Interpreting PFT

Basic Practical Notes

Objectives
Review basic pulmonary anatomy and physiology. Understand the reasons pulmonary function tests (PFTs)

are performed. Understand the technique and basic interpretation of spirometry. Know the difference between obstructive and restrictive lung disease. Know how PFTs are clinically applied.

What do the lungs do?

Primary function is gas exchange.
Let oxygen move in. Let carbon dioxide move out.

How do the lungs do this?

First, air has to move to the region where gas exchange

occurs.
For this, you need a normal ribcage and respiratory

muscles that work properly (among other things).

Conducting Airways
Air travels through the

conducting airways comprised of the following: nose,larynx, trachea, lobar bronchi, segmental bronchi, subsegmental bronchi, small bronchi, bronchioles, and terminal bronchioles.

How do the lungs do this? (cont)

The airways then branch further to become

transitional/respiratory bronchioles. The transitional/respiratory zones are made up of respiratory bronchioles, alveolar ducts, and alveoli.

How do the lungs do this? (cont)

Gas exchange takes place in the acinus.
This is defined as an anatomical unit of the lung made

of structures supplied by a terminal bronchiole.

From Netter Atlas of Human Anatomy

How does gas exchange occur?

Numerous capillaries are wrapped around alveoli.
Gas diffuses across this alveolar-capillary barrier. This barrier is as thin as 0.3 m in some places and has

a surface area of 2.8 square meters at birth increased to about 75 square meters in adult male!

Gas Exchange

From Netter Atlas of Human Anatomy

What exactly are PFTs?

The term encompasses a wide variety of objective methods

to assess lung function.

Examples include:
Spirometry
Blood gases Exercise tests Diffusion capacity Bronchial challenge testing Pulse oximetry

Why PFTs?
Help in diagnosis of diseases.
May help guide management of a disease process. Can help monitor progression of disease and

effectiveness of treatment.

Spirometry
Spirometry is a medical test that measures the

volume of air an individual inhales or exhales as a function of time.

Lung Volumes and Capacities

4 volumes: inspiratory

reserve volume, tidal volume, expiratory reserve volume, and residual volume
4 capacites: vital capacity,

inspiratory capacity, functional residual capacity, and total lung capacity

Lung Volumes Tidal Volume (TV): volume of

air inhaled or exhaled with each breath during quiet breathing Inspiratory Reserve Volume (IRV): maximum volume of air inhaled from the end-inspiratory tidal position Expiratory Reserve Volume (ERV): maximum volume of air that can be exhaled from resting end-expiratory tidal position

Lung Volumes
Residual Volume (RV): Volume of air remaining in lungs after maximium exhalation.

Lung Capacities
Total Lung Capacity (TLC): Sum

of all volume compartments or volume of air in lungs after maximum inspiration Vital Capacity (VC): TLC minus RV or maximum volume of air exhaled from maximal inspiratory level Inspiratory Capacity (IC): Sum of IRV and TV or the maximum volume of air that can be inhaled from the end-expiratory tidal position

Lung Capacities (cont.) Functional Residual

Capacity (FRC):
Sum of RV and ERV or the

volume of air in the lungs at end-expiratory tidal position.

What information does a spirometer yield?

A spirometer can be used to measure the following:
FVC and its derivatives (such as FEV1, FEF 25-75%) Forced inspiratory vital capacity (FIVC) Peak expiratory flow rate Maximum voluntary ventilation (MVV) IC, IRV, and ERV

Pre and post bronchodilator studies

Special Considerations in Pediatric Patients

Ability to perform spirometry dependent on

developmental age of child. Patients need a calm, relaxed environment and good coaching. Patience is the key. Even with the best of environments and coaching, a child may not be able to perform spirometry. Results are affected also by posture and neck position.

Flow-Volume Curves
Flow-volume curve---flow meter measures flow rate in

L/s upon exhalation; flow plotted as function of volume

 Normal Flow-Volume Curve and Spirogram

Spirometry Interpretation:
Normal values vary and depend on: Height Gender Ethnic origin

Acceptable and Unacceptable Spirograms

(from ATS)

Measurements Obtained
FEV1---the volume exhaled during the first second of the

FVC maneuver

FEF 25-75%---the mean expiratory flow during the middle

half of the FVC maneuver; reflects flow through the small (<2 mm in diameter) airways
FEV1/FVC---the ratio of FEV1 to FVC (expressed as a

percent); an important value because a reduction of this ratio from expected values is specific for obstructive rather than restrictive diseases

Spirometry Interpretation: Obstructive vs. Restrictive Defect

Obstructive Disorders
Characterized by a limitation

Restrictive Disorders
Characterized by reduced

of expiratory airflow so that airways cannot empty as rapidly compared to normal (such as through narrowed airways from bronchospasm, inflammation, etc.) Examples: Asthma Emphysema Cystic Fibrosis

lung volumes/decreased lung compliance Examples: Interstitial Fibrosis Scoliosis Obesity Lung Resection Neuromuscular diseases Cystic Fibrosis

Normal vs. Obstructive vs. Restrictive

Spirometry Interpretation: Obstructive vs. Restrictive Defect

Obstructive Disorders FVC nl or FEV1 FEF25-75% FEV1/FVC TLC nl or Restrictive Disorders FVC FEV1 FEF 25-75% nl to FEV1/FVC nl to TLC

Spirometry Interpretation: What do the numbers mean?

FVC
Interpretation of %

predicted:
80-120% Normal

FEV1 Interpretation of % predicted:

>80% Normal

70-79%

Mild reduction 50%-69% Moderate reduction <50% Severe reduction

60%-79% Mild obstruction

50-59% Moderate

obstruction <49% Severe obstruction

Spirometry Interpretation: What do the numbers mean?

FEF 25-75%
Interpretation of %

FEV1/FVC
Interpretation : 80 or higher Normal 79 or lower Abnormal

predicted:
>79% Normal 60-79% Mild

obstruction 40-59% Moderate obstruction <40% Severe obstruction

Maximal Inspiratory Flow

Do FVC maneuver and then inhale as rapidly and as

much as able. This makes an inspiratory curve. The expiratory and inspiratory flow volume curves put together make a flow volume loop.

Flow-Volume Loops

How is a flow-volume loop helpful?

Helpful in evaluation of air flow limitation on inspiration

and expiration
In addition to obstructive and restrictive patterns, flow-

volume loops can provide information on upper airway obstruction:

Fixed obstruction: such as in tumor, tracheal stenosis Variable extrathoracic obstruction: flattened inspiratory loop

such as in vocal cord dysfunction Variable intrathoracic obstruction: flattening of expiratory limb; tracheomalacia

Spirometry Pre and Post Bronchodilator

Obtained a minimum of 15 minutes after administration of the bronchodilator.

Calculate percent change (FEV1 most commonly used---so % change FEV 1= [(FEV1 Post-FEV1 Pre)/FEV1 Pre] X 100).
Reversibility is with 12% or greater change.

THANK YOU