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1、Pulmonary Function TestingPulmonary Function TestingRespiratory Department of the Second Affiliated Hospital of Guangzhou Medical University Huaxing Huang History of pulmonary function testingnMore than 300 years, water sealed spirometer wedged-typed spirometer drum-typed spirometer digitalized spir
2、ometernIn 1679,BORELLI measured lung volume firstly.nIn 1846,HUTCHINSON put forward the concept of vital capacity.nIn 1919,NIANSTROHL put forward the concept of forced vital capacity.nIn 1967,DOLLFUSS put forward the concept of disease of small airway.nIn 1979,ATS setup the work standards of pulmona
3、ry function testing.Clinical Pratice of Pulmonary Function TestingnDiagnosticnObjective AssessmentnMonitoringnEvaluations for Disability / ImpairmentLung volume and capacityVentilation functionDiffusion functionMechanics of breathingMain Programs of Pulmonary Function TestingLung volumenLung volume
4、means the maximal volume of gas contained by a lung.nLung volume = tidal volume(VT) + inspiratory reserve volume(IRV) + expiratory reserve volume(ERV) + residual volume(RV)nLung capacity: inspiratory capacity(IC), vital capacity(VC), functional residual capacity(FRV), total lung capacity(TLC)Curve o
5、f lung capacityIRVERVVTV CRVT L CI CF R CVital capacity The maximum volume of air that can be inspired by forceful expiration.Residual volumeInspiratory reserve volumeExpiratory reserve capacityTotal lung capacity Tidal volumeFunctional reserve volumeTidal volume (VT)nThe volume of air inspired or e
6、xpired wit h each normal breath.n8-15ML/KG Inspiratory capacity（IC） Inspiratory reserve volume（IRV ）nIC, the maximum volume of air that can be inspired by forceful expiration. It is equal to VT plus IRV.nIRV, the maximum extra volume of air that be inspired over and above the normal tidal volum e.nT
7、hese reveal the maximam expansion of lung and chest at static state. Expiratory reserve volume (ERV）nThe maximum extra volume of air that be inspired over and above the normaltidal volume.nIt reflects the power of expiratory muscle and abdominal muscle.Vital capacity （VC）nThe largest amount of air t
8、hat can be expire d after a maximal inspiratory effort frequentl y. nVC varies among normal bodies, so ratios of measured VC to predicted VC are used for judgment.nGrading standard：ratio of measured VC to predicted VC80%normal60-79%mildly reduced40-59%moderately reducedFRC%Pred 120% increased FRCn10
9、L hyperventilationnMV3L hypoventilation Alveolar ventilation (VA)nThe amount of air reaching the alveoli per minute at rest.nAnatomic dead space: the space in the conducing zone of the airways occupied by ga s that does not exchange with blood in the pulmonary vessels, such as the space in nose and
10、pharynx.nAlveolar dead space: some of the alveoli themselves are nonfunctional or only partially functional because of absent or poor blood flow through adjacent pulmonary capillaries.nPhysiological dead space（VD）= Anatomic dead space + Alveolar dead space . nVA=（MVVD）RRVA varies in bodies and range
11、s from 3 to 5.5L.VA reflects the effective ventilation. Reduction of MVV and increased dead space will result in alveolar hypo- ventilation.Dead space that results from deep and slow breathing is less than that of shallow and rapid breathing. So less respiratory rate and more VT will be better for V
12、A.Alveolar ventilation (VA)Maximal volumtary ventilation （MVV）nThe total amount of new air moved into the respiratory passages by deepest and faster breathing in each minute. It depends on lung volume, compliance of lung and thorax, airway resistance and respiratory muscle.n MVV%Pred 80% normal nDam
13、age grading：MVV%Pred 60-79% mildly reduced 40-59% moderately reduced40% severely reduced Increased airway resistance: asthma Thoracic deformity or neuromuscular diseases: kyphoscoliosis, Guillian-Barre syndrome Diseases of lung tissue：pulmonary edema Main causes of reduced MVVTimed Vital Capacity (T
14、VC)n nFVCFVCnFEV1nFEV1 /FVC% /FVC%n nMMEFMMEFn nPEFPEFTimed Vital Capacity (TVC)nFVC(forced vital capacity):This is the amount of air expelled from the lungs after first filling the lungs to maximum extent and then expiring rapidly and forcefully.nFEV1(forced expiratory volume in one second)is the a
15、mount that can be got in the first second when FVC is measured.n nFEVFEV1 1/FVC%/FVC%：ratio of FEVratio of FEV1 1to FVC to FVCTimed Vital Capacity (TVC)nMMEF (maximal mid-expiratory)： After FVC divided into four average parts, divide the amount of the two middle parts by the corresponding expiratory
16、 time, MMEF will be got.Timed Vital Capacity (TVC) FVC%Pred 80% FEV1%Pred 80% FEV1/FVC 70%-80% FEV1%Pred can be used to evaluate the damage degree of ventilation and differentiate obstructive ventilation dysfunction from restrictive ventilation dysfunction.TimeVolume curvetime（s）0 1 2 3 4 5abcVolume (l)FEV1 FVCRVTLCSVC FVCnormalrestrictiveobstructiveClinical SignificancenIn normal body, FVC is closed to VC. Increa
