Graph 2. Flow--volume loopsvolume loops
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PFT IPFT I 1818
Volume Time GraphVolume Time Graph
The volume is plotted against the time, it displays
The volume is plotted against the time, it displaysthe expiration.the expiration.
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PFT IPFT I 1919
1.1. FVCFVC2.2. FEVFEV11
3.3. FEVFEV11/FVC/FVC
4.4. FEFFEF2525%%
5.5. FEFFEF7575%%
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PFT IPFT I 2020
Forced Vital Capacity (FVC)Forced Vital Capacity (FVC)The total amount of air expired asThe total amount of air expired asquickly as possible after taking thequickly as possible after taking the
deepest possible breath.deepest possible breath.
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PFT IPFT I 2121
FEV1FEV1 ::
Volume of air which can be forciblyVolume of air which can be forciblyexhaled from the lungs in the firstexhaled from the lungs in the first
second of a forced expiratorysecond of a forced expiratorymaneuver.maneuver.
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PFT IPFT I 2222
FEVFEV11/FVC/FVC
Ratio ofRatio ofFEVFEV11 toto FVCFVC::
It indicates what percentage of the totalIt indicates what percentage of the total FVCFVCwas expelled from the lungs during the firstwas expelled from the lungs during the first
second of forced exhalationsecond of forced exhalationThis value is critically important in theThis value is critically important in thediagnosis of obstructive and restrictivediagnosis of obstructive and restrictive
diseasesdiseases
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PFT IPFT I 2323
FEF25%Amount of air that was forcibly expelled in the firstAmount of air that was forcibly expelled in the first
25% of the total forced vital capacity test.25% of the total forced vital capacity test.
FEF75%FEF75%
The amount of air expelled from the lungs during theThe amount of air expelled from the lungs during the
first (75%) of the forced vital capacity test.first (75%) of the forced vital capacity test.
FEF25%FEF25%--75%75%
The amount of air expelled from the lungs duringThe amount of air expelled from the lungs duringthe middle half of the forced vital capacity test.the middle half of the forced vital capacity test.
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PFT IPFT I 2424
FlowFlow--volume loopsvolume loops
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PFT IPFT I 2525
FlowFlow--volume loopsvolume loops
Is a plot of inspiratoryIs a plot of inspiratoryand expiratory flow inand expiratory flow in
the vertical axis againstthe vertical axis againstvolume in the horizentalvolume in the horizentalaxis, during theaxis, during theperformance ofperformance of
maximally forcedmaximally forcedinspiratory andinspiratory andexpiratory maneuvers.expiratory maneuvers.
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PFT IPFT I 2626
The contour of the loop assists in theThe contour of the loop assists in thediagnosis and localization of airwaydiagnosis and localization of airwayobstruction as different lung disordersobstruction as different lung disordersproduce distinct ,easily recognizedproduce distinct ,easily recognizedpattern.pattern.
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PFT IPFT I 2727
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Useful also in assesing acceptability of the manoeuvers:Useful also in assesing acceptability of the manoeuvers:11.. Lack of early peak suggest poor effort.Lack of early peak suggest poor effort.22.. Sudden tailing off of expiration curve suggest that theSudden tailing off of expiration curve suggest that the
patient stopped blowing too earlypatient stopped blowing too early
33.. CoughCough
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PFT IPFT I 2929
Obstructive V/S restrictive lungObstructive V/S restrictive lungdisease ???disease ???
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PFT IPFT I 3131
Common Obstructive Lung DiseasesCommon Obstructive Lung DiseasesAsthmaAsthma
COPDCOPD (chronic bronchitis, emphysema and(chronic bronchitis, emphysema and
the overlap between them).the overlap between them). Cystic fibrosis.Cystic fibrosis.
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PFT IPFT I 3232
--Airflow is reduced because the airways narrow and theAirflow is reduced because the airways narrow and the FEVFEV11 isis
reducedreduced--Spirogram may continue to rise for more thanSpirogram may continue to rise for more than 66 seconds because lungseconds because lungtake longer to emptytake longer to empty--FVCFVC may also be reduced because gas is trapped behind obstructedmay also be reduced because gas is trapped behind obstructedbronchi due to increase in intrathoracic pressure during maneuverbronchi due to increase in intrathoracic pressure during maneuvercompresses airways causing early airway closure and gas trapping butcompresses airways causing early airway closure and gas trapping but
this reduction to a lesser extent thanthis reduction to a lesser extent than FEVFEV11
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PFT IPFT I 3333
FEV1FEV1 80% 80% of predictedof predicted NormalNormalFEV1FEV1 6060--80%80% of predictedof predicted mild obst.mild obst.
