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Pulmonary Function Tests

Present by :- Mukesh kumar M.Sc. Nursing M.S.N.

Pulmonary Function Tests


Tests are used to evaluate lung functions. P.F.T. are useful in assessing functional status of respiratory system both in physiological and pathological conditions. Lung function tests are based on measurement of volume of air breathed in out in quiet breathing and forced breathing.

Learning Objectives

Measures1 or more aspects of the respiratory system


Lung volumes Lung capacities Spiro gram Air flow

Lung volume
Lung volumes are static volumes of air breathed by an individual

Lung volumes are following :1. Tidal volume 2. Inspiratory reserve volume 3. Expiratory reserve volume 4. Residual volume

Tidal volume

Tidal volume is the volume of air breathed in and out of lungs in a single normal quiet respiration. It signifies normal depth of breathing

Normal value = 500 ml

Inspiratory reserve volume


Inspiratory

reserve volume is an additional volume of air that can be inspired forcefully after end of normal inspiration.

Normal value = 3300 ml

Expiratory reserve volume


Expiratory

reserve volume is an additional volume of air that can be expired out forcefully after end of normal expiration

Normal

value = 1000 ml

Residual volume
Amount

of air remaining in lungs after forced expiration.


Normal value = 1200 ml

Lung capacities
Lung capacities are the combination of the two or more lung volumes. Lung capacities are four types:1. Inspiratory capacity 2. Vital capacity 3. Functional residual capacity 4. Total lung capacity

Inspiratory capacity
Inspiratory capacity is the maximum volume of air that is inspired after normal expiration. It includes tidal volume and inspiratory resreve volume. IC = TV + IRV = 500+3300 = 3800 ml

Vital capacity
Vital capacity is the maximum volume of air that can be expelled out forcefully after a deep inspiration. It includes inspiratory reserve volume, tidal volume and expiratory resreve volume. VC = IRV + TV + ERV = 3300 + 500 +1000 = 4800 ml

Functional residual capacity


FRC is the volume of air remaining in after lungs after normal expiration. It includes expiratory reserve volume and residual volume. FRC = ERV + RV = 1000 + 1200 = 2200 ml

Total lung capacity

Total lung capacity is the volume of air present in lungs after a deep (maximal) inspiration. TLC = IRV + TV + ERV + RV = 3300 + 500 + 1000 + 1200 = 6000 ml

spirogram
Spirogram is the graphical record of the lung volumes and lung capacities using spirometer. The upward deflection of spirogram denotes ispiration and downward curves indicates expiration. Following Four levels are noted in spirogram:

1. the normal end inspiratory level 2. The normal end expiratory level 3. The maximum inspiratory level 4. The maximum expiratory level

Lung Volumes

IRV TV ERV IC VC TLC

4 Volumes 4 Capacities

Sum of 2 or more lung volumes

FRC
RV RV

Tidal Volume (TV)

IRV TV ERV

IC VC TLC

Volume of air inspired and expired during normal quiet breathing

FRC
RV RV

Inspiratory Reserve Volume (IRV)

IRV TV ERV

IC VC TLC

The maximum amount of air that can be inhaled after a normal tidal volume inspiration

FRC
RV RV

Expiratory Reserve Volume (ERV)

IRV TV ERV

IC VC TLC

Maximum amount of air that can be exhaled from the resting expiratory level

FRC
RV RV

Residual Volume (RV)

IRV TV ERV

IC VC TLC

Volume of air remaining in the lungs at the end of maximum expiration

FRC
RV RV

Vital Capacity (VC)

IRV TV ERV

IC VC TLC

FRC
RV RV

Volume of air that can be exhaled from the lungs after a maximum inspiration FVC: when VC exhaled forcefully SVC: when VC is exhaled slowly VC = IRV + TV + ERV

Inspiratory Capacity (IC)

IRV TV ERV

IC VC TLC

FRC
RV

Maximum amount of air that can be inhaled from the end of a tidal volume IC = IRV + TV

RV

Functional Residual Capacity (FRC)

IRV TV ERV

IC VC TLC

Volume of air remaining in the lungs at the end of a TV expiration FRC = ERV + RV

FRC
RV RV

Total Lung Capacity (TLC)

IRV TV ERV

IC VC TLC

Volume of air in the lungs after a maximum inspiration TLC = IRV + TV + ERV + RV

FRC
RV RV

Common measures of pulmonary function airflow


A. Forced expiratory volume (FEV) :- FEV is the volume of air which can be expired forcefully in a given unit of time (after a deep inspiration). It is also called timed vital capacity or forced expiratory vital capacity (FEVC)

### { Forced vital capacity:- amount of air that can be quickly and forcefully exhaled after maximum inspiration.}

Normal values of FEV


FEV 1 - Amount of air exhaled in 1st second of FVC (FEV= 83% of total vital capacity) FEV 2 - Amount of air exhaled in 2nd second of FVC (FEV= 94% of total vital capacity)

FEV 3 - Amount of air exhaled in 3rd second of FVC (FEV= 97% of total vital capacity) 3rd second = 100%of total vital capacity

After

B.- Respiratory Minute Volume :- RMV is volume of air breathed in and out of lungs every minute. RMV = TV * RR (Normal respiratory minute volume is 6liters ) ## it increase in physiological condition ex.voluntary hyperventilation. ## it decrease in respiratory disorder .

Maximum

breathing capacity(MBC) or Maximum ventilation volume (MVV) :--

MBC is maximum volume of air which can be breathed in and out lungs by forceful respiration per minute. { Hyperventilation= increase in rate and force of respiration } Normal value :Healthy adult male 150-170liters/min. Healthy adult female 80-100liters/min.

Peak

expiratory flow rate (PEFR):-

PEFR is the maximum rate which the air can be expired after a deep inspiration. Normal value = 400 liters/min. significance assessing respiratory diseases, reduction is more significant in obstructive diseases than restrictive diseases. (restrictive dis. PEFR= 200liters/min) (obstructive dis. PEFR= 100liters/min

Indications
Detect disease Evaluate extent and monitor course of disease Evaluate treatment Measure effects of exposures Assess risk for surgical procedures

Pulmonary Function Tests

Airway function

Simple spirometry Forced vital capacity Maximal voluntary ventilation Maximal inspiratory/expiratory pressures Airway resistance

Lung volumes and ventilation


Functional residual capacity Total lung capacity, residual volume Minute ventilation, alveolar ventilation, Distribution of ventilation

Pulmonary Function Tests


Diffusing capacity tests Blood gases and gas exchange tests

Cardiopulmonary exercise tests Chemical analysis of exhaled breath

Blood gas analysis Pulse oximetry Capnography

Factors That Affect Lung Volumes


Age Sex Height Weight Race Disease

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