Pulmonary Function Tests
Introduction
Pulmonary Function Tests (PFTs) are useful
- in diagnosing respiratory disorders.
- to monitor therapy for patients with respiratory
diseases.
Introduction
Clinical uses of PFTs:
a) Evaluate respiratory symptoms
b) Screen for respiratory diseases
c) Assess disease severity
d) Monitor the cause of disease
e) Evaluate the response to therapy
f) Assess the risk of pulmonary exposure to
environmental toxins
Introduction
PFTs measures:
Lung volumes
Lung flows
Diffusion capacity
Airway reactivity
Compliance
Resistance and conductance
Introduction
Respiratory function are assessed by:
lung volume tests
lung flow tests
Lung volume tests
a) Expiratory reserve volume (ERV)
b) Slow vital capacity (SVC)
c) Residual volume (RV)
d) Functional residual capacity (FRC)
e) Inspiratory capacity (IC)
f) Inspiratory reserve volume (IRV)
g) Tidal volume (TV)
h) Total lung capacity (TLC)
Lung flow tests
a) Forced expiratory volume (FEV)
b) Peak expiratory flow rate (PEFR)
c) Forced expiratory flow (FEF)
These can be measured by spirometry
Lung volume tests
• Lung volume tests indicate the amount of gas
contained in the lungs at various stages of
inflation.
Lung volume tests
Tidal volume:
Amount of air inhaled or exhaled at rest
Reference range : 500 to 750 ml
It is infrequently used as a measure of respiratory
disease
Lung volume tests
Inspiratory capacity (IC):
The volume measured from the point of the TV
where inhalation normally begins to maximal
inspiration is known as IC.
Reference range: 500 ml + 3.1 L = 3.6 L
Lung volume tests
Inspiratory reserve volume:
Amount of air that is inhaled with maximal inhalation after the
normal inhalation.
or
The volume measured from the “top” of the TV, (ie. the initial
point of normal exhalation) to maximal inspiration is known as
the IRV.
Reference range: 3.1 L
Lung volume tests
Expiratory reserve volume:
Amount of air that is exhaled with maximal
expiration after the normal exhalation.
Or
During exhalation, the volume from the “bottom” of
the TV (ie. Initial point of normal inhalation) to
maximal expiration is referred to as ERV.
Reference range: 1. 2 L
Lung volume tests
Slow vital capacity:
When the full inhalation-exhalation procedures is repeated
slowly – instead of forcefully and rapidly – it is known as SVC
This value is the maximum amount of air exhaled after a full
and complete inhalation
In patients with normal airway function, SVC and FVC are
usually similar (hence shown as Vital Capacity).
In patients with diseases, such as COPD during the initial stages
of disease, the FVC decreases before the SVC (because
interluminal thoracic pressures are not elevated during the
forced maneuver)
Lung volume tests
Residual volume:
Amount of air that is left in the lungs after full
exhalation
Reference range: 1. 2 litre
RV is unmeasurable by spirometry but measurable by
body plethysmography.
Without RV lungs would collapse like deflated balloons.
In asthma, RV increases due to obstruction
Lung volume tests
Functional residual capacity:
It is the volume of the gas remaining in the lungs at
the end of the TV
It is the sum of the ERV and RV [2.4L]
An increased FRC usually represents hyperinflation of
the lungs and indicates airway obstruction.
FRC decreases in diseases that affect many
alveoli (pneumonia) and by restrictive changes
(fibrotic pulmonary tissue changes)
Functional Residual Volume (2.4 L) + Tidal volume (0.5 L) +
Inspiratory Reserve Volume (3.1L)
Lung volume tests
Total lung capacity:
It is the total amount of gas contained in the lungs
It is the sum of RV and vital capacity
Reference range: 6 L
Lung flow tests
(obtained by spirometry)
Forced expiratory volume:
Changes in FVC measurement from baseline reflect
the degree of current airway obstruction.
FEV0.5, FEV1, FEV3 are the amounts of air exhaled after
0.5 , 1 and 3 seconds respectively
Of these, FEV1 has the most clinical relevance,
primarily as an indicator of the large airway functions.
Lung flow tests
The normal value for FEV1 is 0.75 – 5.5 L & this wide
variation is due to physical variables among patients.
A value of >80% of predicted value or within + 2
standard deviation (SD) is considered normal.
Lung flow tests
In both obstructive and restrictive diseases, the FEV
usually shows a reduction in flow
The magnitude of change reflects the severity of
disease as:
Mild : 61 – 80% of predicted
Moderate: 41 – 60% of
predicted
Severe: < 40% of predicted
Lung flow tests
The ratio of FEV1 to the FVC is another way to estimate the
presence and amount of obstruction in the airways.
This ratio indicates the amount of air mobilized in 1 sec as a
percentage of the total amount of mobilized air.
In healthy individuals, the normal value is FVC 0.5 = 50%; FVC1 =
80%; FVC3 = 98%
In patients with restrictive disease it is usually normal because
both FVC and FEV1 similarly reduced
In patients with obstructive disease, this ratio will decrease
Lung flow tests
Peak expiratory flow rate:
It is the measure of maximum airflow rate
Occurs within the first millisecond of expiratory flow
Measured by using peak flow meter
Lung flow tests
Peak expiratory flow rate:
Range is 400 – 800 L/minute and in women 200- 600L/minute.
Values of 50 – 100L / minute indicate severe acute obstruction.
PEFR reduced in obstructive disease but normal in restrictive
diseases.
Commonly used as objective “at home” measurements of
airway function.
Lung flow tests
Forced expiratory flow:
FEF measures airflow rate during forced expiration.
While FEV measures the volume of air during expiration, FEF
measures the rate of air movement.
The FEF from 25 to 75% of vital capacity is known as FEF 25-75.
This test specifically measure the
flow rate of air in the medium and
smaller airways (bronchioles and
terminal bronchioles).
Because asthma affects these
airways the most, FEF 25-75 is a good
indicator of obstruction.
In obstructive disease FEF
decreases but remain normal in
restrictive disease
Summary
Disease VC RV FEV1: FVC
Chronic obstructive
[chronic bronchitis &
emphysema]
Reversible obstructive
[asthma]
Restrictive [extra
pulmonary & intra
pulmonary]
Combined obstructive
and restrictive
