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CPR 2 > Spirometry > Flashcards

Spirometry Flashcards

1
Q

What is recoil?

A

Ability to return resting volume once stretched

  • lung recoil- inward force produced by the elastic properties of the alveoli; acts to collapse the lung
  • Chest wall recoil (PCWR)- outward force produced by the chest wall
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2
Q

What is intrapleural pressure?

A
  • The pressure within the pleural cavity

- The opposing recoil forces of the chest wall and the lung creates a negative (subatmospheric) PIP

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3
Q

What causes a negative intrapleural pressure?

A

A negative pleural pressure results from the elastic recoil of the lungs and chest wall pulling in opposite directions. The stretched lung (at the end of a normal expiration) tends to recoil inwardly, and the chest waLL tends to recoil outwardly, but in equal and opposite directions. Consequently, pleural pressure (PpI) b3comes negative (I.e., less than atmospheric pressure). Rupture or puncture of the lung or chest wall results in a pneumothorax, during which the trans pulmonary pressure becomes zero and elastic recoil causes the lung to collapse. The mediastinal membrane prevents the other lung from collapsing

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4
Q

What is pneumothorax?

A

The presence of air or gas in the pleural cavity

Tension pneumothorax- cause a shift of the mediastinum and compromise hemodynamic stability

Causes:
Spontaneous
Traumatic

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5
Q

What does spirometry do?

A

Measures lung volume

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6
Q

What is tidal volume?

A

The volume of air inhaled or exhaled with each normal breath

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7
Q

What is inspiratory reserve volume (IRV)?

A

The volume of air that can be inhaled at the end of a normal tidal inspiration

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8
Q

What is expiratory reserve volume (ERV)?

A

The volume of air that can be exhaled after the end of a tidal exhalation

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9
Q

What is residual volume?

A

The air remaining in the lungs after a maximal expiration (this volume of gas cannot be expelled, and cannot be measured by spirotremy)

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10
Q

What is functional residual capacity (FRC)?

A

The total volume of air remaining in the lungs at the end of a tidal exhalation

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11
Q

What is the total lung capacity?

A

The volume of air in the lungs at the end of a maximal inspiration

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12
Q

What is the vital capacity?

A

The volume of air exhaled from maximal inspiration to maximal exhalation; maximum expiration. When done with force this volume is termed the forced vital capacity (FVC)

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13
Q

What is forced expiratory volume in 1 second(FEV1)?

A

The volume of air exhaled in the first second of a FVC test

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14
Q

What is the purpose of FEV and FVC1?

A

From total lung capacity there is forceful exhalation into the spirometer

Measurements of FVC, FEV1 and FEV1/FVC ratio are obtained and restrictive disorders

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15
Q

What is an obstructive disorder?

A

expiratory flow rate is significantly decreased resulting in decreased FEV1 and FVC

-The FEV1/FVC ratio is low

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16
Q

What is a restrictive disorder?

A

Lung inflation is decreased resulting in decreased FEV1 and FVC

The FEV1/FVC ratio is normal or increased

17
Q

W(at is a normal FEV1/FVC ratio?

A

4.5/5.5L*100= about 80%

18
Q

Explain the use of FEF25-75

A

Forced expiratory flow(FEF)

Represents the expiratory flow rate over the middle half of the FVC (between 25% and 75%)

Small airway obstruction may be present even when the FEV1/FVC is above the lower limit of normal

FEF25-75 has the greatest sensitivity for the deduction of early airflow obstruction

19
Q

What happens in FEV1/FVC in restrictive lung disease?

A

Both FEV1 & FVC is reduced

The FEV1/FVC ratio remains normal or may be increased

20
Q

What happens in FEV1/FVC obstructive lung disease?