FEV1FEV1 4040--60%60% of predictedof predicted moderatemoderate
FEV1 FEV1 40%40% of predictedof predicted severesevere
The cardinal feature isThe cardinal feature is FEV1/FVCFEV1/FVC ratio Ifratio If
the ratio less thanthe ratio less than 7070 consider obstructedconsider obstructed
disease .disease .*Predictors: Sex, Age, Ht*Predictors: Sex, Age, Ht
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PFT IPFT I 3434
Predictors: Sex, Age, Ht ??Predictors: Sex, Age, Ht ??
The measurements are related to the following factors:The measurements are related to the following factors:
AgeAge ::FVC and flow rates decline with age. The value of FVC increases up toFVC and flow rates decline with age. The value of FVC increases up to24 years of age and remain stable to age 35.24 years of age and remain stable to age 35.
HeightHeight ::
All spirometric measurements increase with body weight. It is due to anAll spirometric measurements increase with body weight. It is due to anincrease in number and/or size of alveoli relative to airways, the largerincrease in number and/or size of alveoli relative to airways, the largerlungs are likely to take longer than smaller one.lungs are likely to take longer than smaller one.
SexSex ::Most pulmonary function values are lower in female than maleMost pulmonary function values are lower in female than male..
WeightWeight ::A spirometric results are positively correlated with weight to the extentA spirometric results are positively correlated with weight to the extent
that increased weight means growth or muscle mass. Beyond this (inthat increased weight means growth or muscle mass. Beyond this (inobesity) spirometric values (and lung values specially ERV) decreaseobesity) spirometric values (and lung values specially ERV) decreasewith greater weight.with greater weight.
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PFT IPFT I 3535
Flow volume loop inFlow volume loop in
Obstructive lung diseaseObstructive lung disease
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PFT IPFT I 3636
AsthmaAsthma
PeakPeak expiratoryexpiratory flowflow reducedreducedsoso maximummaximum heightheight ofof thethe looploopisis reducedreduced
AirflowAirflow reducesreduces rapidlyrapidly withwiththethe reductionreduction inin thethe lunglungvolumesvolumes becausebecause thethe airwaysairwaysnarrownarrow andand thethe looploop becomebecomeconcaveconcave
ConcavityConcavity maymay bebe thethe indicatorindicatorofof airflowairflow obstructionobstruction andand maymaypresentpresent beforebefore thethe changechange ininFEVFEV11 oror FEVFEV11/FVC/FVC
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PFT IPFT I 3737
EmphysemaEmphysema
AirwaysAirways maymay collapsecollapse duringduringforcedforced expirationexpiration becausebecause ofofdestructiondestruction ofof thethe supportingsupportinglunglung tissuetissue causingcausing veryveryreducedreduced flowflow at at lowlow lunglungvolumevolume andand aa characteristiccharacteristic(dog(dog--leg)leg) appearanceappearance toto thethe
flowflow volumevolume curvecurve
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PFT IPFT I 3838
ReversibilityReversibility
Improvement inImprovement in FEV1 by 12FEV1 by 12--15% or 200 ml15% or 200 ml in repeatingin repeatingspirometry after treatment withspirometry after treatment withSulbutamol 2.5mg or ipratrobiumSulbutamol 2.5mg or ipratrobiumpromide by nebuliser afterpromide by nebuliser after 1515--3030minutesminutes
Reversibility is a characteresticReversibility is a characteresticfeature of B.Asthmafeature of B.Asthma
In chronic asthma there may beIn chronic asthma there may beonly partial reversibility of theonly partial reversibility of the
airflow obstructionairflow obstruction While in COPD the airflow isWhile in COPD the airflow is
irriversible although some casesirriversible although some casesshowed significant improvement.showed significant improvement.
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PFT IPFT I 3939
Interpretation of PFT
sInterpretation of PFT
sStepStep 11.. LookLook at at thethe FlowFlow--VolumeVolume looploop toto determinedetermine
acceptabilityacceptability ofof thethe test,test, andand looklook forfor upperupper airwayairway
obstructionobstruction patternpattern..
StepStep 22.. LookLook atat thethe FEVFEV11 toto determinedetermine ifif it it isis normalnormal ((
8080%% predicted)predicted)..
