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Internal Medicine MD2 Lectures > Pulmonary Function Testing > Flashcards

Pulmonary Function Testing Flashcards

1
Q

What are the categories of PFTs?

A
  1. Airway function
    - Spirometry
  2. Lung volumes and ventilation
    - FRC
    - TLC
    - RV
  3. Diffusion capacity
    - DLCO (diffusion capacity for carbon monoxide)
    - KCO (transfer coefficient for carbon monoxide)
  4. Blood gasses and gas exchange:
    - Shunt studies
  5. Cardiopulmonary exercise tests
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2
Q

What is a spirometer?

A

An apparatus for measuring the volume of air inspired and expired by the lungs

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3
Q

What are the clinical indications for spirometry?

A
  • Diagnose the presence or absence of lung disease
  • Quantify extent of known disease on lung function
  • measure effects of occupational or environmental exposure
  • Determine beneficial or negative effects of therapy (bronchodilators, steroids, lung transplant, beta-blockers)
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4
Q

What are some contraindications of spirometry?

A

Cardiopulmonary problems: pneumothorax, MI, haemoptysis, recent PE

Surgery: abdo, thoracic, brain, eye

Things that might pop lol: HTN, AAA

Stress incontinence

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5
Q

What is the normal range for spirometry?

A

80-120% of the predicted

Reference values depend on age, sex, race and ethnicity

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6
Q

What are the two types of spirometry?

A

Volume-time

Flow-volume

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7
Q

What are the 4 important spirometry parameters?

A
  1. FEV1: volume expired in first second of forced expiration after maximal inspiration
  2. FVC: max volume of air which can be expired with maximal force (after max insp)
  3. FEV1/FVC:
    - gives an index of airflow limitation
  4. PEF: Peak expiratory flow rate
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8
Q

What needs to happen to get good spirometry results?

A
  1. Proper use of spirometer: good mouth seal, nose plugs
  2. No hesitant start (underestimates FEV1)```
  3. Satisfactory exhalation
  4. No artefacts e.g. cough
  5. 2 largest FVC volumes must be within 150mL
  6. 2 largest FEV1 must be within 150mL
  7. Need three consistent flow-volume curves
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9
Q

What is the bronchodilator response?

A
  • Done in the setting of airflow obstruction
  • SABA ceased 4 hours before testing, LABA for 12 hours. No smoking for 1hr prior.

Spirometry –> 4 puffs salbutamol and wait 15 mins –> spirometry

200ml and 12% in FEV1 or FVC = significant bronchodilator response

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10
Q

How can you identify airflow obstruction with spirometry?

A

Reduced FEV1/FVC

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11
Q

What are the spirometry steps for obstructive airway disease?

A
  1. Is there evidence of airflow obstruction? Reduced FEV1/FVC
  2. How severe is the obstruction? Use FEV1
  3. Is there a significant bronchodilator response? (12% increase in FEV1)
  4. What do the flow-volume loops show
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12
Q

What suggests restrictive airway disease on spirometry?

A

Normal or high FEV1/FVC and reduced FEV1 and FVC BUT you can’t define it by spirometry alone.

You need to have reduced lung volumes (TLC)

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13
Q

What are the indications for lung volume determination?

A
  • Diagnose or assess severity of restrictive lung disease
  • Differentiate between obstructive and restrictive disease patterns
  • Assess response to therapeutic interventions
  • Make preoperative assessments of patients with compromised lung function
  • Determine extent of hyperinflation and/or gas trapping
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14
Q

What are the three methods of determining lung volumes?

A
  1. Helium dilution
  2. Nitrogen washout
  3. Body plethysmography
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15
Q

What is diffusion capacity for carbon monoxide (DLCO)?

A

Measures the ability of gases to diffuse across the alveolar-capillary barrier. Diseases in which the uptake of O2 is reduced also cause a decrease in the uptake of CO

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16
Q

Why would you do diffusion capacity/DLCO testing?

A
  • Differentiate obstructive diseases
  • Differentiate restrictive diseases
  • Follow progress of parenchymal lung disease
17
Q

How can you differentiate emphysema and asthma?

A

Decreased DLCO in emphysema

Increased DLCO in asthma

18
Q

How can you differentiate different types of restrictive disease?

A

Decreased DLCO in interstitial lung disease

Normal DLCO in extraparenchymal restriction

19
Q

What is the overview pathway of PFT interpretation?

A
20
Q

What can happen to TLC and RV in obstructive lung disease?

A

Increased TLC- hyperinflation

Increased RV- gas trapping

21
Q

What if the lung tests all come back normal besides having a reduced DLCO (diffusion capacity)?

A

Do an echocardiogram to evaluate for HF

Do a V/Q scan to check for perfusion problems

Internal Medicine MD2 Lectures (14 decks)

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