PULMONARY
FUNCTION TESTING
Additional Laboratory Assessment
If the spirometry results of a subject are
normal, no further testing is needed.
If the results are abnormal, a physician may
order further test to confirm the presence of
restrictive lung disease or to assess the
severity of either restrictive or obstructive
lung disease.
The further tests must be done in a
pulmonary function test laboratory.
DETERMINING LUNG CAPACITIES
AND VOLUMES
BODY PLETHYSMOGRAPH
Measures
changes in volume
and pressure in the thorax.
The patient sits in an
airtight booth and breathes
through a mouthpiece that
is open to room air.
In-line are a
pneumotachometer (a flow
sensor), a pressure
manometer, and a shutter
that cuts off flow sensor
transducer.
BODY PLETHYSMOGRAPHY
The subjects pants against the closed
shutter, and mouth pressures and changes in
the volume of air in the booth are measures.
The subject, with nose clips tightly in place
and sitting in the booth with the door closed,
breathes normally through the mouthpiece.
The subjects then puts and over the cheeks
to prevent their expansion when panting
against the closed shutter.
BODY PLETHYSMOGRAPHY
Instruct the subject to pant ( in small pants )
through the mouthpiece one ore two times
per minute.
At end-exhalation, close the shutter, and tell
the subject to try pant against the closed
shutter.
The shutter is then opened, and the test is
complete.
BODY PLETHYSMOGRAPHY
Method of measuring FRC by measuring TGV (thoracic gas
volume).
RV is the difference between TGV and ERV, and TLC is the
sum of RV and VC, or the sum of TGV and IC.
TLC 80 120 (normal)
70-79
mild
60 69 moderate
< 60 moderately severe
RV 63 135
sRaw - 120
OTHER MEANS OF DETERMINING
LUNG CAPACITIES AND VOLUMES
SLOW VOLUME CAPACITY the same
maneuver as for FVC, except the exhalation
is slow rather than forceful.
VC, tidal volume, IRV, IC, and ERV are
measured.
NITROGEN WASHOUT (OPEN
CIRCUIT)
The theory behind the nitrogen washout test
is that if all or most of the nitrogen is
removed from the lung ad the volume of the
nitrogen exhaled is measured, the FRC can
be determined.
NITROGEN WASHOUT
HELIUM DELITION (CLOSED
CIRCUIT)
The theory behind the helium dilution test is
that if a known concentration of an inert gas
is rebreathed by a subject until its
concentration is the same on inhalation as it
is on exhalation, the change in the
concentration of the inert gas is due to
dilution of the gas by the subjects FRC.
HELIUM DELUTION
DIFFUSING CAPACITY (SINGLEBREATH MEATHOD)
Most common test available to assess lung
diffusing capacity ( the rate at which oxygen
diffuses from the alveoli to the capillaries).
A very low concentration of carbon monoxide
is used.
The amount of CO that diffuses from the lung
into the blood (DLCO) gives direct indication
of the rate at which O2 diffuses from the
lung into the blood.
DLCO
With noseclips in place, the subjects makes a
tight lip seal around the mouthpiece and
breathes normally.
Instruct the subject to exhale down to RV
and then inhale up to TLC as quickly as
possible. The gas inhaled is a special mixture
containing 0.3% CO, 10% He, 21% O2, and
balance N2.
The subject holds his or her breath at TLC for
approximately 10 seconds and then exhales
as quickly as possible.
BRONCHOPROVOCATION
For detection if there is a presence of
airway-reactivity.
Methacholine- a cholinergic agent and
Histamine most common inhaled agents
used.
Hyperventilation using cold air and room air
may also be used.
For exercise induced bronchospasm (EIB),
testing is done after exercise
BRONCHOPROVOCATION
INDICATIONS
When a subject has a symptoms of
bronchospasm but normal pulmonary
function tests.
When there is a baseline study before
occupational exposure.
Follow up testing to check for changes hyperreactivity or severity.
METHACOLINE AND HISTAMINE
PROCEDURE
Prebronchoprovocation spirometry is done.
The FEV1 should be >60 to 70% of the
predicted value
The subject is given nebulized normal saline,
and the spirometry is repeated. If there is a
10% reduction in the FEV1, the test is
positive for airway hyper-reactivity. No
further testing should be done. Continue is
the reduction is equal to or greater than
10%.
METHACOLINE AND HISTAMINE
PROCEDURE
At fixed intervals, increasing doses of
methacoline and histamine are given by
nebulizer. A number of protocols for dosing are
widely available. Spirometry is done at 30-90
seconds after each dose, and test procedure
and results must met the current ATS
acceptability guidelines. A 20% decrease in
FEV1 is considered a postive test for airway
hyper-reactivity, and at that time the testing
is stopped. The dose after which this decrease
occurs is the PD20 (the provocation dose
resulting in a 20% or greater decrease in FEV1.
METHACOLINE AND HISTAMINE
PROCEDURE
A bronchodilator is administered te reverse
the bronchospasm. The reversal is
documented by a return to
bronchoprovocation values.