StepStep 33.. LookLook atatFVCFVC toto determinedetermine ifif it it isis withinwithin normalnormal
limitslimits (( 8080%%))..
StepStep 44.. LookLook atat thethe FEVFEV11/FVC/FVC ratioratio toto determinedetermine ifif it it isis
withinwithin normalnormal limitslimits (( 7070%%))..
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PFT IPFT I 4040
StepStep 55.. LookLook atatFEFFEF2525--7575%% (Normal(Normal (( 6060%%))
IfIf FEVFEV11,, FEVFEV11/FVC/FVC ratio,ratio, andand FEFFEF2525--7575%% allall areare
normal,normal, thethe patientpatient hashas aa normalnormal PFTPFT..
IfIf bothboth FEVFEV11 andand FEVFEV11/FVC/FVC areare normal,normal, butbut FEFFEF2525--
7575%% isis 6060%% ,then,then thinkthink aboutabout earlyearly obstructionobstruction oror
smallsmall airwaysairways obstructionobstruction..
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PFT IPFT I 4141
IfIf FEVFEV11 8080%% andand FEVFEV11/FVC/FVC 7070%%,, therethere isis
obstructiveobstructive defect,defect, if if FVCFVC isis normal,normal, it it isis purepure
obstructionobstruction.. IfIf FVCFVC 8080%% ,, possibilitypossibility ofof additionaladditional
restrictionrestriction isis therethere..
IfIfFEVFEV11 8080%% ,, FVCFVC 8080%% andand FEVFEV11/FVC/FVC 7070%% ,,
therethere isis restrictiverestrictive defect,defect, getget lunglung volumesvolumes toto confirmconfirm..
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PFT IPFT I 4242
ExamplesExamples
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PFT IPFT I 4343
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PFT IPFT I 4444
Mild Obstructive Defect with good response toMild Obstructive Defect with good response to
bronchodilatorbronchodilator
Diagnosis:Diagnosis:B.AsthmaB.Asthma
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PFT IPFT I 4545
AA 6666 year old female complains ofyear old female complains of
cough after dust exposurecough after dust exposure
%Pred%PredRefRefMeasMeas
858522..585822..22FVCFVC
979711..858511..7979FEVFEV11
72728181FEVFEV11/FVC/FVC
828222..232311..8282FEFFEF 2525--7575
10910955..2255..6767PEFPEF
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PFT IPFT I 4646
Normal SpirometryNormal Spirometry
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PFT IPFT I 4848
Flow volume loop suggestive of obstructive diseaseFlow volume loop suggestive of obstructive disease
Spirometry showed Severe Obstructive defect with noSpirometry showed Severe Obstructive defect with no
response to bronchodilatorresponse to bronchodilator
Increased FVC could be because of Airtrapping orIncreased FVC could be because of Airtrapping or
could be combined obstructive and restrictive defect tocould be combined obstructive and restrictive defect to
confirm need to do Lung Volumeconfirm need to do Lung Volume
diagnosis :diagnosis :COPDCOPD
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PFT IPFT I 4949
AA 7575 year old female has a history ofyear old female has a history of
dyspnea and palpitationsdyspnea and palpitations
%Pred%PredRefRefMeasMeas
939322..828222..6262FVCFVC
727211..989811..4545FEVFEV11
69695555FEVFEV11/FVC/FVC
202022..202000..4343FEFFEF2525--7575
828255..484844..5050PEFPEF
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PFT IPFT I 5050
MildObstructive defectMildObstructive defect
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PFT IPFT I 5151
Large Airway ObstructionLarge Airway Obstruction
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PFT IPFT I 5252
11.. Fixed obstructionFixed obstruction22..Variable extrathoracicVariable extrathoracic obstructionobstruction
33..Variable intrathoracic obstructionVariable intrathoracic obstruction
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PFT IPFT I 5353
Flow Volume Loop inFlow Volume Loop in
Large Airway ObstructionLarge Airway Obstruction
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PFT IPFT I 5454
Fixed obstructionFixed obstruction1. Post intubation stenosis1. Post intubation stenosis
2. Goiter2. Goiter
3. Endotracheal neoplasms3. Endotracheal neoplasms
4. Bronchial stenosis4. Bronchial stenosis
Maximum airflow isMaximum airflow islimited to a similar extentlimited to a similar extent
in bothin both inspinspiration andiration andexpexpirationiration
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PFT IPFT I 5555
VariableVariable extrextrathoracicathoracic
ObstructionObstruction1. Bilateral and unilateral vocal cord1. Bilateral and unilateral vocal cord
paralysisparalysis
2. Vocal cord constriction2. Vocal cord constriction
3. Reduced pharyngeal cross3. Reduced pharyngeal cross--
sectional areasectional area4. Airway burns4. Airway burns
The obstruction worsens inThe obstruction worsens ininspinspiration because theiration because the
negative pressure narrowsnegative pressure narrowsthe trachea and inspiratorythe trachea and inspiratoryflow is reduced to a greaterflow is reduced to a greaterextent than expiratory flowextent than expiratory flow
