Date .. .

Spirometry: Determination of Luno

ng
39 Volumes and Capacities

I. APPARATUS Spirometer
It is an instrument used routinely in physiological
Spirometer, mouthpiece, nose clip, Wright's peak flow
determination of lung volnd
meter. clinical studies for the
and capacities. It consists of: (Fig. 39.1) lumes
1. A double-walled cylindrical chamber
Kymograph ntaining
water between the two cylinders, water to mainad
an airtight seal.
Spirometric bell
9L
2. A Bell. It is cylinder of 9 litres capacity made
of light weight metal which dips into this water
from above. The top of the bell carries a hookt
Pen which a chain is attached. The chain passes over
a frictionless pulley and carries a counter weight
Water-
and a pen. This pen moves up and down as the
Outer cylinder volume of air in the bell decreases or increases.
thus the bell displacements are recorded on the
Inner cylinder kymograph. (Fig. 39.1-inset)

Inspiratory valve- Expiratory valve Thread/wire

To room air
Bi-directional tap

Mouth piece-

Bell support Bi-directional valve tap

Free breathing valve

Spirometric bell

Chart reverse knob Nose clip

Paper speed selector Mouth piece
60 0 1200
Y-piece
Expiratory valve
Chart bed
Inspiratory valve

Pilot lamp

Power switch (on/off)

Pen recorder

Fig. 39.1: A spirometer: components and controls; Inset shows its working

164
 Chapter 39 Spirometry: Determination of Lung Volumes and Capacities 165|
It carries a mm
The
kymograph.
which is calibrat
square
for time as well as for
graph (i) X-axis represents time
(a) at drum speed: 60 mm/min;
he speed of the kymograph drum can
volume. 1 mm = 1 sec.
lected with the help of selector lever that has
b e selected w
(b) at drum speed: 1200 mm/min;
marking of60-0-1200
20 mm = 1 sec.
l 6 0 mm/min for normal spirometric recordings,

(ii) 1200 mm/min for recording of timed vital II. THEORY

capacity, and A convenient way of measuring the lung volumes and
(iii) 'zero mark is neutral position, in which capacities is by using a spirometer, and the procedure
does not move.
kymograph of recording these is called spirometry. The various
4. Pilot lamp with power switch. It glows when the lung volumes and capacities are shown on a spirogram
ower switch is put in the 'On' position. (Fig. 39.2) and can be divided into two broad headings

Breathing assembly, 1e.

breathing valves with static and dynamic.
5.
mouth piece:
) There are two unidirectional breathing A. Static Lung Volumes and Capacities
valves, one for inspiration and the other for Time factor is not involved, therefore,
expiration. These are connected with the help expressed in mL or litres
of Y-shaped piece to a free-breathing valve. Volumes
(i) Free breathing bore metallic
valve is 25 mm I. Tidal Volume (TV)
It is the volume of air breathed in or out of lungs,
tube having bi-directional tap which can be
Normal: 500 mL.
turned to allow the subject either to breathe during quiet respiration.
room air or spirometric air i) Decreases due to less contraction of respiratory
muscles weakness or
absorber to CO, from the muscles; causes: respiratory
6. Soda lime remove

expired air depression of respiratory centre.

(ii) Increases in muscular exercise.
or any other gas into the bell
7. Inlet for filling O,
drain the water from the apparatus
8. Tap to 2. Inspiratory Reserve Volume (IRV)
9. Levelling screws
It is the maximal volume of air which can be inspired
on the right side door of the
10. Slot present after completing a normal tidal inspiration, i.e.
for the recorded paper.
apparatus provides an outlet inspired from the end-inspiratory position. Normal:
at the top of the
11. Chart reverse knob is provided 2000-3200 mL.
the recorded
cabinet; by turning it clock-wise,
chart is wound up again. 3. Expiratory Reserve Volume (ERV)
Calibration It is the maximal volume of air which can be expired
12. Chart paper:
the
Y-axis represents volume:
(i) after a expiration, i.e. expired from
normal tidal
I mm = 30 ml. end-expiratory position. Normnal: 750-1000 mL.

