4.
2 PULMONARY
FUNCTION TESTS
Lung Volumes
Ö Static lung volumes are of four types:
○ Tidal volume (500 mL (0.5 L))
○ Inspiratory reserve volume (3,300 mL (3.3 L))
○ Expiratory reserve volume (1,000 mL (1 L))
○ Residual volume (1,200 mL (1.2 L))
Inspiratory
reserve volume
(IRV)
Vital
capacity
(VC)
Tidal volume
(TV)
Expiratory
reserve volume
(ERV)
Residual
volume
(RV)
Tidal volume (TV)
Ö Volume of air breathed in and out of lungs in a single normal quiet respiration.
Ö Normal Value – 500 mL (0.5 L).
Pulmonary Function Tests 157
Inspiratory reserve volume (IRV)
Ö Additional volume of air that can be inspired forcefully after the end of normal inspiration.
Ö Normal Value - 3,300 mL (3.3 L).
Expiratory reserve volume (ERV)
Ö Additional volume of air that can be expired out forcefully, after normal expiration.
Ö Normal Value - 1,000 mL (1 L).
Residual volume (RV)
Volume of air remaining in lungs even after forced expiration. It helps to aerate the blood in
between breathing and during expiration and maintains the contour of the lungs.
Normal Value - 1,200 mL (1.2 L)
Lung Capacities
Ö Static lung capacities are of four types
○ Inspiratory capacity
○ Vital capacity
○ Functional residual capacity
○ Total lung capacity.
Inspiratory Capacity (IC)
Ö Maximum volume of air that is inspired after normal expiration (end expiratory position). It
includes tidal volume and inspiratory reserve volume.
IC = TV + IRV
= 500 + 3,300
= 3,800 mL
Vital Capacity (VC)
Maximum volume of air that can be expelled out forcefully after a deep (maximal) inspiration.
VC includes inspiratory reserve volume, tidal volume and expiratory reserve volume.
VC = IRV + TV + ERV
= 3,300 + 500 + 1,000
= 4,800 mL
Variations of Vital Capacity
Physiological Variations
Ö Sex: In females, vital capacity is less than in males
Ö Body built: Vital capacity is slightly more in heavily built persons
Ö Posture: Vital capacity is more in standing position and less in lying position
Pulmonary Function Tests 158
Ö Athletes: Vital capacity is more in athletes
Ö Occupation: Vital capacity is decreased in people with sedentary jobs. It is increased in persons
who play musical wind instruments such as bugle and flute.
Pathological Variations
Ö Asthma, Emphysema, Weakness or paralysis of respiratory muscle, Pulmonary congestion,
Pneumonia, Pneumothorax, Hemothorax, Pyothorax, Hydrothorax, Pulmonary edema and
Pulmonary tuberculosis.
Functional Residual Capacity (FRC)
Ö Volume of air remaining in lungs after normal expiration (after normal tidal expiration).
Functional residual capacity includes expiratory reserve volume and residual volume.
FRC = ERV + RV
= 1,000 + 1,200
= 2,200 mL
Total Lung Capacity (TLC)
Volume of air present in lungs after a deep (maximal) inspiration. It includes all the volumes.
TLC = IRV + TV + ERV + RV
= 3,300 + 500 + 1,000 + 1,200
= 6,000 mL
Lung volumes
and capacities IC
Inspiratory
IRV capacity
Inspiratory FRC
reserve volume Functional
VT residual capacity
Tidal volume 2.5L VC
ERV 0.5L Vital capacity
Expiratory 1.5L TLC
reserve volume Total lung
RV 1.5L capacity
Residual volume
IRV VT ERV RV IC FRC VC TLC
Spirogram
Ö Spirogram is the graphical record of lung volumes and capacities using spirometer. Upward
deflection of the spirogram denotes inspiration and the downward curve indicates expiration.
Pulmonary Function Tests 159
6,000 Maximun
inspiratory
level
5,000
4,000 IRV IC
IRV
Volume (ML)
IC VC
VC
TCL
3,000 Normal end
inspiratory
level
2,000 Normal end
expiratory
RV ERV
ERV level
FRC
1,000 Maximum
expiratory
level
RV
Forced Expiratory Volume Or Timed Vital Capacity
Definition
✓ Forced expiratory volume (FEV) is the volume of air, which can be expired forcefully in a
given unit of time (after a deep inspiration).
Ö It is also called timed vital capacity or forced expiratory vital capacity (FEVC). It is a dynamic
lung volume.
○ FEV1 = Volume of air expired forcefully in 1 second - 83% of total vital capacity
○ FEV2 = Volume of air expired forcefully in 2 seconds - 94% of total vital capacity
○ FEV3 = Volume of air expired forcefully in 3 seconds - 97% of total vital capacity
Ö Vital capacity may be almost normal in some of the respiratory diseases. Decreased in some
respiratory diseases (obstructive diseases like asthma and emphysema)
Ö Slightly reduced in some restrictive respiratory diseases like fibrosis of lungs.
