PFTs Flashcards
What information is obtained from PFTs?
assesses functional status of the lung as it relates to:
- how much air volume can be moved in and out of the lungs
- how fast the air in the lungs can be moved in and out
- how stiff the lungs and chest wall are (compliance?)
- diffusion characteristics of the membrane through which gas moves
- measurement of how long the lungs have responded to tx
Indications for PFTs?
- screening for lung disease in pts with sxs
- following progression of pulmonary disease (restrictive or obstructive)
- evaluating the effectiveness of therapeutic intervention
- evaluating the pt prior to certain types of surgery (risk for post op respiratory complications, reflects the pts ability to take a deep breath, to cough, and to clear the airways of excess secretions (high risk pts: smokers, COPD)
- objective assessment of impairment or disability
What are the differeent types of PFTs?
- spirometry
- peak flow
- measurement of lung volumes
- quantification of diffusion capacity
- VO2 uptake: exercise capacity
What does spirometry measure?
- FEV1
- FVC
- it is the most readily available and most useful PFT
- $1500-2500
What is the definition of spirometry? What is the test dependent on?
- spirometry with flow volume loop assesses the mechanical properties of the respiratory system by measuring expiratory volumes and flow rates
- test is dependent on pt cooperation
- flow volume loops provide illustration of pt’s spirometric efforts
- flow is plotted against volume to display a continuous loop from inspiration to expiration
- overall shape of the flow volume loop is impt in interpreting spirometric results
What does a normal volume-time curve look like?
- rapid upslope and approaches a plateau soon after exhalation
- max volume attained is FVC and the volume attained after 1 second is the FEV1
What do normal values of spirometry depend on?
- age, gender, body, ht, wt, race
Why is age a variable?
- natural elasticity of the lungs decreases with age
- smaller and smaller lung volumes and capacities as we age
Why is gender a variable?
- usually lung volumes and capacities of males are larger than the lung volumes and capacities of females
- even when males and females are matched for ht and wt, males have larger lungs than females
Why is race a variable?
- Blacks, hispanics and Native Americans have diff PFT results compared to caucasians
- so a race approp. table should be used to measure pulmonary function
Why is body height and size a variable?
- body size has huge effect on PFT values
- small man will have smaller PFT result than a man the same age who is much larger
- if person becomes too obese, the abdominal mass prevents the diaphragm from descending as far as it could and PFT results will demonstrate a smaller measured PFT outcome
What are the examples of obstructive disease?
- asthma
- bronchitis
- excessive mucus plugging
- foreign body inhalation
- invasive tumors
- COPD
What does restricted airflow mean?
- restriction in lung disorders always means a decrease in lung volumes
- TLC is significantly reduced
- TLC is the volume of air in the lungs when the pt has taken a full inspiration
- TLC can’t be measured by spirometry because air remains in the lungs at the end of max exhalation - RV
What is TLC?
- FVC+ RV
What ways can we measure TLC?
- helium dilution
- nitrogen washout
- body plethysmography (gold std)
- chest radiograph or HRCT
What is FEV1?
- forced expiratory volume in 1 sec
- it is 75% of FVC
What is FVC?
- volume of air that can be max forcefully exhaled
What is the FEF 25-75% measuring? Why do we measure this? What is it a sensitive test for?
- avg FEF during the middle portion of FVC
- value of this: first quarter of FVC is effected by pt’s effort in overcoming the inertial forces which resist thoracic wall expansion
the last quarter is polluted by the pts diminishing effort in instigation of bronchospasm during forced expiration and the breathlessness associated with terminal completion of a FVC test (middle portion is less pt dependent)
sensitive test for early obstructive airway disease
What is the PEFR?
- the peak expiratory flow rate during expiration
- measure of highest expiratory flow rate during PFT test
- becomes sensitive test for presence of obstructive disease
- pts with low PEFR would have to be further evaluated
- useful measure to see if tx is improving obstructive disease (asthma - bronchoconstriction)
What is the VC?
- vital capacity: max vol expired after max inspiration