PULMONARY

FUNCTION TEST
Dr Piyush Kumar Mishra
Assistant Professor
 Introduction

Pulmonary Function Test are also called They are mainly utilized to access the
respiratory function test. lung function rather than to make a
pathological diagnosis.
 Importance of PFT

To access the physical

fitness for certain jobs To follow the progress of To access the respiratory
To access the severity of
involving (a) Strenous a disease and its status before
disease objectively.
physical exercise, (b) response to treatment anesthesia.
Flying at high altitude

Screening of people for PFT are carried out by

pulmonary disease in using following various Spirograph Blood and gas analysis
certain occupation method

Peak flow meter Polygraph Radiological instruments

 Tests for Ventilation

Test for Pulmonary gas exchange

Classification
Tests for respiratory control

Other special test

 Static lung function tests

Dynamic lung function tests

Determination of lung compliance

Tests for
ventilation Determination of dead space

Uniformity of ventilation

Ventilation perfusion ratio

 Tidal volume(TV)
Inspiratory reserve volume(IRV)
Expiratory reserve volume(ERV)
Residual volume (RV)
Static Vital capacity (VC)
Lung Total lung capacity (TLC)
Function Inspiratory capacity (IC)
Functional residual capacity (FRC)
Closing volume (CV)
Closing capacity (CC)
• Tidal Volume: Volume of air breathed n or out during quiet respiration. Normal value -
500ml. It is more in trained person
• Inspiratory Reserved Volume: It is the maximal volume of air, which can be inspired
after completing a normal tidal inspiration. Normal Value is 2000-3000ml.
• Expiratory Reserved Volume: It is the maximal volume of air, which can be expired
after completing a normal tidal inspiration. Normal Value is 1000-1200ml.
• Residual Volume: It is the volume of gas which remains in the lungs after a maximal
expiration (1200ml)
• Vital capacity: It is the maximal amount of air which can be expelled from the lungs by
forceful effort following a maximum expiration
Normal Value :Male- 4.8 L
Female-3.2 L
VC=TV+IRV+ERV
Using spirometer vital capacity can be determined
Physiological increase & Decrease
in Vital Capacity
i)Divers ii)Swimmers iii)Trained athletes iv) people living at high altitude v)
Standing position
In pregnancy a decrease in vertical is compensated by an increase in transverse
diameter hence there is no change in vital capacity.
• Physiological Decrease
. Old age
. Lying posture
. Obesity
 Pathological Decrease in Vital
Capacity
• Disease of the respiratory appratus e.g; poliomyelitis,plueral
effusion,respiratory obstruction,asthma,pneumothorax,pulmonary
fibrosis,emphysema,mysthenia gravis etc.
Factors that influence vital capacity
• Respiratory muscle power
• Airway patency resistance
• Compliances of the lungs
• Elasticity and Viscosity of lungs
Vital Index:
Vital capacity related to body surface area is called vital index.
VI=2.6L/m2
Total lung capacity (TLC):It is the volume of gas contained in the lungs after a
maximal inspiration. Total lungs capacity is equal to vital capacity plus the
residual volume. Normal value is 6000ml
TLC=TV+IRV+ERV+RV
Inspiratory Capacity(IC):The maximal volume of gas which can be inspired from
the resting expiratory level. This consists of inspiratory reserve volume and
tidal volume .Normal value is 3-3.5L
IC=IRV+TV
Expiratory Capacity (EC): Maximal volume of air that can be expired from
resting end inspiratory level. Normal value is 1200-1500ml
EC=ERV+TV
Functional Residual Volume (FRV): The volume of gas remaining in lungs at the
resting expiratory level. It consist of expiratory reserve volume and residual
volume. Normal value is 2.5 L
FRC =ERV +RV
 Determination of FRC
• FRC is done by simple spirograph. This is measured with the help of
nitrometer
• Nitrogen washout technique: In this case a nitrometer is used.At the end
of normal expiration the subject inspire pure oxygen for a period of 5
minutes and expires into large douglas bag previously washed with oxygen.
The expired gas contains nitrogen from the subjects lungs and its volume
and concentration is measured .
• FRC = 2500ml
Condition affecting FRC : These are
.FRC is increased in emphysema and old age
.FRC is decreased in interstitial pulmonary fibrosis and atelectasis
 Physiological significance
• This gas helps in the continuous exchange of gases between the lungs and
blood between two breathe.
• Breath holding is possible due to this.
• Dilution of toxic inhaled gas occus due to FRC reserve
• Without FRC lungs would collapse
• Prevent sudden changes in the partial pressure of gases in blood
• Closing volume: The volume of air that can be expelled after the closure of
the basal alveoli is called closing volume.
• In the old age and smoker CV is increased due to loss of elasticity
• Closing Capacity : This consist of closing volume +residual
volume.Determination of closing volume is a sensitive test for small airway
disease
Minimum Volume: In a collapsed lungs a small amount of air is
trapped.This is called minimal volume or minimal air. Medicolegally it is
vital .
 Dynamic Lung Function Tests
• Minute ventilation or pulmonary ventilation (PV)
• Alveolar ventilation (AV)
• Maximum yoluntary ventilation (MVV)
• Timed vital capacity (TVC) or Forced expiratory yolume(FEV)
• Maximum mid-expiratory flow rate (FEF 25-75%)
• Mid- expiratory time (MET)
• Forced end expiratory flow (FEF- 25%)
• Peak expiratory flow rate
• Forced expiratory flow between- 200- 1200 mL of FVC
• Minute ventilation: This is also called pulmonary yentilation. It is defined as the volume
of air that can be inspired or expired per minute.
PV = TV*Respiratory rate
500*12=6L /min
• Maximum breathing capacity or maximum voluntary ventilation (MBC or MVY): It
is the greatest volume of air that can ventilate the lungs in 1 minute by maximum effort.
• The subject is asked to breathe as rapidly and deeply as he can for a 15-second
interval. This can be either recorded on a slow moving paper by spirograph or collected
into Douglas bag. The volume is calculated for 1 minute.
The normal value is 90-170 L/min.
• Factors that influence MBC (MVV): 1. Respiratory muscle power, 2. Airway patency,3
Compliance of the lungs and the thorax, 4. Elasticity and viscosity of the lung
• MVV is reduced in: 1.Emphysema,2.Airway obstruction and in restrictive Lung diseases
• MVV is increased in: Trained persons, 2 Persons living at high altitude.
• Breathing reserve (BR): indicates the reserve capacity of the lungs.
BR = MVV - PV.
• Dyspneic index (DI): This is also called % of BR Normal DI varies from
90 98%. When the DI below 60%, then there is dyspnea.
• Dyspnea: Conscious unpleasant breathing or difficulty in breathing under
resting state.
Timed vital capacity: The amount of air that can be expired with maximum effort after a maximal inspiration in a
given unit time is called as timed vital capacity.
It has three components :
1. FEV1 : Amount of air expired forcefully in 1 second
2. FEV2 : Amount of air expired forcefully in 2 second
3. FEV3 : Amount of air expired forcefully in 3 second .
These are usually expressed in percentage of forced capacity in first, second & third seconds.
FEV1 =80% of FEV
FEV2 =95% of FEV
FEV3 =98-100% of FEV
Significance of FEV
This helps in differentiating obstructive lungs disease from restrictive lungs disease
Restrictive lung disease
• Myasthenia gravis
• Poliomyelitis
• Pleural effusion
• Pulmonary fibrosis
 Tests For Pulmonary Gas Exchange