0 1 2 3 4 5 6 7 8
6 Maximum
inspiratory
level
5 Normal
FEV2
FEV3
FEV1
2
Maximum
1 expiratory
level
0
Pulmonary Function Tests 160
Restrictive And Obstructive Respiratory Diseases
Restrictive Respiratory Disease
Ö Restrictive respiratory disease is the abnormal respiratory condition characterized by difficulty
in inspiration. Expiration is not affected.
Ö Restrictive respiratory disease may be because of abnormality of lungs, thoracic cavity or/and
nervous system.
Maximum
6 inspiration
level
5 Restrictive
FEV1
disease
Volume (liter)
4
3
2
Maximum
1 expiratory
level
0
Obstructive Respiratory Disease
Ö Obstructive respiratory disease is the abnormal respiratory condition characterized by difficulty
in expiration.
Pulmonary Function Tests 161
6 Maximun
inspiratory
Obstructive level
FEV1
5 disease
4
3
2
Maximum
1 expiratory
level
0
0 1 2 3 4 5 6 7 8
Time (second)
Respiratory Minute Volume
Ö Respiratory minute volume (RMV) is the volume of air breathed in and out of lungs every minute.
It is the product of tidal volume (TV) and respiratory rate (RR).
RMV = TV × RR
= 500 × 12
= 6,000 mL
Ö Normal respiratory minute volume is 6 L
Ö Increased - in physiological conditions such as voluntary hyperventilation, exercise and
emotional conditions.
Ö Reduced - in respiratory diseases.
Pulmonary Function Tests 162
Maximum Breathing Capacity or Maximum Ventilation Volume
Ö Maximum breathing capacity (MBC) is the maximum volume of air, which can be breathed in and
out of lungs by forceful respiration per minute.
Ö It is also called maximum ventilation volume (MVV)
Ö In healthy adult male, it is 150 to 170 L/minute and in females, it is 80 to 100 L/minute.
Peak Expiratory Flow Rate
Ö Peak expiratory flow rate (PEFR) is the maximum rate at which the air can be expired after a
deep inspiration.
Ö In normal persons, it is 400 L/minute.
Ö Determination of PEFR rate is useful for assessing the respiratory diseases especially to
differentiate the obstructive and restrictive diseases.
Ö Restrictive diseases, the PEFR is 200 L/minute and in obstructive diseases, it is only 100 L/
minute.
Ventilation
Pulmonary Ventilation
Definition
✓ Pulmonary ventilation is defined as the volume of air moving in and out of respiratory
tract in a given unit of time during quiet breathing. It is also called minute ventilation or
respiratory minute volume (RMV).
Ö Normal value of pulmonary ventilation is 6,000 mL (6 L)/minute.
Ö It is the product of tidal volume (TV) and the rate of respiration (RR).
Pulmonary ventilation = Tidal volume × Respiratory rate
= 500 mL × 12/minute
= 6,000 mL/minute
Alveolar Ventilation
Definition
✓ Alveolar ventilation is the amount of air utilized for gaseous exchange every minute.
Ö Alveolar ventilation is different from pulmonary ventilation. In pulmonary ventilation, 6 L of air
moves in and out of respiratory tract every minute.
Pulmonary Function Tests 163
Ö Normal value of alveolar ventilation is 4,200 mL (4.2 L)/ minute.
Alveolar ventilation = (Tidal volume – Dead space) x Respiratory rate
= (500 – 150) mL × 12/minute
= 4,200 mL (4.2 L)/minute.
Dead Space
Ö Dead space is defined as the part of the respiratory tract, where gaseous exchange does not take
place. Air present in the dead space is called dead space air.
Anatomical Dead Space
Ö Anatomical dead space extends from nose up to terminal bronchiole. It includes nose, pharynx,
trachea, bronchi and branches of bronchi up to terminal bronchioles.
Physiological Dead Space
Ö Physiological dead space includes anatomical dead space plus two additional volumes (wasted
ventilation). Wasted ventilation is the volume of air that ventilates physiological dead space.
Wasted air refers to air that is not utilized for gaseous exchange.
Ö Volume of normal dead space is 150 mL.
Area without N2
ൌ ൈ
Area with N2 + Area without N2
Ventilation-Perfusion Ratio
Ö Ventilation¬ perfusion ratio is the ratio of alveolar ventilation and the amount of blood that
perfuse the alveoli.
Ö Normal value of ventilation ¬perfusion ratio is about 0.84.
Ö Ventilation-perfusion ratio signifies the gaseous exchange. It is affected if there is any change
in alveolar ventilation or in blood flow.
Ö In chronic obstructive pulmonary diseases (COPD), ventilation is affected because of obstruction
and destruction of alveolar membrane.
ൌ
ൌ
Alveolar ventilation
–ൌ
Pulmonary blood flow
ൌሺ– ሻൈ
ൌሺͷͲͲ–ͳͷͲሻൈͳʹȀൌͶǡʹͲͲȀ
ሺሻൌͷǡͲͲͲȀ
ǡ
4,200
Ǧൌ
5,000
ൌͲǤͺͶ
Pulmonary Function Tests 164
REMARKS
Pulmonary Function Tests 165
Pulmonary Function Tests 166
