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Pulmonary Function Test

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Pulmonary Function Test

  2. 2. PFT • Pulmonary function tests (PFTs) are a group of tests that measure how well your lungs works, how well the lungs take in and exhale air, and how efficiently they transfer oxygen into the blood
  3. 3. • PFT or LFT are useful in assessing the functional status of the respiratory system both in physiological and pathological condition • It is base on the measurement of volumes of air breathed in and out in normal breathing and forced breathing • It is carried out by using a spirometer
  4. 4. Lung volume and capacities • Lung vol: are the static vol: of air breathed by an individual, ie vol: of air present in lung under specific position of the torax • 4 lung volumes • Depends on age, weight, gender and body position • 2 or more vol: when combined are capacity
  5. 5. Lung volumes • TV-the vol: of gas exchanged during a relaxed insp: followed by an exp: 500ml • IRV-extra vol: of gas that can be inspired above tidal insp: 3000ml • ERV-extra vol: of gas that can be expired after a normal tidal exp: 1000ml • RV-vol: of gas remain in lungs after a forceful exp: 1500ml
  6. 6. • IC-max: amount of gas inspired in to the lungs after a normal tidal exp: [IC=TV+IRV] 3500ml • FRC-amount of gas remain in the lungs after normal exp:[ FRC=ERV+RV] 2500ml • VC-max: amount of gas expired from the lungs after a max: insp: [VC=IRV+TV+ ERV] 4500ml • TLC-max: amount of gas inspired to expand the lungs to its max:extend [TLC=TV+IRV +ERV +RV] 6000ml Lung capacity
  7. 7. Graph
  8. 8. Mechanics of Breathing • Inspiration Active process • Expiration Quiet breathing: passive Can become active Pulmonary Function Tests Evaluates 1 or more major aspects of the respiratory system • Lung volumes • Airway function • Gas exchange
  9. 9. Indications/purpose • Detect disease, It serve as a diagnostic tool investigation role • Evaluate severity, extent and monitor the course of disease • Evaluate treatment • Measure effects and result of treatment exposures
  10. 10. PFTs can help diagnose • Asthma • Chronic bronchitis • Respiratory infections • Lung fibrosis • Bronchiectasis • Allergy
  11. 11. • Emphysema • Cystic fibrosis • Asbestosis which is a condition caused by exposure to asbestos • Sarcoidosis, which is an inflammation of your lungs, liver, lymph nodes, eyes, skin, or other tissues • Pulmonary tumor
  12. 12. Spirometry • It is an instrument for measuring the air capacity of the lungs • Measurement of the pattern of air movement in and out of the lungs during controlled ventilatory maneuvers. • spirometre is used to measure the air flow, ventilatory regulation, ventilatory mechanics and lung volume during a forced expiratory maneuver from full inspiration.
  13. 13. • Pft used to evaluate physiological aspect of breathing from resp:muscle function to the diffusion of gas at the alviolar wall. • Pft helps physiotherapist to distinguish between obstructive and restrictive lung problem and to select appropriate treatment • It also measure the effect of the given treatment.
  14. 14. Lung Factors Affecting Spirometry • Mechanical properties • Resistive elements
  15. 15. Mechanical Properties • Compliance –Describes the stiffness of the lungs –Change in volume over the change in pressure • Elastic recoil –The tendency of the lung to return to it’s resting state –A lung that is fully stretched has more elastic recoil and thus larger/ maximal flows of gas
  16. 16. Resistive Properties Affected by: Lung volume Age Sex Height Weight Race Disease Bronchial smooth muscles
  17. 17. PFT procedure • Forced expiratory maneuver is the common clinical approach • Results are found in patients chart/moniter • Common spirometric values areFEV1 and FVC FEV1/FVC ratio • Lung volume and peak expiratory flow rate (PEF or PEFR) are measured to differentiate obstructive or restrictive problems • Forced expiratory flow (FEF)
  18. 18. • Sit up straight • Get a good seal around the mouth piece • Rapid inhale maximally • Without any delay blow out as hard as fast as possible (blast out) • Continue the exhale until the patient can`t blow no more • Expiration should continue at least 6sec (in adult) and 3 sec (children under 10yrs) • Repeat at least 3 technically acceptable times (without cough, air leak and false start) Procedure
  19. 19. Normal spirogram
  20. 20. How to interpret abnormal PFT • If FVC&FEV1 is less than 80% (total vol:of air expelling is approx: 80% with in 1sec ie; FEV1) • Suggestions of some pathology, at this point and can`t decide obstructive/ restrictive problem
  21. 21. Forced expiratory volume in 1 second (FEV1) • FEV1 is the volume of air that can forcibly be blown out in one second, after full inspiration. • Average values for FEV1 in healthy people depend mainly on sex and age height and mass. • Values between 80% and 120% are considered normal.
  22. 22. Forced vital capacity (FVC) • Forced vital capacity(FVC) is the volume of air that can forcibly be blown out after full inspiration
  23. 23. FEV1/FVC ratio (FEV1%) • FEV1/FVC (FEV1%) is the ratio of FEV1 to FVC. In healthy adults this should be approximately 75–80%.
  24. 24. Forced expiratory flow (FEF) • Forced expiratory flow (FEF) is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration. • generally defined by fraction, The usual intervals are 25%, 50% and 75% (FEF25, FEF50 and FEF75)
  25. 25. Identify an obstructive problem • Obst: disorders (asthma, copd) air flow reduces because of narrowing of air ways • FEV1 is reduced • Spirogram is continued to 6 sec to empty lung, FVC also reduced because gas is trapped behind the obstructed bronchi • Cardinal feature of obstructive defect is reduction in the FEV1/FVC ratio
  26. 26. • In obstructive diseases (asthma, COPD, chronic bronchitis, emphysema) FEV1 is diminished because of increased airway resistance to expiratory flow. • The FVC may be decreased due to the premature closure of airway in expiration • This generates a reduced value (<80%, often 45%). 60-80% -mild 40-60% -moderate <40% -severe obstructions
  27. 27. Obstructive spirogram
  28. 28. Obstructive Disorders
  29. 29. Restrictive problem • Restrictive disorders can be cause by disease of the lung parenchyma (lung fibrosis) and chest wall disease(kyphoscoliosis) • This prevent the full expansion of the lungs therefore FVC may be reduced • FEV1 will increased because of the stiffness of the fibrotic lungs increases the expiratory pressure • Hence expired air comes out very quickly resulting with a high FEV1/FVC ratio
  30. 30. Restrictive spirogram
  31. 31. Restrictive Lung Disease
  32. 32. THANK YOU…..
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