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Year 1 HLB Respiratory > Pulmonary Function Tests > Flashcards

Pulmonary Function Tests Flashcards

1
Q

What is the last set of organs to full develop?

A
  • lungs
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2
Q

When describing the developing of the lungs, what does antenatal refer to?

A
  • pre embryonic - embryonic - foetal - everything prior to birth
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3
Q

Babies are at an increased risk of death if they are born prematurely, before 28 weeks of gestation. What is one of the main factors contributing to this?

A
  • lack of surfactant - lungs can collapse
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4
Q

What is respiratory distress syndrome?

A
  • babies born prematurely (28 weeks) - lungs unable to inflate and deflate unaided
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5
Q

What is the growth phase in lung development?

A
  • birth to young adulthood - grow until 23 generations are present
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6
Q

What is the plateau phase in lung development?

A
  • from mid 20s to late 30s
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7
Q

What is the decline phase in lung development?

A
  • lung function, compliance, elasticity all begin to decline
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8
Q

What are a few factors that can influence antenatal development of the lungs?

A

1 - maternal smoking 2 - poor maternal nutrition 3 - placenta insufficiency

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9
Q

What is placenta insufficiency?

A
  • low nutrients supplied by placenta to foetus
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10
Q

How can babies born prematurely affect lung development?

A
  • ⬇️ surfactant
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11
Q

What factors can influence the babies lung development postnatally (after birth)?

A
  • maternal smoking - infections - allergens
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12
Q

What are pulmonary function tests?

A
  • tests designed to assess how well the lungs work
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13
Q

When are pulmonary function tests used?

A
  • to diagnose a respiratory disease - in patients presenting with respiratory symptoms
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14
Q

What are some common respiratory symptoms that would initiate a pulmonary function test?

A
  • cough - wheeze - shortness of breathe
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15
Q

Are pulmonary function tests used in smokers to diagnose disease?

A
  • generally no - can be used to identify high risk groups though
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16
Q

In addition to diagnosing patients, can pulmonary function tests be used for prognosis?

A
  • yes in chronic lung disease - asthma, COPD, pulmonary fibrosis - good for monitoring disease progression
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17
Q

Are pulmonary function tests useful when assessing a patients treatment?

A
  • yes - provide objective measures of lung function
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18
Q

What do pulmonary function tests actually measure?

A
  • airflow - lung volume - gas exchange - airway reactivity
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19
Q

What is airway reactivity?

A
  • how airways react to allergens - asthma has a high airway reactivity
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20
Q

Roughly how much lung volume do we lose each each year in the decline phase of lung development?

A
  • 30ml/year
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21
Q

What are some basic things that affect lung function, not disease factors?

A
  • gender - age - weight - ethnicity - height
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22
Q

What are a patients lung function tests compared against?

A
  • normative data collected over long periods
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23
Q

What are some things that patients must not do prior to a lung function test as they may affect the test results?

A
  • take bronchodilator medication - exercise (30 mins prior) - smoke (24 hours prior) - alcohol (4 hours prior) - caffeine (24 hours prior)
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24
Q

What is the normal age patients can do lung function tests well?

A
  • > 6 years old - < 6 years old are unable to do the tests
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25
Q

What is tidal volume?

A
  • amount of air in and out of lungs at rest
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26
Q

What is inspiratory reserve volume?

A
  • max air patient can inhale above tidal volume
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27
Q

What is expiratory reserve volume?

A
  • max air patient can exhale below tidal volume
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28
Q

What is vital capacity?

A
  • total air patient can breathe in and out maximally
  • DOES NOT include residual volume
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29
Q

What is residual lung volume?

A
  • air left in lungs after maximum exhalation
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30
Q

What is functional residual capacity?

A
  • expiratory reserve volume (below tidal volume) + residual lung volume
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31
Q

What is total lung capacity?

A
  • max air in and out of lungs including residual lung volume
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32
Q

What are dynamic lung volumes?

A
  • those that are dependent on the rate at which they happen
  • FORCED expiratory volume (FEV1)
  • PEAK expiratory flow
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33
Q

Peak expiratory flow (PEF) is a common dynamic lung volume measured, what is it?

A
  • maximum speed of expiration - measured in L/min
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34
Q

Forced expiratory volume 1 (FEV1) is a common dynamic lung volume measured, what is it?

A
  • maximum air expelled in the first second
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35
Q

Forced vital capacity (FVC) is a common dynamic lung volume measured, what is it?

A
  • total air exhaled
  • following maximum inhalation
  • FEV1 is measured from this
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36
Q

Relaxed vital capacity is a common dynamic lung volume measured, what is it?

A
  • maximum air exhaled in a relaxed breathe - similar to a heavy sigh
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37
Q

What are some common conditions that are contradictions for completing dynamic lung volume tests?

A
  • haemoptysis (coughing up blood)
  • pneumothorax
  • severe hypertension
  • recent myocardial infarction
  • tachyarrhythmia
  • pulmonary embolism
  • aortic aneurysm
  • essentially anything involving high pressure
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38
Q

Why is a peak flow meter useful in a clinical setting?