Diffusion Capacity of the Lung ( Table 97.2)

It is defined as the amount of gas that can diffuse in 1 min when there is a
pressure gradient of 1mm Hg. Thus diffusion capacity for O2 ( DO2) is 21
mL/mm Hg.
• DCO2= 400-450 mL/min/mm Hg
DO2 and DCO2 are estimated indirectly by using DCO2
DCO= 17 mL/min/mm Hg
Thus, DO2 = DCO×1.25
DCO2= DCO×26.6
This is reduced in all the lung diseases that causes imbalance in Ventilation /
perfusion ratio.
 Tests For Respiratory Control

• Ventilatory responses to inhalation of air with varied PO 2 and PCO2 :

A decrease in PCO2 in inspired air stimulate pulmonary ventilation.
Increase in pulmonary ventilation is proportional to PCO2 of inspired air
within limits. Response to low PO2 is less compared to the response to
PCO2 of inspired air.
• Response to varied arterial PH: The response to a drop in blood PH is
also less compared to the response to PCO2. A blunted response to ↓ PO2 ↑
PCO2 or ↓ PH suggest that the respiratory neurons are in depressed state.
• EMG of respiratory muscles: The EMG of the respiratory muscles is
studied to find out the pattern of neural discharge form the respiratory
centers. This is affected in neural and respiratory muscle pathology.
 Other •
•
Plain Xray
Determination of Pulmonary Vascular
Pressure
Special • CT Scan
• MRI
Test • Bronchoscopy
THANK YOU