PULMONARY FUNCTION TESTS
Introduction
Pulmonary function tests (PFTs) are a group of tests
that measure how well the lungs take in and release
air and how well they move gases such as oxygen
from the atmosphere into the body's circulation.
Clinical applications of PFTs
Screen & diagnosis for respiratory disease
Evaluate respiratory symptoms
Assess disease severity
Monitor the course of disease
Evaluate the response to therapy
Pulmonary Function Tests
Lung volume tests
Lung flow tests
Diffusion capacity tests
Airways reactivity
Compliance, resistance and conductance
Lung volume tests:
Indicate the amount of gas contained in the lungs at various
stages of inflation.
Tidal volume (TV)
Inspiratory capacity (IC)
Inspiratory reserve volume (IRV)
Expiratory reserve volume (ERV)
Slow vital capacity (SVC)
Residual volume (RV)
Functional residual capacity (FRC)
Total lung capacity (TLC)
Procedures & Instruments
Spirometry is a test that shows how well you breathe in
and out.
The device that is used to make the measurements is
called a Spirometer.
It is a painless test.
Patient will be asked to breathe in fully and to blow out
as hard and fast as patient can into the mouthpiece of the
Spirometer.
The entire test usually takes less than 10 minutes, although
sometimes it is repeated after taking a puffer medication.
Fig: Analog type Spirometer
Fig: Modern digital Spirometer
How to prepare for the test:
Do not smoke for one hour before test
Do not drink alcohol within four hours of test
Do not eat a large meal within two hours of test
Wear loose clothing
Do not perform vigorous exercise within 30 minutes of
test
Do not take puffer medications for a few hours before
spirometry
Body Plethysmography
Patient is seated in a large closed box.
Mouthpiece containing a pressure transducer senses
the intrathoracic pressure.
Boyle’s law:
P1 x V1/T1 = P2 x V2/T2
Results are described as a percentage of predicted
values or with standard deviation (SD) from the mean
from a physically matched healthy population.
Body Plethysmograph
Lung volume tests
Tidal volume (TV): amount of air inhaled and exhaled at
rest (500-750 ml).
Inspiratory capacity (IC): volume measured from the
point of the tidal volume where inhalation normally
begins to maximal inspiration (2400-3800 ml). TV+
IRV.
Inspiratory reserve volume (IRV): additional volume of
air that can be forcibly inhaled following a normal
inspiration (1900-3300 ml).
Expiratory reserve volume (ERV): additional volume
of air that can be forcibly exhaled following a normal
expiration (700-1000 ml).
Vital capacity (VC): maximal volume of air that can
be forcibly exhaled after a maximal inspiration
(3100-4800 ml). VC= TV+IRV+ERV.
Slow vital capacity (SVC): maximum amount of air
exhaled after a full and completed inhalation.
Residual volume (RV): volume of air remaining in the
lung after a maximal expiration (1700-2100 ml).
Functional residual capacity (FRC): volume of air
remaining in the lungs at the end of a normal expiration
(2300-3300 ml). FRC=RV+ERV.
Total lung capacity (TLC): volume of air in the lungs at
the end of a maximal inspiration (4-6 L).
TLC=FRC+TV+IRV=VC+RV.
Lung Volumes
Lung volume changes under physiological and pathological
conditions
Spirometry Patterns
Normal Vs. Obstructive Vs. Restrictive
Lung flow tests
Forced expiratory volume in 1 second (FEV1): volume
of air that is forcefully exhaled in one second (3.5-4.5 L
for male and 2.5-3.25 L for female).
FEV1 is the indicator of large airways function.
↓ in obstructive and restrictive diseases.
Magnitude of change in FEV1 indicates severity of the
obstruction.
Mild (61-80% of predicted), moderate (41-60%) and
severe (≤40%).
Ratio of FEV1 to the FVC also estimates the presence
and amount of obstruction in the airways.
FEV1/FVC= Percentage of the total amount of air
exhaled from the lungs during the first second of forced
exhalation.
50 % of FVC in first 0.5 sec; 80 % in 1 sec; 98 % in 3
sec.
Peak expiratory flow rate (PEFR):
Measure of the maximum airflow rate [400-800 L/min
(male) & 200-600 L/min (female)].
50-100 L/min (severe obstruction).
Measured by Peak flow meter and is an indicator of
large airflow obstruction.
Used in monitoring of asthmatic patients.
Forced expiratory flow (FEF):
Measures airflow rate during forced expiration.
FEF 25-75 measures the flow rate of air in the medium
and small bronchioles.
It also measures alveolar airflow.
Good indicator of obstruction in asthma (↓).
Diffusion capacity tests
Tests of gas exchange measure the ability of gases to
cross (diffuse) the alveolar-capillary membrane
(interstitial lung disease).
Measures per minute transfer of gas from alveoli to blood.
Decreases during losses in the surface area of alveoli or
thickening of the alveolar-capillary membrane;
Helps in assessing pulmonary fibrotic changes (drug
induced).
Reflects pulmonary capillary volume (asthma, pulmonary
edema).
Effects of pulmonary diseases on PFTs
Disease Vital capacity Residual volume FEV1/FVC
COPD Normal or ↓ Normal or ↑ ↓
Reversible Normal or ↓ ↑ ↓
obstructive
(asthma)
Restrictive (extra ↓ ↓ Normal
and
intrapulmonary)
Combined ↓ ↓ ↓
obstructive &
restrictive
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