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Pulmonary Function Tests

Pulmonary function tests assess the respiratory system's capacity at different exertion levels. There are static and dynamic tests. Static tests measure lung volumes and capacities like vital capacity. Dynamic tests measure rates like forced expiratory volumes which are reduced in obstructive lung diseases. Pulmonary function is affected by factors like posture, respiratory muscle strength, chest wall expansion, lung elasticity, and airway resistance. Tests like spirometry are used to evaluate volumes and flow rates.

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281 views

Pulmonary Function Tests

Pulmonary function tests assess the respiratory system's capacity at different exertion levels. There are static and dynamic tests. Static tests measure lung volumes and capacities like vital capacity. Dynamic tests measure rates like forced expiratory volumes which are reduced in obstructive lung diseases. Pulmonary function is affected by factors like posture, respiratory muscle strength, chest wall expansion, lung elasticity, and airway resistance. Tests like spirometry are used to evaluate volumes and flow rates.

Uploaded by

MohamedSalah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Pulmonary Function Tests

Pulmonary
Ventilation
Lung

RBCs

Tissues

Out

External
respirati
on
IN

Respirat
ory
function
of blood

Gas
exchange
Pa O2 & Pa
CO2

Internal
respirati
on

Pulmonary Function Tests


They are physiological tests that assess the capacity of the
respiratory system to meet the requirements of different levels of
exertion,
ability and endurance.
They working
are classified
into:

Static tests
Lung volume and capacities
particularly the vital capacity.
Pulmonary ventilation (MRV).
Alveolar ventilation (EPV).
Determination of the dead space
(DS).

Dynamic tests
Maximal

breathing

capacity

(MBC) or Maximal voluntary


ventilation (MVV).
Timed vital capacity &
Forced

expiratory

volume.
Maximal (peak) expiratory flow
rate (PEFR).

Lung volumes and


capacities

Lung volumes and


capacities
Tidal volume (TV):

Is the volume of air inspired or expired with each normal quite


breath (eupnoea).
It equals 500 ml in the normal young adult male.

Inspiratory reserve volume (IRV):

It is the maximum extra volume of air that can be inspired by


forced inspiration after normal inspiration.
It equals 3000 ml.
Expiratory reserve volume (ERV):

It is the maximum volume of air that can be expired by forced


expiration after the end of normal expiration.
It equals 1000 ml.

Residual volume (RV):

It is the volume of air that remains in the lung after forced


expiration.
It is about 1200 ml.
Minimal air:

It is the volume of air remaining in the lungs after opening the


chest and expelling the residual volume.
It is the air that enter the lung with the first breath of the new
birth.
It has a medicolegal importance to determine whether the
newborn was born live or dead. If a piece of lung floats, minimal air
is present indicating that the infant respire then died. If it does not
float, it means that he was born dead.

Lung capacities
1. Inspiratory capacity (IC):

It is the maximal volume of air which can be inspired by forced


inspiration after normal expiration.
It equals TV + IRV = 500 + 3000 = 3500 ml.
2. Functional residual capacity (FRC):

It is the volume of air remaining in lung after normal


expiration.
It equals ERV + RV = 1000 + 1200 = 2200 ml.

3. Vital capacity:

It is the maximum volume of air that can be expired by forced


expiration after forced inspiration.
It equals IRV + TV + ERV = 500 + 3000 + 1000 = 4500 ml.
4. Total lung capacity:

It is the maximum volume of air contained in the lung after forced


inspiration.
It equals RV + VC = 1200 + 4500 = 5700ml.

The various lung volumes and capacities are


measured by means of a technique known as
spirometry, except the residual volume and
the capacities that include this volume which
are functional Residual capacity (FRC) and
Total Lung Capacity (TLC).

spirometry:

A subject breathes in a closed system in which


air is trapped within a light plastic bell floating
on water. The bell moves up when the subject
exhales and down when the subject inhales. The
movements of the bell cause corresponding
movements of a pen, which traces a record of
the breathing on a rotating drum recorder.

Residual
volume
Definition:
It is the volume of air that remains in the lung after forced
expiration.
It is about 1200 ml. in young adult male. It has a higher values in
females due to weaker respiratory muscles.
This residual air leaves the lung only after opening the chest (as in
pneumothorax) causing lung collapse.

Significance:
Physiologically:
It keeps air in alveoli to aerate blood between breathes. This
prevents marked changes in blood concentration of O2 and CO2 with
each respiration.
Clinically:
The ratio of RV/TLC normally ranges from 25-30%. It increases in
conditions associated with difficult expiration. e.g., bronchial asthma
and decreased lung elasticity as emphysema.

Vital capacity
Definition:
It is the volume of air that can be expired by forced expiration after
forced inspiration.
It varies with the body size, so, it is usually related to body surface
area.
Normally, it is about 2500 ml/m2 in male and 2000 ml/m2 in
female.
It is one of the best pulmonary function tests as it is an
efficient measure of the pulmonary capacity.

1) Posture:
VC is greater in the standing and sitting position than in the recumbent position.
This is because in the standing position:
a) The diaphragm descends freely.
b) about 400 ml blood are shifted to the lower limbs by the effect of gravity ---->
decrease of the blood content in the pulmonary vessels which permits greater alveolar
expansion.

2) Condition of the respiratory muscles:


Stronger respiratory muscles gives greater VC and vice versa.
This is because the lungs can distend more efficiently with stronger respiratory
muscles (as in athletes). If the respiratory muscles are affected by disease such as
poliomyelitis, myasthenia gravis, VC is decreased.

3) Expansibility of the thoracic wall:


The greater the expansibility of the chest wall, the greater VC and vice versa.
So, VC decreases in conditions which decrease the expansion of the thoracic wall
e.g. tumors in the chest wall and deformities of the vertebral column. e.g. kyphosis &
scoliosis.