A
  • cheap - easy to use - portable
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39
Q

Peak expiratory flow measures the maximum speed of expiration, but what is it measuring in the airways that contributes to the rate of air?

A
  • resistance in airways
40
Q

Why can peak expiratory flow be reduced?

A
  • increased resistance in airways - generally due to narrowing
41
Q

What conditions would we expect to a reduction in peak expiratory flow?

A
  • COPD - asthma - bronchiectasis
42
Q

Why are routine measurements of peak expiratory flow not routinely conducted in patients with COPD?

A
  • COPD is generally irreversible - may be used for prognosis - BUT will not get better
43
Q

Why is peak expiratory flow measurement useful in self managed asthma?

A
  • can see if patient is using inhales - can see if patient is responding to treatment
44
Q

Why is peak expiratory flow used by occupational health in the workplace?

A
  • good measure to identify risk of asthma
  • asthma is most common respiratory occupational disease
  • certain jobs ⬆️ risk of lung disease
45
Q

How can neuromuscular disorders impair peak expiratory flow?

A
  • unable to innervate muscles in chest properly
46
Q

How does tracheal tumour or thyroid goitre (swelling of the thyroid gland) impair peak expiratory flow?

A
  • ⬆️ resistance - block or narrow airways
47
Q

What is diurnal peak flow monitoring?

A
  • relates to the variation/fluctuation in peak expiratory flow rate
  • measured over (24 hours)
  • >20% variation in day = diurnal variation
48
Q

How is diurnal peak flow monitoring monitored and why?

A
  • patients given a peak flow meter and diary - measure throughout the day
49
Q

What is the hormone that has been linked with diurnal peak expiratory flow?

A
  • cortisol
50
Q

Spirometry is the most common method for assessing lung function, what is it?

A
  • pulmonary function tests - measures the amount and/or speed of air that can be inhaled and exhaled
51
Q

What 3 measures are given during spirometry?

A

1 - forced vital capacity (FVC) 2 - forced expiratory volume in 1 second (FEV1) 3 - FEV1/FVC ratio

52
Q

When using spirometry how many measures are taken, and which value is used?

A
  • 3 attempts - maximum value used
53
Q

Why is the shape of the graph in spirometry important?

A
  • it will vary depending on lung disease - restrictive vs. obstructive
54
Q

Above what values is classed as a normal forced expiratory volume?

A
  • >80%
55
Q

What is obstructive lung disease?

A
  • inability to exhale
56
Q

What is restrictive lung disease?

A
  • inability to inhale
57
Q

In obstructive lung disease, what happens to the forced expiratory volume 1 (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio?

A
  • ⬇️ FEV1 - difficult to exhale (can take up to 15 seconds) - ⬇️ FVC - but will eventually get air out - ⬇️ FEV1/FVC ratio
58
Q

In restrictive lung disease, what happens to the forced expiratory volume 1 (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio?

A
  • ⬇️ FEV1 - ⬇️ FVC - ⬆️ FEV1/FVC ratio
59
Q

In obstructive lung disease, does forced expiratory volume 1 (FEV1) or forced vital capacity (FVC) reduce more?

A
  • FEV1 has larger ⬇️
  • larger ⬇️ in FEV1 drives ⬇️ FEV1/FVC ratio
  • FVC can actually increase due to trapped air
60
Q

In restrictive lung disease, does forced expiratory volume 1 (FEV1) or forced vital capacity (FVC) reduce more?

A
  • FVC has larger ⬇️ due to ⬇️ compliance - larger ⬇️ in FVC drive ⬆️ FEV1/FVC ratio
61
Q

Is spirometry good for distinguishing between restrictive and obstructive lung disease?

A
  • yes - BUT cannot confirm exact diagnose
62
Q

What does GOLD stand for in COPD, and what are the 4 things the GOLD stage for COPD measures?

A
  • Global initiative for Chronic Obstructive Lung Disease

1 - severity of current symptoms

2 - spirometry results

3 - COPD prognosis

4 - presence of comorbidities

63
Q

In obstructive lung disease which airways are mostly affected?

A
  • medium and large sized airways
64
Q

In restrictive lung disease is the FEV1/FVC ratio always increased?

A
  • no it can be normal as well
65
Q

What are flow volume loops?

A
  • inspiration and expiration plotted against volume and time on a graph
66
Q

What are flow volume loops useful for?

A
  • identify where an obstruction is - intra vs extrathoracic obstruction
67
Q

What does extra-thoracic mean?

A
  • outside of thoracic cavity - likely to be in thoracic wall or spinal problems
68
Q

Why are flow volume loops not routinely used?

A
  • hard to conduct - poor reproducibility - flow is dependent on high lung volumes
69
Q

When are airways most dilated and airways resistance is at its lowest?

A
  • at total lung capacity
70
Q

During flow volume loop test, is inspiration or expiration more reproducible and energy dependent?