6,000 Maximum inspiratory positio

5,000 Vital
Inspiratory
reserve capaciy Inspiratory
4,000 volume capacity
Total lun9
capacity
End inspiratory position
3,000
u End expiratory position

2,000
Tidal Functional
Maximum expiratory position
Volume residual
capacity
1,000 Residual Expiratory
reserve
volume volume

various lung volumes and capacities

Fig. 39.2 A spirogram showing
 166 Unit I: Human Experiments
4. Residual Volume (RV) (i) FEV, (Forced Expiratory Volume in 2 sec),
It is the volume of air which remains in ie. volume of FVC expired in the
maximal expiration. Normal: 1200 mL.
lungs after a first
secs of exhalation. Normal: 95% of Fv Wo
(i) FEV, (Forced Expiratory Volume in 2
5. Closing Volume (CV) i.e. volume of FVC expired in the firs ) ,
first three
secs of exhalation. Normal: 98-100%.
It is the lung volume above residual volume which
in the
at
Clinical Significance of TVC (FVC): To dis FVC.
airways lower, dependent parts of the lungs nguish
and 'obstructi
begin to close off because of the lesser transmural between 'restrictive lung disor
pressure in these areas. (page 170).

2. Forced Expiratory Flow during 25-75%

Capacities
1. Inspiratory Capacity (1C) of Expiration (FEF25.75)
This is the mean expiratory flow rate during middle Sor
It is the maximal volume of air which be
can
inspired of FVC. Some workers call it erroneously as 'Maximu
after completing tidal expiration, i.e. from the Mid Expiratory Flow Rate (MMEFR). Normal: 300T
end-expiratory position. It can be computed as: TV +IRV.
min. It is a sensitive indicator of small airway
Normal: 2500-3700 mL. ease
where most of chronic obstructive pulmonary dise
seases
(ike bronchial asthma, emphysema) start.
2. Vital Capacity (VC)
The time taken for FE25-75% 1S Called 'Mid
Refer to page 161. Expiratory Time' (MET). Normal: MET 0.5 sec; increa
in obstructive lung disorders.
3. Functional Residual Capacity (FRC)
It is the volume of air which is contained in the 3. Minute Ventilation (MV) or
lungs
at end-expiratory position, i.e. after the completion of Pulmonary Ventilation (PV)
tidal expiration. It can be computed as: RV + ERV. This is the volume of air expired or inspired out of
Normal: 2.5 litres. the lungs in one minute. Therefore,
PV TV x RR per min
4. Total Lung Capacity (TLC) 500 x 12
It is the volume of air contained in the lungs after a
= 6L/min, normally.
maximal inspiration. It can be computed as: VC + RV.
Normal: 6 litres.
4. Maximum Breathing Capacity (MBC)
Important Note or Maximum Voluntary Ventilation or
With the exception of functional residual capacity, total Maximum Ventilation Volume (Mvv)
lung capacity and residual volume, all other lung volumes It is the largest volume of air that can be moved into
and capacities can be measured with the help of a simple and out of the lungs in one minute by maximum
spirometer.
voluntary effort. Normal: 90-170 L/min (average 100L
min).
B. Dynamic Lung Volumes and Capacities
Time
5. Pulmonary Reserve (PR) or Breathing
dependent, therefore, expressed Reserve (BR)
in mLmin or Lhmin It is the maximum amount of the air above the
1. Timed Vital Capacity (TVC) or Forced Vital pulmonary ventilation, which can be breathed in and
Capacity (FVC) out of lungs in one minute.
If VC is recorded on a kymograph (spirograph) at the It can be computed as: MVV - PV.
known speed, the volume of air expelled can be timed. Itis usually expressed as percentage of MV
Thus, FVC is the maximum volume of air which can ie. (MVV
be breathed out as 'forcefully' and 'rapidly' as possible
-PV) x
100/MVV; and called as percentage
pulmonary reserve or Dyspnoeic ndex (D).
following a maximum inspiration. Thus TVC is exactly Normul . PR (DD 2 60 70% (usually 90).
similar to VC except that there is a special stress on If <60%,
Dyspnoca is usually present
rapid, forcible and complete exhalation.
Components of TVC (FVC): III. PROCEDURE
(i) FEV, (Forced Expiratory Volume in 1 sec), 1. Fill the space between the two
i.e. volume of FVC expired in the first sec of
cylhnd
chambers 3/4th with water; put the inve
exhalation. Normal: 80% of FVC. bell from above so as to dip into this wat
 hapter 39%: Spirometry. Determination of Lung Volumes and Capacitbes1
with the frer orestning valve open move the breath as he can
(i) The subject takes as deep a
ell manually to tirnes up and down to in his mouth
w it with the fresh room air, finally fill it
and then places the mouthpiece
his teeth and sealing
gripping it lightly with
He then blows out as hard
with ronm air as

