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CVPR Week 5: Pulmonary function tests Flashcards

1
Q

Spirometry measures?

A

lung function

  • FVC
  • FEV1
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2
Q

FVC AKA

A

Forced vital capacity

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3
Q

FVC definition

A

s defined as the amount of air that can be forcibly exhaled from the lungs after taking the deepest breath possible

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4
Q

FEV1 AKA

A

Forced expiratory volume in 1 second

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5
Q

FEV1 definition

A

FEV1 is the maximal amount of air you can forcefully exhale in one second

the test shows if there is airway obstruction

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6
Q

Lung volume tests measure?

A

Measures lung capacity

  • TLC
  • RV
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7
Q

TLC AKA

A

Total lung capacity

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8
Q

TLC definition

A
  • about 6,000 mL
  • is the maximum amount of air that can fill the lungs
  • (TLC = TV + IRV + ERV + RV)
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9
Q

RV AKA

A

Residual volume

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10
Q

RV Definition

A

the volume of air still remaining in the lungs after the most forcible expiration possible

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11
Q

PFT AKA

A

Pulmonary function tests

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12
Q

PFT Values

A
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13
Q

In pulmonary, capacity is?

A

The sum of at least 2 volumes

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14
Q

What are PFTs used for?

A
  • Diagnosis and treatment of lung disease
  • Evaluate disease progression or improvement during treatment
  • Pre-operative evaluation
  • Clinical diagnosis of dyspnea
  • Evaluate impairment
  • Changes due to exposures or drugs (occupational exposures or drugs like amiodarone and chemotherapies)
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15
Q

Common drugs that cause pulmonary toxicity

A
  • Chemotherapies
  • amiodarone
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16
Q

Preoperative PFTs value and indications

4 listed

A
  • somewhat useful for predicting the risk of postoperative complications
  • Lung function alone should not be used to deny a patient non-pulmonary surgery
  • In lung resection, used to predict a post-resection FEV1 of 0.8L
  • Exercise testing may also be useful
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17
Q

Symptom diagnostics to help in the evaluation

5 listed

A
  • Cough
  • Dyspnea
  • Wheezing
  • Orthopnea
  • Chest pain
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18
Q

Lab or imaging study diagnostics to help in the evaluation

4 listed

A
  • Hypoxemia
  • Hypercapnia
  • Polycythemia
  • Abnormal CXRs
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19
Q

Physical exam finding diagnostics to help in the evaluation

A
  • signs of overinflation
  • Wheezing
  • Crackles
  • Cyanosis
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20
Q

Spirometry values measured

A

Often measured before and after bronchodilators

  • FEV1
  • FVC
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21
Q

For most cases, what test values are needed to define lung disease is present and follow patients with obstructive disease

A
  • FEV1
  • FVC
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22
Q

How to perform spirometry

8 listed

A
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23
Q

The flow volume loop of spirometry

A
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24
Q

How is an obstructive defect determined from PFTs?

A
  • FVC is the total amount of air exhaled from total lung capacity down to residual volume
  • FEV1 is the amount of air exhaled in 1 second (most people should be able to exhale 70% of their VC in 1 second)
  • Expressed as FEV1/FVC ratio
  • This is a difficulty in getting air out rather than in
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25
Q

Air movement deficits in Obstructive lung diseases

A

Difficulty getting air “out”

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26
Q

Air movement deficits in Restrictive lung diseases

A

Difficulty getting air “in”

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27
Q

Ratio of what indicates airflow obstruction?

A

<70% of FEV1/FVC

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28
Q

FEV1/FVC of <100 and >70

A

mild

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29
Q

FEV1/FVC of <70 and >60

A

Moderate

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30
Q

FEV1/FVC of <60 and >50

A

Moderately severe

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31
Q

FEV1/FVC of <50 and >35

32
Q

FEV1/FVC of <35

A

Very severe

33
Q

Severity of airflow obstruction classifications

34
Q

Common obstructive lung defects

A
  • Asthma
  • COPD/Chronic bronchitis
  • Ephysema
  • Bronchiectasis
35
Q

Asthma level of obstruction

A

It may be variable obstruction improving post-bronchodilator

36
Q

Asthma PFTs

A
  • PFTs may be normal if patient’s asthma is under control
  • Normal spirometry doesn’t rule out the disease for this reason
  • Spirometry can help define the severity of the disease
  • Bronchodilatory response - increase in FEV1 of 12% and greater than 0.2 L suggests response
  • Lack of bronchodilator response does not rule out asthma or mean that bronchodilators are not useful
  • Lung volumes are usually not needed
37
Q

Asthma normal spirometry

A

spirometry may be normal if the patient’s asthma is under control and for this reason the disease cannot be ruled out by normal spirometry

38
Q

Asthma bronchodilator response considerations

A
  • increase in FEV1 of 12% and greater than 0.2 L suggests a response
  • Lack of a bronchodilator response does not rule out asthma or mean that bronchodilators are not useful
39
Q

