SPIROMETRY

Competency No. PY.6.8

Demonstrate the correct technique to perform & interpret Spirometry.
L.D. No, 3
Pulmonary function tests are of two types : Date:
1. Static lung function tests
2. Dynamic lung function tests
These tests are essentially anatomical
However, changes in these values may bemeasurements
caused by
and evaluate ventilatory functions
reason, it is important to know the normal values and howalteration in physiological processes and f
to interpret deviations from normal.
In this demonstration, only the
remember that no single pulmonary commonly used pulmonary function tests are described. One she
function test yields all information that may be desired.
Static Lung Function Tests:

The lungvolumes and capacities are defined as

follows:
Volumes:
There are four primary volumes.
1. Tidal Volume (TV)
It is the volume of air inspired or expired duringeach
350-500 ml. normal respiratory cycle. Normalvalue is
2 Inspiratory Reserve Volume (1.R.V.).:
It is the maximal volume of air that can be
forcibly inhaled from the normal end inspiratory
position. Normal value is 2500 ml. to 3000 ml.
3. Expiratory Reserve Volume (E.R.V.):
It is the volume of air that can be forcibly expired following a normal
expiratory position. expiration from the end
Normal value isabout 900 to 1100 ml.
4 Residual Volume (R.V.).
It is volume of air, remaining in the lungs at the end of maximalexpiration. Normal value is 700
to 1000 ml.

Capacities:
There are four capacities each of which includes tWo or more of the primary olumes.
1. Inspiratory capacity (1.C.). :
It is the maximal volume of air that can be inspired from the end of normal expiration.
I.C. =TV. + 1.R.V. (Normal value is 3200-3500 ml.).
2. Vital Capacity (V.C.). :
It is the volume of air that can be forcibly exhaled after a maximal inspiration.
V.C. =T.V. + E.RV. +1.R.V. Normal value is 3300 to 4500ml.
3. Functional Residual Capacity (F.R.C.):
It is the volume of air remaining in the lungs at the end of normal expiration.
F.R.C. = R.V. + E.R.V. Normal value is 1800 - 2300 ml.
4. Total Lung Capacity.
It is the volume of air contained In the lungs at the end of a maximal inspiration.
T.L.C. = V.C. + R.V. Normal value is 5000 - 5500 ml.
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 LungFFunction Tests:
Dyramic
Forced Expiratory Volume (FEV) / Timed Vital Capacity (TVC):
1. the fraction of the vital capacity expired at the end of first, second and third seconds of
Itis
expiration.
Volume expired in first sec.
X100
Vital capacity
Normal value is FEV 85- 87%
FEV2 95- 97%
FEV3 100%

Bis used to distinguish between obstructive and restrictive respiratory disease.

2.
Maximum Ventilatory Volume (MVV) or Maximum Breathing Capacity (MBC) :
It is the largest volume of air that can be moved in and out of the lungs in one minute by
maximum voluntary ventilatory efforts. Normal value is 80 to 140 L/ min.

Determination of lung volumes and capacities :

Iung volumes and capacities such as Tidal volume, Expiratory reserve volume, Inspiratory reserve
volume, Inspiratory capacity and Vital capacity are commonly measured directly on the spirometer.
Static and dynamic lung functions can be measured by spirometer.
The residual volume (RV) is the only volume that cannot be measured directly by spirometry.

Materials:
1. Recording Spirometer
2. Stop watch or wrist watch
3. Nose clip

The recording spirometer consists of two cylinders. The outer cylinder is double walled and is
fitted inside with a container containing soda lime. Water is filled between the two walls of the
outer cylinder. This acts as an air tight seal. The inner cylinder is inverted and floats on the
water and is referred to as the bell of the spirometer. It is suspended by a chain which moves
over pulley and is balanced by a weight to which a writing pointer is attached. During
respiration the bell of spirometer moves up and down leading to the movement of the writing
pointer. Thus a graphic record is obtained. This record is called as "Spirogram".

Procedure:
1. Adjust the speed of the paper to 2.5 mm/sec.
2.
3
Fil the spirometer bellto 3/4m its capacity with atmospheric air.
Ask the subject to sit comfortably and wait for sometime.
4
Sterilize the rubber mouth piece in antiseptic solution
5.
6
Instruct the subject to hold the mouth piece firmiy between gums and lips in his mouth.
Close his nose with the clip.