The subjec t i% made to sit comfortably in a stool

it with his lips.
possible in a short sharp blast.
fariny, the spirometeT, nOe 15 clipped and the should be
(1ii) During the test, the subject
malthpire is inerted between the teeth and that no leaks
the lips. Allow him to breathe in the room carefully watched to ensure
OCcur between the mouthpiece and his lips.
ait. this is done to make him familiar to the dial of
breathe through the mouthpiece with the nose
(iv) PEFR can be read directly from
the Wright's peak flow meter (Fig. 39.3).
dipprd adequate period
After a Ap ol one minute, the free breathing
(v) Take three readings after an

between each Note the

of rest attempt.
valve is turned t0 connect the subject to
maximal value.
spirometer, immediately start the kymograph
al a speed ol 60 mm/min and record normal
(A)
breathing for about one minute. This is used
compuling the tidal
for volume, respiratory
rale and he resting pulmonary ventilation.
5. The ubject is then instructed to breathe PEAK PLO TE

In willh maximum effort from the end of

wstiy, xpiralion and subsequently to breathe
oul completely with maximum effort. He is
beloehand instructed not to breathe in while
Iw is brallhing out. At least three such forced Ao

vilal capcily (FVC) curves are obtained and

he aNimum (besl pertormance) of the three
vale is aken lor caleulation purposes.
Chun the spwad of kymographto1200mm/min
and epeal tle whole procedure (step 5) but
willh tle specific instructions to the subject to B)
beathe oul completely as rapidly and forcibly

he can. Repeat this thrice and evaluate the

b t econd lor caleulating out the timed vital
a i t y d its component.
7

uing the speed of kynmograph to 60 mm/min,

te subt is now instructed to breathe in and
Fig. 39.3 (A) Wright's peak flow meter and (B) Mini Wright
nt s Lapully and devply as he can for a period
peak flow meter
of 15 sevonds. The pulmonary ventilation (tidal
volume s n'spiratory rate) thus calculated from

the nvund is called the manimum breathing IV. CALCULATIONS

aaity (MBC) or mavimum voluntary (A) Static Lung Volume and Capacities
ntilaton (AMVV). These are computed trom the forced vital capacity
S Teak epinatory flow rate (PEFR). It is the (FVC) spirogram recorded at 0 mm/min sperd.
[Link] velaaitv (litres/minute) with which 1. TV. Place a ruler across the rrord to cut mavimum
r s fonnd out ot the lungs in a single torced number of expiratory tops (expiration being mone

350 400 1/mun. stable); draw another line parallel to the first to
r a t r y ettort. Normal
cut the maximum number of inspiratory tops
Note (Fig 394).
The TV (mL) = the vertical distance between
ud asses large central airway ohstrnction
two lines (mm) x 30

2 IRV (mL) = the vertical distance between

chair End inspiratory and maimum
( The subert stands or sits upright on a
30
inspiratory positions (mm)
 168 Unit ll: Human Experiments

Zero time

RV

MET
25%

m 100%

ERV
75%

1 sec

FVC spirogram TVC spirogram MBC graph

Fig. 39.4: Calculation of lung volume and capacities (Abbreviations as given in text) (Also see to Fig. 39.2)

perpendicular lines, one vertical from 75%

Note mark and the other horizontal from 25% mark
I mm along the y-axis = 30 mL, page 165.
The vertical and horizontal distances from
the
point of intersection denote the volume of air
3. ERV (mL) = The vertical distance between End expired and time (MET) respectively. The flow
expiratory and maximum expiratory rate thus can be conmputed.
positions (mm) x 30
3. Minute ventilation (MV). Count either the
4. VC (mL) = the vertical distance between number of inspiratory or expiratory tops over
maximum inspiratory and maximum a period of 15 seconds from FVC
expiratory positions (mm) x 30 spirogram (let
it be N), then MV (mL/min) = N x 4 x TV.
= TV + IRV + ERV.
4. MBC. Calculate it from MBC graph like the
5. IC (mL) = TV + IRV
MV; express in L/min (Fig. 39.4).
5. Pulmonary reserve (PR). Calculate from the
(B) Dynamic Lung Volume and Capacities MV and MBC (refer to page 166).
1. TVC (FEV,, FEV,, FEV,). These are computed
from TVC spirogram recorded at 1200 mm/
min speed. Mark zero point (or time) (i.e.
Important Note
These days computerized muitifunctional spirometers
point where inspiration ends and expiration (Fig. 39.5) are available which allow high quality
begins), move 20 mm (= 1 sec) right to the measurements for all static and dynamic lung volumes.
point marked; drop a perpendicular line from to be made
virtually breath by breath. These spirometers
the second point onto the expiratory tracing. display to high-resolution graphie display as well as the
This will give the volume of air expired in the predc ted The seen on
cuves. generated reports may be
first second of exhalation (FEV,) (Fig. 39.4). the display or can be printed. All pulmonary funetien
lest paramcters with actual, predicted and perrentige
Express it either as absolute volume in ml or
predicted values, as well as normal range with the optt
as the percentage of FVC. Similarly, determine
o interpretation and lung age can also be obtaine
FEV, and FEV, by moving 40 mm and 60 mm Moreover, all tests perfomed are presented wi
respectively to the right of 'zero' time. the selected test
highlighted and the percentage vunt
2. FEF25-75% Divide expiratory tracing on TVC from best
spirogram into 4 equal parts; draw two
 Capacitues
Volumes and
Determination of Lung
aLe 39 Spirometry:

.2
5
Ar .s

i n a kometer

Fig. 39.5 Computerized multifunctional spirometer

with graphic display

3. Instructs him to take a deep breath. (Yes/No)

OSPE
4. Asks the subject toplace the mouthpiece in his
Aim: To assess the Peak Expiratory flow rate (PEFR) mouth, gripping it lightly with his teeth and
sealing it with his lips. (Yes/No)
of the subject provided.
5. Instructs him to blow out rapidly, completely and
Procedure steps: Refer to page 167 (Yes/No)
forcefully into the mouthpiece.
Check list 6. Checks for leak at the mouth. Yes/No)
1. Asks the to stand up holding the peak flow 7. Takes the reading directly from the dial of peak
subject
meter facing him. (Yes/No) flow meter. (Yes/No)

2 Explains the procedure to the subject. (Yes/No)

Important Viva-Voce Questions

. Name the lung volumes and capacities which cannot be Q.3. Give the physiological significunce of FRC
measured by simple spirometry. Ans. FRC by maintaining the residual volume constant
Ans. Functional residual capacity (FRC), total lung acts as a bufter and allows the continuous echange
capacity (TLC) and residual volume (RV) cannot of gases to occur even during erpiration. Thus it
be measured
by simple spirometry. in the ot
Name the factors that influence the vital capacity. prevents sudden change partial pressure
Ans. Page 161. gases in the blood
 170 Unit I: Human Experiments
Q.7. Why are all lung volumes and Capacitie
Q.4. Name the conditions in which FRC increases. 4
Ans. FRC is increased in the conditions of hyper- measured from end-erpiratory position? ually
is more stable, becauseat
inflation of the lungs; this may result from: old Ans. This position this positin
the tendency
of lungs to rec from the
age, emphysema, bronchial asthma, etc. is just balanced by the tendency of the chest wall
Q.5. What is the importance of FEV?
Ans. FEV, helps to distinguish between restrictive and
to recoil in the opposite direction. chest wal
methods of determining FRC.
obstructive lung disorders: Q.8. Name the
Ans. FRC can be determined by two methode.
(i) in restrictive disorders (kyphosis, scoliosis),
circuit method
VC decreases while FEV, is normal; TLC, flow i) open
method, and
nitrogen wash out
rates and MVV also fall as VC decreases.
ii) in obstructive disorders (bronchial asthma, (i) close circuit method -helium [Link]
emphysema), VC is normal while FEV,
Q.9. What is close-circuit spirometry. When is it dtod
Ans. When a person inspires from and expires int
decreases.
same spirometer, it is called close-circuit snithe
It is usually done to measure the basal
Note rate (page 171). metabolic
FEV, is a much more sensitive index (i.e. most
Q.10. What is con1puterized spirometry? How does it
it difer
reproducible) of the severity of obstructive lung disorders
from conventional spirometry?
but it docs not allow for the differentiation of the various
Ans. Page 168.
causes of obstruction.
Q.11. How does spirometry help in the differentiation of
and large airway obstruction? small
Q.6. Give the physiological significance ofpulmonary reserve.
Ans. Refer to Q.5.
Ans. Page 161.

Study Notes
Results and Discussion
Tabulate your results in the following table:

S. Value
Parameters Remarks
No. Observed Predicted
1. TV (mL)

2. IRV (mL)
ERV (mL)

4 IC (mL)
5. VC (mL)
6. FEV, (mL)
7. FEF2s75% (L/min)
8 MV (L/min)
9 MBC (L/min)
10. %PR (DI)

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