Asthma lung volumes

A

Lung volumes are not usually needed

40
Q

COPD PFTs

3 listed

A
  • A decrease in FEV1 helps define the severity of the disease along with functional status and exacerbations for prognostication
  • Lack of bronchodilator response does not mean that bronchodilators are of no use
  • Lung volumes can show hyperinflation (elevated TLC) and air trapping (elevated RV)
41
Q

Lung volumes measure

A

TLC and RV

42
Q

Lung volume testing usefulness

A

not needed as a routine test but is useful in defining restrictive lung diseases

43
Q

Increased TLC in obstruction

A

means hyperinflation and increased RV air trapping

44
Q

Lung volume testing for defining restrictive diseases

3 listed

A
  • Defined as a decrease in lung volume
  • decreased TLC below the lower limit of normal
  • FVC and FEV1 are both reduced but the ratio is normal meaning difficulty getting air in and not getting air out
45
Q

Restrictive defect is defined by?

A

Based on a reduced TLC

A decreased VC in the presence of a normal to increased FEV1?FVC ratio is suggestive of restriction but should also have lung volumes to confirm

46
Q

Mild restrictive disease

A

TLC = <lln>70</lln>

47
Q

Moderate restrictive disease

A

TLC = <70 and >60

48
Q

Severe restrictive disease

49
Q

Causes of decreased TLC in restrictive lung disease

A
  • Interstital lung disease/pneumoconiosis
    • scarring and fibrosis of alveolar septae
  • Loss of lung tissue
    • Surgical resection
  • Breathing mechanics
    • mechanical/neuromuscular disease leads to a restrictive process however the lungs themselves are normal
  • Obesity
    • restriction due to the chest wall and abdomen impinging on the thoracic space
    • lung parenchyma is normal
50
Q

Obesity mechanism of decreased TLC

2 listed

A
  • restriction due to the chest wall and abdomen impinging on the thoracic space
  • lung parenchyma is normal
51
Q

Breathing mechanics mechanism of decreased TLC

A

A mechanical/neuromuscular disease leads to a restrictive process however the lungs themselves are normal

52
Q

Loss of lung tissue mechanisms of decreased TLC

A

Surgical resection

53
Q

Interstitial lung disease/pneumoconiosis mechanism of decreased TLC

A

scarring and fibrosis of alveolar septae

54
Q

DLCO AKA

A

Diffusion capacity for Carbon Monoxide

55
Q

DLCO test

A
  • Assesses the amount of functional alveolar-capillary surface area or how much blood is in the lung available for gas exchange
  • Used to assess whether lung parenchyma is normal; particularly in restrictive processes
  • Decrease can be an early sign of pulmonary fibrosis or pulmonary vascular disease
56
Q

What can cause a decreased DLCO?

A
  • Obstructive lung disease (emphysema: loss of alveolar surface area)
  • Restrictive lung disease (interstital lung disease, not usually in obesity or neuromuscular weakness)
  • Radiation therapy
  • Amiodarone Bleomycin Nitrofurantoin and other chemotherapies
  • Pulmonary vascular disease: PE/pHTN
57
Q

Interpretation considerations of PFTs

5 listed

A
  • Interpretation should be made in light of the clinical question
  • No single test is diagnostic
  • Results can be affected by patient effort, machine reproducibility, disease state of the patient
  • Evaluate the quality of the test
  • Use of prediction equations are based on population studies and may not represent the patient being studied
58
Q

Considerations for the quality of a test

3 listed

A
  • The lab should follow ATS recommendations (special training and certification for RTs to perform PFTs
  • Results should be reproducible
  • Minimum of 6 seconds exhalation time with a 2-second plateau on a volume-time curve
59
Q

Interpretation criteria

5 listed

60
Q

PFT study

A

normal test

61
Q

PFT Study

A
  • this is obstructed
  • and looks like they have a bronchodilator response
  • FEV1/FVC = <48 so pretty bad and there is a response to bronchodilators
62
Q

PFT Study

63
Q

PFT Study

A
  • mildly restrictive and a little DLCO
  • FEV1 and FVC is reduced but their ratio is normal
  • DLCO is corrected for anemia
64
Q

Obstructive vs Restrictive: Lung volume

A

obstructive ↑

Restrictive ↓

65
Q

Obstructive vs Restrictive: FEV1

A

Obstructive: ↓↓

Restrictive: ↓

66
Q

Obstructive vs Restrictive: FVC

A

Obstructive: ↓

Restrictive: ↓

67
Q

Obstructive vs Restrictive: FEV1/FVC

A

Obstructive: ↓

Restrictive: nml/↑

68
Q

Obstructive vs Restrictive

  • Lung volume
  • FEV1
  • FVC
  • FEV1/FVC
70
Q

Upper airway obstruction

71
Q

PFT Prediction equations

72
Q

PFT Normal curve

73
Q

PFT Prediction equations Crapo

74
Q

Obstructive defect

A
  • A disproportionate reduction of maximal airflow with respect to the maximal lung volume
  • FEV1 decreases more than FVC
  • Earliest limitation is in small airways (FEF 25-75)
75
Q

Obstructive defects treatments

76
Q

Bronchodilatory response

77
Q

Bronchodilator response

CVPR (93 decks)

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