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PFT IPFT I 5656
In variableIn variable intrintrathoracicathoracicobstructionobstruction
1.1. TracheomalaciaTracheomalacia2. Polychondritis2. Polychondritis
3. Tumors of the lower trachea3. Tumors of the lower trachea
or main bronchus.or main bronchus.The narrowing is maximal inThe narrowing is maximal inexpexpiration because ofiration because ofincreased intrathoracicincreased intrathoracicpressure compressing thepressure compressing the
airway.airway.The flow volume loop shows aThe flow volume loop shows agreater reduction in thegreater reduction in the
expiratoryexpiratory phasephase
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PFT IPFT I 5757
Small Airways obstructionSmall Airways obstruction
DiseasesDiseases affectingaffecting primarilyprimarily thethe smallsmall (peripheral)(peripheral)airwaysairways cancan bebe extensiveextensive yetyet notnot affectaffect thethe FEVFEV11(e(e..gg..earlyearly COPD,COPD, interstitialinterstitial granulomatousgranulomatous disorders)disorders)..
SmallSmall airwaysairways statusstatus isis reflectedreflected byby thethe FEFFEF2525--7575%%(mid(mid--rangerange flow),flow), bestbest determineddetermined fromfrom thethe flowflow--volumevolume looploop..
SomeSome patientspatients havehave normalnormal spirometryspirometry withwith thetheexceptionexception ofof aa reducedreduced FEFFEF2525--7575%%,, thisthis isis suggestivesuggestiveofof possiblepossible smallsmall airwaysairways dysfunctiondysfunction andand potentiallypotentiallyearlyearly obstructionobstruction..
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PFT IPFT I 5858
ExampleExample
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PFT IPFT I 5959
AA 3838 year old female complains ofyear old female complains of
wheezing on exertionwheezing on exertion
%Pr%Preedd
RefRefMeasMeas
10310333..545433..6666FVCFVC
838322..777722..3030FEVFEV11
78786363FEVFEV11/FVC/FVC
515144..202022..1515FEFFEF2525--7575
383866..252522..3939PEFPEF
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PFT IPFT I 6060
Flow volume loop suggests a fixed upperFlow volume loop suggests a fixed upperairway obstructionairway obstruction
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PFT IPFT I 6161
Effect of Smoking:Effect of Smoking: Smoking in patients with COPD is associatedSmoking in patients with COPD is associated
with decline inwith decline in FEV1 of90FEV1 of90--150 mL/year150 mL/year
Smoking cessation is (associated withSmoking cessation is (associated withincrease inincrease in FEV1FEV1 for first year) followed withfor first year) followed witha decline of only 30 mL/yeara decline of only 30 mL/year
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PFT IPFT I 6262
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PFT IPFT I 6363
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PFT IPFT I 6464
Restrictive Lung DiseasesR
estrictive Lung Diseases
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PFT IPFT I 6565
A. Intrinsic Restrictive Lung DisordersA. Intrinsic Restrictive Lung Disorders
1.1. SarcoidosisSarcoidosis
2.2. Idiopathic pulmonary fibrosisIdiopathic pulmonary fibrosis
33.. Interstitial pneumonitisInterstitial pneumonitis
44.. TuberculosisTuberculosis
55.. Pnuemonectomy (loss of lung)Pnuemonectomy (loss of lung)
66.. PneumoniaPneumonia
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PFT IPFT I 6767
C.C. Neuromuscular Restrictive LungNeuromuscular Restrictive LungDisordersDisorders
1.1. Generalized WeaknessGeneralized Weakness malnutritionmalnutrition
2.2. Paralysis of the diaphragmParalysis of the diaphragm
3.3. Myasthenia GravisMyasthenia Gravis
4.4. Muscular DystrophyMuscular Dystrophy
5.5. PoliomyelitisPoliomyelitis
6.6. Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
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PFT IPFT I 6868
Full expantion of the lungFull expantion of the lungis limited and thereforeis limited and thereforethethe FVCFVC is reducedis reduced
FEVFEV11 may be reducedmay be reducedbecause the stiffness ofbecause the stiffness of
fibrotic lungs increasesfibrotic lungs increasesthe expiratory pressurethe expiratory pressure
FEVFEV11/FVC/FVC will be Normalwill be Normalor Increasedor Increased
*if you suspect restrictive*if you suspect restrictivepattern you must checkpattern you must checkTLCTLC
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PFT IPFT I 6969
Flow volume loop inFlow volume loop in
Restrictive lung diseaseRestrictive lung disease
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PFT IPFT I 7070
Flow volume loop inFlow volume loop inRestrictive lung diseaseRestrictive lung disease :: Full lung expantion isFull lung expantion is
prevented by fibrotic tissue inprevented by fibrotic tissue inthe lung parenchyma and thethe lung parenchyma and theFVCFVC is reduced .is reduced .