A
  • inspiration = ⬆️ energy depended
  • inspiration = ⬇️ reproducibility
  • expiration is determined by elastic recoil, so good reproducability
71
Q

What is static lung volume tests?

A
  • test to measure total lung capacity - not dependent on flow rate
72
Q

Are static lung volume tests able to make accurate diagnosis?

A
  • yes
73
Q

Why are static lung volume tests not used routinely?

A
  • measured in a lab - not portable
74
Q

How do static lung volume tests determine total lung capacity, including the residual lung volume?

A
  • helium dilution method - whole body plethysmography
75
Q

What is the helium dilution method?

A
  • patient inhales known volume and concentration of helium - patient then exhales providing a final concentration and volume, including functional residual volume
76
Q

Why is helium a good gas to use for determining static lung volumes?

A
  • it is insoluble in blood and lung tissue - gas will not be absorbed and stays in the lungs
77
Q

What is a plethysmograph?

A
  • an airtight box - volumes and pressures in the box can be measured
78
Q

How does plethysmography work?

A
  • patients breathe normally in the airtight box - sensor in box measuring pressure change - sensor in mouth piece measuring pressure and air flow changes - changes in volume and pressure in the box can be used to determine functional residual volume
79
Q

Is total lung capacity reduced in both restrictive and obstructive lung disease?

A
  • both are affected, but in a different way
  • restrictive = ⬇️ total lung capacity
  • obstructive = ⬆️ total lung capacity
80
Q

Why does obstructive lung disease cause an increase in total lung capacity?

A
  • obstructive lung disease = inability to exhale - air is therefore trapped in the lungs
81
Q

In restrictive lung disease, do intra and extra pulmonary pathologies reduce total lung capacity?

A
  • yes - restrictive = inability to inhale
82
Q

What is the transfer factor also commonly referred to as?

A
  • diffusion capacity - DLCO or TLCO, used interchangeably
83
Q

What is transfer factor used for?

A
  • measured in a single breathe - ability of gas to diffuse between alveoli and capillaries
84
Q

What is the A-a gradient?

A
  • difference between alveolar (A) and arterial (a) concentration of oxygen
85
Q

What can the transfer factor be used to estimate?

A
  • A-a gradient
86
Q

When using DLCO/TLCO, what is the transfer coefficient?

A
  • transfer of a gas per unit of alveolar volume
87
Q

How is the transfer coefficient calculated from the DLCO/TLCO?

A
  • measures carbon monoxide in ventilated alveoli
  • divided by the non ventilated alveoli
88
Q

What must the transfer coefficient be corrected for?

A
  • haemoglobin levels - anaemic patients would skew the results
89
Q

What can reduce the TLCO/DLCO?

A
  • ⬆️ ventilation/perfusion mismatch - ⬇️ blood flow (pulmonary embolism) - ⬇️ alveolar surface area (emphysema)
90
Q

What can increase the TLCO/DLCO?

A
  • ⬆️ pulmonary capillary blood flow - ⬆️ cardiac output (exercise) - polycythaemia (⬆️ red blood cells) - pulmonary haemorrhage
91
Q

Do extra thoracic restrictive lung conditions affect TLCO/DLCO?

A
  • no - lung tissue is not involved
92
Q

Why do extra thoracic restrictive lung conditions not affect TLCO/DLCO?

A
  • blood vessels vasoconstrict in unventilated section of the lungs
  • blood flow is diverted from under ventilated part of lungs
93
Q

In a patient who is a heavy smoker and has emphysema, would you expect to see a change in the TCLO/DLCO and transfer coefficient ?

A
  • yes
  • both would ⬇️
94
Q

Why would a patient who is a heavy smoker with emphysema, be expected to have a low TCLO/DLCO and transfer coefficient ?

A
  • emphysema = obstructive lung disease
  • smoking is primary cause of obstructive lung disease (COPD)
  • emphysema will ⬇️ surface area (SA) at alveoli
  • ⬇️ SA = ⬇️ diffusion
  • ⬇️ SA = ⬇️ ventilation
95
Q

In a woman with suspected pulmonary fibrosis, which is a restrictive lung disease (inability to inhale) what would we expect to see in the forced vital capacity (FVC), forced expiratory volume 1 (FEV1) and the FEV1/FVC ratio?

A
  • larger ⬇️ in FVC
  • ⬇️ or normal FEV1
  • ⬆️ FEV1/FVC ratio
96
Q

When is the the DLCO/TLCO and transfer coefficient (KCO) especially useful when looking at a patient with restrictive lung disease?

A
  • determine where restriction is intra or extra thoracic
  • intra thoracic = ⬇️ TLCO/DLCO and KCO
  • extra thoracic = normal TLCO/DLCO and KCO
97
Q

What is the transfer coefficient (KCO) that is used in TLCO?

A
  • KCO is the ratio between ventilated and non-ventilated lung tissue
  • TLCO is then divided by VA which gives TLCO

Year 1 HLB Respiratory (25 decks)

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