A

FEV1 is reduced significantly

FVC is reduced

FEV1/FVC ratio is below 0.8

21
Q

Summarize obstructive disease

A

Expiratory flow rate decreased

Airway occlusion, air trapping

Examples:

  1. Chronic bronchitis
  2. Emphysema
  3. Asthma
22
Q

Summarize restrictive lung diseases

A

Lung inflation is decreased

Intrinsic- lung tissue
Extrinsic - chest wall, pleura or neuromuscular

Examples:

  1. Pulmonary fibrosis
  2. IRDS
  3. Scoliosis
23
Q

What is emphysema ?

A

Disintegration of the lungs elastic framework and destruction of alveolar

Enlargement of air spaces distal to the terminal bronchioles

Signs of air trapping- prolonged expiratory phase, barrel chest, flat diaphragm

Commonly caused by cigarette smoking

Genetic risk factor- alpha-1-antitrypsin (AAT) deficiency

24
Q

Contrast main difference in flow volume loops in restrictive and obstructive lung diseases

A

Obstructive lung volumes> normal (increased TLC, FRC, RV); restrictive lung volumes < normal. In obstructive, FEV1 is more dramatically reduced compared with FVC —> decreased FEV1/FVC ratio. In restrictive, FVC is more reduced or close to same compared with FEV1–> increased or normal FEV1/FVC ratio

25
Q

What is independent effort portion of the flow volume loop?

A

Despite varying effort of exhalation the latter parts of the curves all merge

26
Q

Explain effort dependence/independence

A

The curve is effort dependent until PEF is achieved

Regardless of effort the flow after PEF is limited due to compressed airways (effort independence)

Dynamic Compression of Airways increases resistance to airflow

This effect is magnified in lungs with low elastic recoil (high compliance)- airways are floppy and the lung recoil does little to augment airway pressures above +ve intrapleural pressure during forced expiration

27
Q

What is COPD?

A

Combination of chronic bronchitis, emphysema and asthma

The most common chronic lung disease in the US

Commonly caused by cigarette smoking

The classical feature is decreased airflow due to chronic obstruction of the small airways

Results in a decrease in FVC, FEV1 and FEV1/FVC ratio

In severe cases air is trapped in the lungs during forced expiration

28
Q

What is a peak flow device?

A

Used for monitoring lung disease

Provides information about exacerbations

Objective data is collected the practitioner

29
Q

What is Helium dilution technique?

A

Useful in healthy individuals with no lung obstruction

Helium doesn’t get beyond obstruction, thus yielding a false FRC

Body plethysmography

Known concentration of helium in a known volume of gas (oxygen) in spirometer

Person is asked to breathe until the gas equilibrates between the spirometer & the lungs

C1 x C2= C2 x (V1 + V2)

From this
V2= FRC/RV/TLC (depending on starting time)

30
Q

What is a Body Plethysmograph?

A

Body box

Airtight box that measures changes in pressure and volume on inspiration and expiration

Boyles law is used to estimate lung volume

31
Q

What does Body Plethysmograph measure?

A

Measures functional residual capacity. The subject sits in an airtight box and breathes air through a mouthpiece. The mouthpiece is closed at the end of a normal expiration, and the subject continues to try to breathe against a closed mouthpiece. P1 is the lung pressure at the end of expiration and P2 at the end inspiration. 🔼V is the volume change accompanying inspiration and expiration; It results from changes in thoracic volume against a closed mouthpiece. The body plethysmograph is used clinically for measuring FRC in patients in patients with airway obstruction

32
Q

Contrast patient demographic for COPD and Asyhma

A

Age of onset: COPD- above 35, asthma- any age

Onset of dyspnea: COPD- gradual asthma- sudden

Productive cough: COPD- years asthma- with attack

Childhood wheeze: COPD- uncommon. asthma- common

Family history: COPD- uncommon asthma- common

Smoking history: COPD- yes Asthma- variable

33
Q

Contrast FEV1 and FVC stats in COPD and asthma

A

FEV1 & FVC: COPD- reduced asthma- reduced during an attack

FEV1:FVC: COPD- reduced asthma- reduced during an attack

VC: COPD- reduced asthma- nearly normal

Response to steroids and bronchodilator: COPD- minimal asthma- strong

CPR 2 (32 decks)

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