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1、Pulmonary Function Testing,For medical students of PUMCSept. 7th, 2005,What Pulmonary Function Tests Do You Need ?,Spirometry Lung Volumes Body Plethysmography Diffusing Capacity (DLCO) Arterial Blood Gas Analysis,Spirometer：最古老的水鼓式,Volume displacement spirometer 滚筒式,Pneumotach 流速仪,Portable spiromet
2、er 便携式,Pocket sized spirometer,Body box 体描箱,Diffusion,What Information Does PFT Provide ?,The function of the airways The function of pulmonary parenchyma Pulmonary vasculature Respiratory muscle,Spirometry Indications,Detect lung disease (screening) Quantify extent of known disease Measure effect o
3、f environmental exposure Determine benefits/risks of therapy Assess surgical risk Evaluate disability or impairment,Lung Volumes Indications,Diagnose / assess restrictive lung disease Assess hyperinflation in obstructive disease Assess response to treatment Lung transplantation Lung volume reduction
4、 Radiation, chemotherapy,Diffusion Capacity (DLCO) Indications,Follow progress of interstitial lung disease Assess pulmonary involvement in systemic disease Evaluate gas exchange in obstructive disease Assess pulmonary vascular diseases Quantify disability in interstitial lung disease,Data Quality i
5、n Spirometry,Equipment standardization, calibration, and quality control Test performance guidelines, criteria for acceptability of results Technologist/technician training,Testing Guidelines,Forceful expiration, no hesitation, at least 6 seconds At least 3 acceptable maneuvers obtained Two largest
6、FVC and FEV1 values within 200 ml Best test = largest FVC + FEV1,Spirometry,Interpretation of Spirometry,Look at Flow-Volume Loop,Is it a good PFTs? Is it normal? Characteristic pattern of obstruction? Pattern of restriction? Pattern of upper airway obstruction?,Normal Flow-Volume Loop,Cough,Variabl
7、e Effort,Severe Obstruction,Restriction,Upper Airway Obstruction,Are the Data Consistent with Flow-Volume Curve?,FVC (VC): an expression of lung size FEV1: influenced by lung size and the dimensions of airway FEV1/FVC: a measure of airway obstruction (Tiffeneau coefficient) Reduced FVC only suggests
8、 restriction,Criteria for Restriction,Reduced TLC is a Golden standard Reduced FVC with normal FEV1/FVC ratio is sensitive but lacks of specificity,Examine the response to bronchodilation,FEV1: 12% or more increase and 200ml increase sGaw*: 30-40% or more increase,* Chest 1992; 101:1572-1581,Case 1,
9、A 60 year old female was evaluated for dyspnea on exertion .,Case 1,Case 1,How to interpret the test?,Case 2,A 55 year old male was evaluated preoperatively for cataract surgery.,Case 2,Case 2,How to interpret the test?,Case 3,30 y/o male, 186 cm, 68 kgSevere interstitial fibrosis,Case 3,Case 3,Ref
10、Meas % FVC 6.01 1.12 19 FEV1 4.89 1.04 21 FEV1% 81 93 TLC 7.45 2.09 28 DLCO 35 9 26,How to interpret the test?,Case 4,TD 29 y/o male, 185 cm, 80 kg, smoker, recurrent chest infections, having a morning cough, denied shortness of breath or wheezing.,Case 4,Case 4,Ref Meas % FVC 5.84 6.79 116 FEV1 4.5
11、3 4.29 95 FEV1% 77 63 TLC 7.92 9.04 114 RV 2.08 1.92 92 Raw 0.99 4.03 406 sGaw 0.23 0.055 24,How to interpret the test?,Case 4,How to interpret bronchodilator test (spirometry, sGaw)?,Bronchodilator TestPre Post %Change FVC 6.79 6.81 0 FEV1 4.29 4.56 6% Raw 4.03 1.39 -66% sGaw 0.055 0.151 175%,Can y
12、ou make a statement as to the patients underlying lung disease?,Case 5,PF 56 y/o female, 165 cm, 100 kg cough and dyspnea on exertion, exercise-induced bronchospasm suspected.,Case 5,SpirometryRef Meas % FVC 3.28 3.50 107 FEV1 2.45 2.40 98 FEV1% 75 69,How to interpret the spirometry?,What other test
13、s do you order to answer the clinical question?,Case 5,Case 5,Hyperventilation Challenge,Case 5,Hyperventilation Challenge,Case 5,Hyperventilation ChallengePre Post %Change FVC 3.50 2.14 -39% FEV1 2.40 1.03 -57% PEF 6.22 2.52 -59%,What is the patients response to hyperventilation challenge?,Case 6,S
14、W 58 y/o female, 160 cm, 84 kgreferred for dyspnea on exertion,Case 6,1) Difficulty to perform spirometry 2) Audible stridor during expiration,Case 6,Case 6,Ref Pre % Post % %ChangeFVC 3.00 2.39 80 2.38 79 0 FEV1 2.22 1.18 53 0.51 23 -57 FEV1% 74 49 21 -57 TLC 4.73 4.03 85 RV 1.72 1.64 95 RV/TLC% 37 41 DLCO Could not be performed,Summary,Pulmonary function tests are valuable for the assessment of lung diseases. By ensuring proper calibration of equipment and performance of test maneuvers, one can differentiate among several different diseases.,