4) Resistance to air flow:


VC decreases when the resistance increases and vice versa
So, VC decreases in bronchial asthma.

5) Lung elasticity:
Decrease in lung elasticity causes a decrease in VC.
So, VC decreases in condition of emphysema, pneumonia, and pulmonary fibrosis.

6) Pulmonary blood volume:


Increased blood volume in the pulmonary circulation (as left sided heart failure)
will decrease VC because the excess blood decreases lung distensibility and takes
the space for air.

7) Abdominal content:
Increased abdominal contents decreases VC as it hinders the

descend of

diaphragm. This occurs in abdominal distension, ascites, late pregnancy, and


tumors.

Posture
Conditi
on of
respirat
ory
muscles

Abdomi
nal
content

Pulmon
ary
blood
flow

Factor
s
affecti
ng VC

Expansibil
ity of
thorathic
wall

Lung
elastic
ity

Resista
nce to
air flow

Forced (Timed) vital capacity (FVC)


&
Forced Expiratory volumes (FEV)
Definition:
It is a measurement of vital capacity in unit time.
Procedure:
The person inspires maximally to the total lung capacity, then
exhales into the spirometer with maximal expiratory effort as fast and
as strong as possible.
Normal values:
Normally, the whole value of FVC is expelled in 4 seconds. The %
volume of air expired after one second (FEV1 / FVC %) is 83%, after two
second (FEV2 / FVC %) is 93%, and after 3 second (FEV3 / FVC %) is

FE
V2

FE
V3

Significance:
It is a useful clinical pulmonary test that measure the rate of
expiration. Its values is reduced in obstructive lung diseases as
bronchial asthma and emphysema. i.e., less volumes of air are
expelled in longer duration.

A- normal
B-obstructive
C-restrictive
D-obstruction of upper airway

Pulmonary Ventilation (Minute Respiratory


Volume) (MRV)

Definition:

It is the total amount of air inspired per minute.


It equals the respiratory rate per minute x the tidal volume.
MRV

RR

TV

= 12 x 500 = 6 L / min.

Alveolar Ventilation (Effective Pulmonary


Ventilation) (EPV)

Definition:

The volume of air that enters the alveoli per minute and hence
can undergo gas exchange with blood in the pulmonary capillaries.

-So, Alveolar ventilation (EPV) = Respiratory rate x (MRV Dead space


ventilation) =
12
x (500
- During quite normal inspiration, only the first 350 ml of the 500 ml
150 ) = 4.2 L / min.
inspired with each breath that enters the alveoli and mixes with
alveolar air. The remaining 150 ml occupies the conducting zone
(anatomical dead space).
Significance:
Alveolar ventilation is sensitive to changes in the respiratory rate and
depth rather than pulmonary ventilation.

Example:
In pulmonary congestion: There is shallow (decreased depth) rapid
(increased rate) breathing. The respiratory rate may increase to 30/
minute while TV is reduced to 200 ml. In such case, MRV is normal 6
L/min. while the alveolar ventilation is markedly decreased (200 - 150 x
30) = 1.5 L/min.

Dead space
(DS) air

Definition:
It is the volume of air which dose not undergoes gas exchange
with blood in pulmonary capillaries.
Types of Dead space:
Anatomical dead space:
It is the volume of air in the conducting zone of the respiratory
system whose wall is thick and hence interferes with the gas
exchange
During quite normal inspiration, only the first 350 ml of the 500 ml inspired with
each breath that enters the alveoli and the remaining 150 ml occupies the conducting zone
(anatomical dead space). With the next expiration, air in DS is expired first to atmosphere
followed by alveolar air. So, DS is filled with atmospheric air at end of inspiration and
with alveolar air at end of expiration.

Alveolar dead space:


In disease states, some of the alveoli have poor or absent blood flow
through pulmonary capillaries (under- or non-perfused). Some others are
hyperventilated. In both conditions, some air in those alveoli does not
undergo gas exchange with the blood in the pulmonary capillaries. From
functional point of view, this air should be considered dead space.
Physiological DS = Anatomical DS + nonfunctioning alveoli

In the normal person, the anatomical and physiologic dead spaces


are equal because all the alveoli are functional (ventilated and
perfused with blood).

Maximal breathing capacity (MBC)


= Maximal voluntary ventilation (MVV)
Definition:
It is the maximal volume of air that can breathed / minute (moves in
and out) using the fastest and deepest respiratory effort possible.
Measurement:
The subject breathes as fast and as deep as possible for 15 seconds in
a spirometer. Then the volume recorded is multiplied by 4 to get the
volume in one minute. The person breath only for 15 seconds to avoid
fatigue of the respiratory muscles
Normally,
MBC = 80 160 L / min. for male & 60 - 120 L/min. for
female.

MBC is the best pulmonary function test.

Breathing Reserve (BR):


Definition:
It is the difference between MBC and pulmonary ventilation.
BR = MBC MRV = 100 6 = 94 L/min.
Dyspnea index (DI):
Definition:
It is the ratio between BR& MBC.

Significance:
Dyspnea index is usually 90%. If it decreases less than 60% dyspnea
(difficulty in breathing) occurs.

Maximal (peak) expiratory flow rate (PEFR)


Definition:
It is the maximal velocity of air flow that can be produced during
a forced expiration.
Measurement:
After a maximal inspiration, the subject expires as forcefully as he
can, and the maximum flow rate is measured by an apparatus
called peak flow meter.
Significance:
This test is an alternative to FEV. Low value are obtained when
there is an obstruction to air flow (as in asthma & other diseases
associated with bronchoconstriction).

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