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7. While the subject breathes naturally, obtain a graphic record of quiet breathing on a os.
paper.
Upstroke denotes inspiration and down stroke denotes expiration. Horizontal line inde
time and vertical line indicates volume. The height of this record indicates tidal volume:
(Scale : Vertical line: 1 cm = 200 ml.)
The height of this record indicates the tidal volume.
8. Now ask the subject to exhale as forcibly as he can at the end of quiet expiration. This rees.
indicates expiratory reserve volume.
9. Now ask the subject to inhale as deeply as he can at the end ofquiet inspiration. This re h
indicates inspiratory reserve volume.
10. Ask the subject to take deep inspiration followed by deep expiration. This record indicates h
vital capacity.
11. From the point of end of maximum inspiration, ask the subject to breathe out forcibly. Channa
the speed of the paper to 25 mm per sec. Continue this record for 3 to 4 secs. This recnm
indicates timed vital capacity (TVC)or Forced Expiratory Volume (FEV).
12. Ask the subject to breathe normally for a while.
13. Now instruct the subject to breathe as deeply and as rapidly as he can for 15 secs. From this
record calculate M.V.V.

Convert these values into BTPS (body temperature, pressure, saturated with water vapour).

From your record calculate following values :

1. Alveolar ventilation.
Alveolar ventilation/ min= (Tidal Volume- Dead Space) Xrate of respiration.
(Dead space 150 ml.)
2. Resting minute ventilation (RMW)
It is defined as the volume of air which moves in or out of the lungs per minute at rest.
Minute volume = Tidal volume X rate of respiration. Normal value is 5 to 10 litres/ min.
3. Dyspnoeic Index (Percentage breathing reserve):
If the values for MVV and RMV are known, percentage breathing reserve may be calculated.
MVV-RMV
Percentage breathing reserve X 100
MW
Normally t is 90 to 96%. The dyspnoeic point is reached when the percentage breathing
reserve falls to 60%.

Observations :
1. Tidal volume
2 Expiratory reserve volume
3. Inspiratory reserve volume
4 Inspiratory capacity
5 Vital capacity
6 Timed vital capacity
7 Maximum ventilatory volume
8 Resting minute volume
Percentage breathing reserve
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Values in ml. [For Indian Population ]
Test Males Females
TV 400 300

LL
E.R.V. 800 600
LR.V. 2800 2400
L.C. 3200 2700
RV. 1000 J. 700
F.R.C. 1800 1300
V.C. 4000 3300
T.L.C. 5000 4000
R.M.V. 5 Lit./ min. 4 Lit./ min.
M.V.V. 120-140 LI min. 80- 100 L/min.

Questions and answers:

Q.1. What are the physiological variations of vital capacity?
Ans. Physiological variations in Vital Capacity.
i) Sex -- More in males than in females
ii) Surface area -Vital capacity increases with surface area.
iii) Posture - Increases in standing position
iv) Late pregnancy - decreases
Exercise, training - Increases

Q.2. What is the importance of MVW and FEV?

Ans. MVV - The MVV is reduced in both obstructive and restrictive lung diseases. The MW is
useful for calculation of respiratory indices such as dyspnoeic index.
FEV- FEV1 & FEV2are reduced in obstructive lungdiseases and in restrictive lung diseases
vital capacity is reduced and values of FEV1 & FEV2 are normal.

Q.3. What is dyspnoeic index? What is its significance?

Ans. MW - RMV
Dyspnoeic index X 100
MVW
Where MVW = Maximum voluntary volume
RMV = Resting minute volume
Normal dyspnoeic index is 90% when it is reduced below 60-70% dyspnoea results. This is
called dyspnoeic point. The grading of dyspnoea is done by this index.
Q.4. What is ATPS, BTPS, STPD?
Ans. ATPS Ambient temperature pressure saturated with water vapour.
BTPS Body temperature pressure saturated with water vapour.
STPD Saturated temperature pressure with dry air
P,V, Pz Vz

T1

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 IDEAL RECORD OF LUNG VOLUMES AND CAPACITIES

6000.
(ml.)
5000
VOLUME
LUNG inspiratory Visal
reserve capacity
4000 volume
Tidal Inspiratory
3000 vome capacty

2000 Expiratory
reserve vourme Funcionel
resldual capacity
1000
Residuat
volume EXPRATION
TME

SPIROMETER

K Floating dnum or
spirometer bel

Metal chnber
cOntainng
-Recording
drum

Gs
charnber
- Inspiraion
Epirtion

outa) Counter
botancing

Tubs
(Rubber)
Mouth piece

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