Elastic recoil may increased byElastic recoil may increased byfibrotic tissue lead to increasefibrotic tissue lead to increasethe airflowthe airflow
BothBoth FEV1FEV1 andand FVCFVC may bemay bereduced because the lungs arereduced because the lungs aresmall and stiff ,but the peaksmall and stiff ,but the peakexpiratory flow may beexpiratory flow may be
preserved or even higher thanpreserved or even higher thanpredicted leads to tall,narrowpredicted leads to tall,narrowand steep flow volume loop inand steep flow volume loop inexpiratory phase.expiratory phase.
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PFT IPFT I 7171
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PFT IPFT I 7272
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PFT IPFT I 7373
ExampleExample
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PFT IPFT I 7474
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PFT IPFT I 7575
Mild restrictive defect suggested by reduced in FVCMild restrictive defect suggested by reduced in FVCwith normal to high FEV1/FVCwith normal to high FEV1/FVC
Need lung volume and diffusion capacity to assess ifNeed lung volume and diffusion capacity to assess ifit is intrinsic or extrinsic typeit is intrinsic or extrinsic type
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PFT IPFT I 7676
Obstructive & restrictive defectsObstructive & restrictive defects
ParameterParameter ObstructionObstruction RestrictionRestrictionFEVFEV11 ReducedReduced ReducedReduced
FVCFVC NormalNormal ReducedReduced
FEVFEV11/FVC/FVC ReducedReduced NormalNormal
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PFT IPFT I 7777
Acceptability andReproducibilityAcceptability andReproducibility
CriteriaCriteria
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PFT IPFT I 7878
Acceptability CriteriaAcceptability Criteriafree from artifacts:free from artifacts: Cough or glottis closure during the first second ofCough or glottis closure during the first second of
exhalationexhalation Eary termination or cutoffEary termination or cutoff Variable effortVariable effort
LeakLeak Obstructed mouthpieceObstructed mouthpiece Have good startsHave good starts Have a satisfactory exhalationHave a satisfactory exhalation 6 s of exhalation6 s of exhalation
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PFT IPFT I 7979
R
eproducibility CriteriaR
eproducibility CriteriaAfter 3 acceptable spirograms been obtainedAfter 3 acceptable spirograms been obtained Are the two largest FVC within 0.2 L of each other?Are the two largest FVC within 0.2 L of each other?
Are the two largest FEV1 within 0.2 L of each other?Are the two largest FEV1 within 0.2 L of each other?
If both of these criteria are met, the test session mayIf both of these criteria are met, the test session maybe concluded.be concluded.
If both of these criteria are not met, continue testingIf both of these criteria are not met, continue testing
until Both of the criteria are met with analysis ofuntil Both of the criteria are met with analysis ofadditional acceptable spirograms; OR a total of eightadditional acceptable spirograms; OR a total of eighttests have been performedtests have been performed
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PFT IPFT I 8080
Acceptability of the testAcceptability of the test
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PFT IPFT I 8181
Early Glottic Closure
Normal
Poor EffortCough
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PFT IPFT I 8282
ExampleExample
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PFT IPFT I 8383
1.What is the defect?1.What is the defect?
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Mild obstructive defect with good response toMild obstructive defect with good response tobronchodilatorbronchodilator
DiagnosisDiagnosisB.AsthmaB.Asthma